People looking to access a new weight loss drug that will be available in the Irish market from next week will have to pay for it out of their own pocket – at a cost of more than €2,500 a year.
Private health insurers say they will not cover the cost of Mounjaro, a medicine from Eli Lilly which has been approved for the treatment of obesity and diabetes in the Irish market.
The drug is still going through a “value for money” assessment that is not expected to conclude until later this year. Even then, the man leading that assessment has expressed doubts that it will be freely available under the Drug Payments Scheme for all patients – something that would cap its monthly cost for users at €80.
As a result, it will be available only on private prescription at a cost of €215 or more a month. That equates to an annual charge of at least €2,580. As patients need to continue to take the medicine long-term in order to avoid the lost weight returning, that will be an annual cost.
Private health insurers have in recent years started authorising the cost of certain treatments even where they are not yet available in Ireland to public patients.
However, a spokeswoman for VHI, which accounts for close to half of the 2.5 million people covered by private health insurance, said it would not be covering the cost of Mounjaro or similar drugs, Ozempic and Wegovy.
Laya Healthcare, the second largest player, said it would not be covering the cost of the drug as it was not administered in a hospital setting. All three drugs are administered by the patient using an injectable pen.
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Irish Life Heath was unable to say definitively whether it would or would not cover the cost.
The HSE’s Drug Payments Scheme covers the cost of just one weight loss drug – Saxenda – but only to patients with a body mass index above 35 who are also pre-diabetic and at risk of cardiovascular disease.
[ Insurers will not cover obesity meds set to cost users €2,500-plus a yearOpens in new window ]
Speaking on RTÉ last week, Prof Michael Barry, who is assessing Mounjaro’s value for money in his role as director of the National Centre for Pharmacoeconomics (NCPE), said he expected that even if the State agreed to pay for the medicine, it would come with similar conditions.
“I don’t envisage a situation where all patients who would potentially benefit from these drugs will actually be receiving them through the community drug schemes,” he said. “I just think that that would be unaffordable.”
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