Does Austrian Health Insurance Cover Weight Loss Medications?

Weight-loss injections such as Wegovy and Mounjaro are legally available in Austria. But they are still largely paid out of pocket, with prices running to several hundred euros per month, depending on the dose and manufacturer, according to Kronen Zeitung. For most patients, that price tag is unlikely to change soon. The key issue is not whether the drugs are authorised, but whether Austria’s social insurance system treats them as reimbursable medicines, and under what conditions exceptions are possible. READ ALSO: Can I be denied health cover in Austria because of pre-existing conditions? Why aren’t ‘weight loss injections’ generally reimbursed? The Austrian Health Insurance Fund (ÖGK) told Kronen Zeitung that “medicines to support weight-reducing measures are, under the General Social Insurance Act, fundamentally not reimbursable”. It added that this applies regardless of whether the drug has approval for that indication. In practice, this means that even though weight loss injections have received authorisation from the European Medicines Agency (EMA) for treating obesity, that alone does not create a general right to reimbursement in Austria, according to the report. The legal framework also distinguishes between overweight and obesity. There is no general basis for reimbursement for overweight patients, as “overweight alone” is not recognised as an illness under social insurance law. For obesity (Adipositas), on the other hand, the relevant definition of illness is met, which, in theory, opens up possibilities for coverage, but only under strict conditions. READ ALSO: Will my Austrian health insurance pay for medical expenses abroad? Can you still get reimbursed on an individual basis? Reimbursement can be possible in individual cases, even for drugs that are not listed in the the Erstattungskodex, EK, the list of medicines that can be dispensed at the expense of social insurance providers, if strict requirements are met. Advertisement Legal experts Karl Stöger, from the University of Vienna, and Gisela Ernst, from Haslinger/Nagele Rechtsanwälte, told the report that non-listed medicines can be reimbursed if there are compelling therapeutic reasons and no suitable alternative is available. However, the report noted that in practice, the required approval by a control doctor (kontrollärztliche Bewilligung) is not always granted. When reimbursement is refused, patients often have to pursue legal action, either by paying upfront and then seeking reimbursement or by filing a claim to establish future coverage, according to the same legal experts cited. READ ALSO: Spas, pregnancy and contraceptives: What Austrian healthcare covers - and what it does not What does ÖGK say about how obesity should be treated? ÖGK emphasised that sustainable weight loss for people with severe obesity generally requires a “multimodal” approach. In the report, it described this as a treatment pathway that includes exercise, dietary changes and psychological support. Austria's insurance umbrella company argued that weight loss injections should not replace these measures. It said the “seemingly easier” option of an injection is not “appropriate”, and cannot be financed by a solidarity-based health system in that way. It also pointed to study data suggesting that up to one third of weight loss may not be fat loss but a reduction in muscle mass, as reported by Kronen Zeitung. Advertisement For these reasons, ÖGK said it currently cannot give a general commitment to reimburse so-called GLP-1 analogues used for weight reduction. READ ALSO: When can I ask for reimbursement for medical expenses in Austria? What exceptions does ÖGK mention? While ÖGK ruled out a blanket promise of coverage, it said it was important to offer treatment options in specific cases. It gave examples of situations where reimbursement could be considered, including: Adults where a specialised obesity centre submit an application after conservative treatment options have been exhausted, if the person’s obesity means they cannot reach fitness for weight loss surgery, if the operation risk is very high, or if surgery cannot be performed without prior weight reduction Children and adolescents with massive overweight or obesity, in addition to lifestyle modification and psychoeducation, under the supervision of a paediatric obesity centre with regular monitoring, for a maximum of two years Advertisement READ ALSO: Everything foreigners need to know about the Austrian healthcare system What support exists beyond medication? ÖGK said it offers programmes and courses for adults, children and teenagers with weight-related health problems, including a free nationwide programme called Easykids. The programme involves support from experts in nutrition, exercise and psychology to help children and teenagers who are overweight work towards a healthier lifestyle and improved wellbeing. There are also several public obesity clinics and centres in Austria, provided by organisations such as the Austrian Obesity Association (Österreichische Adipositas Gesellschaft) and the Austrian Society for Obesity and Metabolic Surgery (Österreichische Gesellschaft für Adipositas- und Metabolische Chirurgie). READ ALSO: Healthcare in Austria: Why are there fewer 'public' doctors? Key vocabularyAbnehmspritze – weight loss injection Kostenübernahme – cost coverage (by an insurer) Erstattung – reimbursement Erstattungskodex (EKO) – reimbursement code listing medicines eligible for routine coverage kontrollärztliche Bewilligung – approval by a control doctor (required in some cases) Adipositas – obesity