The Dutch Health Care Institute (Zorginstituut Nederland) has launched a new evaluation to determine whether popular weight-loss medications Wegovy (semaglutide) and Mounjaro (tirzepatide) should be included in the basic health insurance package. This marks a reversal from last year when the institute advised against broader coverage. The new review will examine the drugs' medical benefits, potential risks, and whether they provide good value for money.
Current Coverage Remains Very Limited
For now, insurance reimbursement for these medications remains highly restricted. Only people with severe obesity or specific related health conditions qualify under strict medical criteria, broader coverage is not yet available. Other weight-management drugs like Saxenda and Mysimba are currently included in the basic insurance package, but also only under specific conditions.
What Could Change
This new evaluation opens the door for more patients to potentially qualify for coverage in the future. Dutch media outlets describe insurance reimbursement as moving "closer" for people living with serious obesity, though any final decision will depend on the institute's recommendations and the government's subsequent response. A formal decision could still be several months away.
Why This Is Controversial
Cost concerns: In 2024, government advisers warned about uncertain cost-effectiveness and the potential impact on healthcare budgets if large numbers of people became eligible for these expensive medications. Additional concerns included healthcare system capacity to manage treatment and global supply chain pressures that could limit drug availability.
Public support: A national survey conducted this year found strong public backing for insurance coverage, particularly when the drugs are prescribed by medical specialists and combined with lifestyle changes such as diet and exercise programs.
Photo Credits: Alones
What This Means If You Live in the Netherlands
Nothing changes immediately: Your health insurer's current rules remain in effect while the review is underway. Check your insurance policy or speak with your GP (huisarts) to understand your current eligibility.
Who qualifies now: Coverage today is conditional and narrow, targeting only people with severe obesity or specific medical conditions that justify the treatment. If you want to use these medications purely for weight loss and don't meet the strict medical criteria, you typically must pay out of pocket. Costs can be substantial: these drugs often run hundreds of euros per month.
Next Steps
The Zorginstituut's advice will guide the Ministry of Health and insurance companies on whether to expand coverage. Expect thorough examination of clinical effectiveness, long-term health outcomes, and overall healthcare costs before any decision to widen reimbursement. Until the review is complete and a policy decision is made, eligibility remains restricted and is evaluated case-by-case by healthcare providers.
