A symbolic image representing healthcare cost balance as the Dutch Healthcare Institute limits early access to obesity drugs like Wegovy and Mounjaro amid cost and evidence concerns. (Image: Generated for editorial illustration)
The Dutch Healthcare Institute is taking a controlled, stepwise approach to the reimbursement of new obesity drugs, including Novo Nordisk’s Wegovy and Eli Lilly’s Mounjaro, as debate grows over the cost and long-term value of the therapies. Under the new framework, the medications will first be available only to patients with severe obesity or obesity-related health conditions, before broader access is considered.
The agency, which oversees the composition of the Netherlands’ basic health insurance package, said it will soon begin assessing both drugs for inclusion under a tiered model. The first groups eligible for review will include individuals with a BMI of 30 or higher who also suffer from related diseases, and those with severe or very severe obesity (BMI ≥ 35). These two cohorts represent patients with the most urgent health needs linked to their weight.
Officials said the move reflects a clear shift in the reimbursement strategy following the negative 2024 recommendation for Wegovy, when the Institute declined to include the drug in the national package due to limited data on long-term benefits and side effects. The agency noted that while Wegovy demonstrated weight reduction efficacy, evidence gaps prevented a reliable assessment of its cost-effectiveness a key criterion for inclusion. The financial stakes were high: with an estimated 4.1 million eligible patients, unrestricted use could theoretically cost the healthcare system up to €10 billion annually.
“Last year, we concluded there was insufficient clarity on who benefits most and whether the cost was proportionate to the benefit,” the Institute said. The current reassessment, informed by discussions with healthcare professionals and patient organizations through the Obesity Round Table, focuses narrowly on groups where clinical evidence for health improvements is strongest.
This measured rollout enjoys broad backing from clinicians, patient associations, and insurers, all of whom have called for a realistic balance between access and affordability. The Institute emphasized that even this limited approval could apply to over one million patients, including those with comorbidities such as chronic kidney disease, heart failure, and sleep apnea.
For now, anyone prescribed obesity medication will still need to participate in a combined lifestyle intervention a structured behavioural and dietary program required before drug therapy can be approved. Future expansion of coverage, the agency said, will depend on stronger evidence of durable clinical benefit and cost justification.
“We must prevent unnecessary medicalization of a large group of people,” said Mark Janssen, chairman of the National Health Care Institute. “We need to address obesity at its root. Otherwise, it’s like mopping with the tap wide open.” Janssen warned that widespread use without stronger prevention policies could strain both healthcare affordability and workforce capacity.
The Netherlands’ stance contrasts with broader European prescribing rules. The European Medicines Agency (EMA) allows Wegovy for people with a BMI of 27 or higher who also have at least one related condition. But Dutch authorities argue that a narrower reimbursement window is essential to control spending and ensure equitable access.
The Institute expects its evaluation of Wegovy and Mounjaro to set a precedent for how the Netherlands manages future obesity drugs, a class expected to grow rapidly in the coming years. While pharmaceutical makers promote these medications as tools for chronic disease management, policymakers are increasingly focused on budget sustainability and the risk of over-medicalizing lifestyle conditions.
With the Netherlands’ health budget already under pressure and demand for obesity treatments soaring, the phased approach sends a clear signal, access will follow evidence, not hype. Janssen said the Institute’s goal is to keep obesity prevention and responsible drug use “on the public agenda,” ensuring that new medicines serve patients with proven need rather than fuelling unsustainable demand.
For now, only those with the highest disease burden stand to gain from the first round of approvals. The Institute has left open the possibility of expanding reimbursement once more data emerge, but it insists that lifestyle programs will remain a mandatory first step.
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As the global market for obesity drugs surges past billions in annual sales, the Dutch response stands out as one of Europe’s most cautious. Instead of rushing toward widespread reimbursement, the country is opting for a controlled rollout testing not just the effectiveness of Wegovy and Mounjaro, but the limits of healthcare economics in an era of blockbuster obesity drugs.