Weight-loss jabs on prescription? Barmer boss expects insurers to pay

Right now, anyone in Germany who wants a weight-loss injection for obesity has to pay for it themselves. That could change, according to one of the country's most senior health insurance bosses.

Christoph Straub, the outgoing head of the insurer Barmer, thinks public health insurers will soon cover the jabs.

What did he say?

"I assume we will probably include the weight-loss injection as a treatment option," Straub told the newspapers of the NPG editorial network.

He says costs don't have to explode. The condition: drug prices must be tied more closely to their real benefit. "The price can and must be lowered in negotiations," he said.

Straub also doesn't want patients with severe obesity to prove they've already tried diets or more exercise. Surgery for obesity no longer requires that, he pointed out, so the same should apply to injections. His comparison: "We don't ask a smoker to quit before we operate on his bronchial carcinoma."

He added a caveat, though: the injection is "not the solution for everything and everyone."

Why is it such a fight?

At the moment, weight-loss injections approved specifically for obesity count as "lifestyle drugs" in Germany. Those can't be prescribed at the expense of the statutory health insurance, the system that covers most people in Germany. Some active ingredients can be prescribed on a regular insurance prescription, but only for other conditions such as type 2 diabetes.

The cost is the big worry. Carola Reimann, head of the AOK federal association (another big public insurer), has been much more sceptical. By her calculation, treating every insured person with a BMI of 30 or higher would cost around 45 billion euros a year. At a BMI of 35 or higher, it would be about 14 billion. She called it a "maximum scenario".

What came before?

The EU approved Wegovy for obesity treatment in 2022. In Germany, though, the Social Code excludes drugs mainly used to lose weight from insurance cover. Since 2023, patients have paid out of pocket.

What's next?

Straub's comments are an assessment, not a decision. For now, the rules stay as they are. But with a major insurer chief openly backing a change, the debate over who pays for these drugs is far from over.