Will Mounjaro or Wegovy be reimbursed soon? This is the current state of affairs

Will Mounjaro or Wegovy be reimbursed soon? This is the current state of affairs

Summary:

• Mounjaro and Wegovy are currently not reimbursed for overweight.
• The Dutch Healthcare Institute was discuss both medications on October 5, 2026, in the Scientific Advisory Council.
• Possible criteria (not yet established): BMI ≥35, or BMI ≥30 with a weight-related condition.
• The Scientific Advisory Council (WAR) met for the first time on October 5, 2026, to discuss both medications.
• The consultation is ongoing from October 12 to 18, 2026.

For many people with overweight, the question is simple yet persistent: why isn't a medication that demonstrably helps covered by health insurance?Mounjaro (tirzepatide) and Wegovy (semaglutide) quickly cost several hundred euros per month, and until now, the answer to the reimbursement question was short: no, not for overweight. That situation is now officially under discussion for the first time at the Dutch Healthcare Institute, with a concrete date on the agenda.

How does medication reimbursement actually work?

The decision is made by the Minister of Health, Welfare and Sport (VWS). The Dutch Healthcare Institute (Zorginstituut Nederland) advises the minister on this. It is an independent organisation that assesses which care should be reimbursed.

An assessment goes through several steps:

1. First discussion: the Scientific Advisory Council (WAR) assesses whether the medication is medically and scientifically well supported.
2. Consultation: involved parties, such as professional groups, patient organisations and manufacturers, can respond to this initial assessment.
3. Second discussion: the WAR discusses the file again.
4. Package advice: the Advisory Committee on the Benefits Package (ACP) also weighs the costs and cost-effectiveness.
5. Decision: the Dutch Healthcare Institute advises the minister, who makes the final decision.

This takes months, sometimes longer. And none of these steps guarantees that a medication will actually be reimbursed.

What is specifically planned now?

For semaglutide (Wegovy) and tirzepatide (Mounjaro) for obesity, this process has now started for the first time. On October 5, 2026, the Scientific Advisory Council met for the first time to discuss both medications. The technical consultation is currently ongoing (October 12 to 18), during which involved parties can respond to the initial assessment.

A second discussion in the Scientific Advisory Council (WAR), an advice from the Advisory Committee for the Healthcare Package (ACP), and a publication date for a final decision are not yet known. In other words: October 5 was the starting point of a longer process, not the moment when it will become clear if and when these medications will be reimbursed.

Which criteria are on the table?

From the initial documents of the Dutch Healthcare Institute, it appears that a phased approach based on BMI is being considered. Two groups are mentioned: people with a BMI of 35 or higher, and people with a BMI of 30 or higher in combination with a weight-related condition (such as type 2 diabetes or cardiovascular diseases). These are criteria that are currently part of the discussion, not established policy. Nothing has been decided yet about who would or would not be eligible in the future, let alone under what conditions.

What does this mean for you, now?

At this moment, nothing changes yet: Mounjaro and Wegovy are still not reimbursed for overweight through basic health insurance. A first discussion in the Scientific Advisory Council is only the first step in a multi-phase process, and as described above, there can be a considerable time between such an initial discussion and a final decision.

Do you want to follow this closely yourself? The current status is on the work agenda of the Dutch Healthcare Institute. We will keep this article updated and revise it as soon as there is news.