Treatment with Saxenda costs at least 2000 euros per patient per year. As a result, health insurers lost much more money than expected, the AD writes.
Wrong
Patients with a BMI of 40 or higher or with a BMI of 35 or more and underlying diseases such as cardiovascular disease or osteoarthritis are eligible for reimbursement. They must also follow a special lifestyle program.
According to the Partnership Overweight Netherlands (PON), confusion has arisen about the two lifestyle programs that exist: a combined lifestyle intervention (gli) and an intensive lifestyle intervention (gli+). With gli+, for example, patients also receive cognitive behavioral therapy. And an important difference: gli is reimbursed from the basic insurance, gli+ is not.
The + you disappeared when the medicine was admitted, so that more people were eligible for the medicine. While in fact only people with severe obesity who follow the more intensive lifestyle program gli+ are eligible.
“A gli+ is only given in obesity centers in Zwolle and Rotterdam. The number of patients participating in or eligible for this was examined. Then you arrive at those much lower numbers,” explains Karen Freijer, manager of PON against the AD.
Adjust fee
The fee has been adjusted from July. People who follow the regular lifestyle program for severe obesity are only eligible for Saxenda after a year if they see no results.
Whether the number of users will fall sharply due to the adjustments remains to be seen. In addition, health insurers expect a new influx of Saxenda users in July, because they will then have followed the normal lifestyle program for a year.