The Body Clinic

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?

To understand what is happening now, it helps to know how a medication eventually gets included in the basic insurance package. The Dutch Healthcare Institute is the independent body that advises the Minister of Health, Welfare and Sport (VWS) on what is and is not reimbursed from the basic insurance. An application goes through several steps: first, the Scientific Advisory Council (WAR) issues an initial assessment of the medical and scientific substantiation; then there is room for consultation with involved parties (such as professional groups, patient organizations, and manufacturers); and finally, the Advisory Committee for the Healthcare Package (ACP) issues an integral advice, which also considers costs and effectiveness, before the minister makes a decision. This is a process that takes months, sometimes longer, and none of the intermediate steps guarantees a positive outcome.

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 will discuss both medications for the first time. This will be followed by a technical consultation from 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 is 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, in any case immediately after October 5 2026.