Estonia considers expanding coverage for weight-management drug

The Estonian Health Insurance Fund (EHIF) is considering expanding coverage for a Type 2 diabetes drug to patients with obesity, pending a cost-benefit analysis due this fall.

If supported by a University of Tartu assessment, the proposal would broaden coverage for Wegovy, currently reimbursed only for Type 2 diabetes under strict conditions.

GLP-1 agonist drugs such as Ozempic, Wegovy and Mounjaro currently cost about €90 –180 a month and are not covered when prescribed for weight management, leaving patients to pay the full price.

Endocrinologist Kristina Isand, however, said excess body weight and related complications should be treated as a chronic condition in clinical practice.

"That's the shift in mindset we need — that obesity is a chronic illness, just like Type 2 diabetes," Isand said.

"When I prescribe this medication to a patient with Type 2 diabetes, they understand they'll be taking this for the rest of their life, no problem," she continued. "If we view obesity the same way, as a chronic illness, then it's exactly the same situation."

EHIF reimbursement lead Getter Hark said the Wegovy application is currently under review, pending an updated analysis weighing the prospective cost against its broader health benefits.

"They'll be taking absolutely all of the drug's possible health benefits into account and comparing them with the costs," Hark explained, adding that this includes indirect costs linked to obesity-related complications and their prevention.

She said an earlier assessment is being updated due to changes in drug prices and data, and added that if completed on schedule this fall, coverage could be expanded starting as soon as next spring.

Hark noted potential costs could vary widely depending on eligibility criteria and patient numbers.

"In the previous report, the estimated annual cost ranged from €18 million to €500 million, depending on how many patients would be covered," she added.

Isand said that in addition to treating Type 2 diabetes, GLP-1 and GLP-2 agonist drugs may also improve metabolic and cardiovascular health as well as offer multi-organ benefits beyond just weight management.