The obesity treatment drug Wegovy (active ingredient semaglutide) has received public insurance coverage in six countries, including the U.S., United Kingdom, and Japan. As South Korea begins the process of including it in health insurance coverage, there’s growing interest in whether this will alleviate the financial burden for patients struggling with obesity.
Industry sources reported on Thursday that Wegovy is currently covered by public insurance in six countries: the U.S., United Kingdom, France, Switzerland, Canada, and Japan. Several other nations are also in the process of applying for coverage.
In these countries, patients meeting specific criteria can receive financial support for treatment through public insurance. While Wegovy’s approved indications are consistent across countries, including South Korea, the actual insurance coverage and support levels may vary based on each nation’s reimbursement criteria. It’s important to note that indications, which refer to the approved uses of a drug, differ from reimbursement criteria that determine insurance benefits.
In South Korea, the insurance coverage process for Wegovy has begun. Novo Nordisk Korea recently submitted a request for coverage decision to the Health Insurance Review and Assessment Service. The proposed coverage targets patients with cardiovascular diseases, adolescents with obesity, and individuals with severe obesity.
Wegovy, a GLP-1 receptor agonist, works by suppressing appetite and increasing feelings of fullness. It’s administered as a weekly injection for obesity treatment. Currently, it’s prescribed as a non-reimbursed medication in South Korea, meaning patients bear the full cost. However, if coverage is approved, eligible patients could see a significant reduction in their financial burden.
The path to insurance coverage involves several steps. The Health Insurance Review and Assessment Service will evaluate the appropriateness of coverage, followed by price negotiations with the National Health Insurance Service. Only after these processes will the final coverage decision and price be established. The specifics of who will be eligible for coverage and when it will be implemented are expected to be clarified in the coming months.
For patients, the key question is how much the drug’s price will decrease once it’s covered by insurance. While the typical out-of-pocket cost for medications at pharmacies is 30%, the specific rate for Wegovy has not yet been determined.
To illustrate, if the monthly cost of the covered medication is 300,000 KRW (approximately 222 USD) and the out-of-pocket rate is 30%, patients would pay 90,000 KRW (about 67 USD) monthly. However, this is a hypothetical calculation. The actual amount will depend on the negotiated price, out-of-pocket rates, and individual patient criteria.
Meanwhile, Eli Lilly’s competing product, Mounjaro (active ingredient tirzepatide), is prioritizing coverage for its type 2 diabetes indication. Lilly Korea has expressed concerns that simultaneous discussions on coverage for both diabetes and obesity indications could delay access for diabetes patients.
A spokesperson for Lilly Korea stated that its top priority is securing coverage for Mounjaro’s type 2 diabetes indication. It acknowledges the unmet medical needs of obesity patients in Korea and will remain engaged in policy discussions, including those related to the reimbursement landscape.
The obesity treatment market in South Korea is set to become more competitive with the approval of Hanmi Pharmaceutical’s domestic drug EPPE (active ingredient epeglanatide). The combination of Wegovy’s potential insurance coverage and the entry of new domestic drugs raises the possibility of reduced treatment costs for patients, a development that many are watching closely.