The Dutch healthcare agency Zorginstituut Nederland said on Thursday it will begin a new assessment of the obesity drugs Wegovy and Mounjaro to determine whether they should be included in the basic health insurance package.

The institute will initially focus only on two patient groups: people with a BMI of 30 or higher and related health conditions, and those with severe obesity and a BMI from 35.

The phased approach means that new obesity drugs will, for now, be assessed -and possibly paid for – only for these two groups. The strategy, which targets patients with serious health problems caused by obesity, has broad backing from healthcare professionals, patient groups and insurers.

Last year, the institute said Wegovy should not be included in the basic insurance package because its long-term health benefits were unclear and it would also increase costs.

Under European Medicines Agency guidelines, Wegovy can be prescribed to people with a BMI above 27 and at least one related condition, which would cover some 4.1 million people in the Netherlands.

The institute estimated that, even with stricter eligibility and limited uptake, costs could still reach around €1.3 billion a year.

It said it is now focusing on groups for whom there is the strongest evidence of health improvement, such as patients with heart failure, kidney disease or sleep apnoea linked to obesity.

The institute estimates that more than one million people fall into this category.

Institute chairman Mark Janssen said the aim is to balance prevention and treatment while keeping healthcare affordable. “Without tackling the real causes of obesity, large-scale medicalisation could endanger both affordability and access to care,” he said in a statement.

Doctors can currently prescribe Wegovy, but patients have to pay for the drug themselves. Some 120,000 people in the Netherlands were prescribed slimming drugs in 2024.

In a government-backed survey earlier this year, 90% of respondents said weight-loss drugs should be included in the basic insurance package, although three-quarters said conditions should be attached to free prescriptions.

These would include prescribing only by a specialist and proof that people requesting the medicine have shown commitment to lifestyle changes.