Health Insurance
Treatment or Programmes for Weight Reduction
The three major health insurance companies – VHI, Laya and Aviva – exclude treatment or programmes for weight reduction or eating disorders other than anorexia nervosa and bulimia nervosa and certain bariatric surgery procedures.
Visits to a Deitician
Dietetic services are available free of charge through the public health service. However, availability may vary in different areas of the Health Service Executive (HSE).
Dietetic fees are partially covered by the main private health insurance companies in Ireland. Reimbursement from health insurance companies ranges from €13 to €40 per visit (on average €25).
The cost of a one (1) hour consultation with a dietician ranges from €90 to €150 per visit.
Obesity Drug Treatments – Patient Pays
Obesity drug treatments can be prescribed for chronic weight management in adults with obesity or overweight with at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol), for use in addition to a reduced calorie diet and increased physical activity.
In the USA, a four-week course of Wegovy has a list price of $1,349 a month. Mounjaro has a list price of $974 for four weekly doses.
In the UK, pharmacies will charge patients with private insurance or those paying out of their own pockets between £199 and £299 ($251-$377) for a month’s supply of Novo Nordisk’s weight-loss drug Wegovy.
In Ireland:
- Wegovy costs between €240 and €355 per month depending on the dose. It is currently not covered on the medical card or Drugs Payment Scheme.
- Mounjaro costs between €289 and €350 per month depending on the dose. It is currently not covered on the medical card or Drugs Payment Scheme.
The cost of administering Wegovy (Semaglitude) and Zepbound (Tirzepatide) is not currently covered by (a) any national health service nor (b) any private medical insurance – so the cost must be borne by the patient.
- Saxenda® (Liraglutide) 6 mg/ml solution for injection in pre-filled pen is available for reimbursement under the Community Drug Schemes from 1st January 2023. A Managed Access Protocol is in place for liraglutide (Saxenda®) for a subgroup of the licensed indication, defined as:
“Adult patients, as an adjunct to a reduced-calorie diet and increased physical activity for weight management, with an initial body mass index of ≥ 35 kg/m2 with prediabetes and high-risk of cardiovascular disease. Treatment should be discontinued for patients who have not lost ≥ 5 % of their initial body weight after 12 weeks of treatment at the 3.0 mg/day dose”.
This Managed Access Protocol outlines the criteria that must be satisfied in order for a patient to be recommended for reimbursement of liraglutide (Saxenda®).
A clinician must submit an online application for individual reimbursement approval for each patient. All clinicians (GPs and hospital prescribers), once user-registered with the HSE – Primary Care Reimbursement Service (PCRS), can apply for reimbursement of liraglutide (Saxenda®).
The managed access of liraglutide (Saxenda®) includes two phases of reimbursement approval. Phase 1 reimbursement support is for an initial duration of six months (24 weeks). For continued reimbursement support after this time, a second reimbursement application is required to determine the patient’s response to treatment after 12 weeks of liraglutide (Saxenda®) at the 3 mg/day dose. Total duration of reimbursement support is two years (24 months) from the date of the initial Phase 1 application. Due to the information that is required to be submitted, the clinician responsible for the initiation of treatment should complete the online application.