Patients who meet set criteria will be able to get Mounjaro through the General Health System (GHS) from Thursday, October 15, without their doctor having to file a named-patient request. The Health Insurance Organisation (HIO) is adding the drug, which is used to treat type 2 diabetes and mainly obesity, to the GHS list of pharmaceutical products.
Until now, access to Mounjaro through the GHS depended on named-patient requests being examined by the relevant committees. Under the new system, the treating doctor will submit a request through the GHS pre-approval process, and it will be assessed against a single approved protocol. The drug will be reimbursed according to specific criteria set by the HIO.
The new procedure mainly concerns patients with obesity, but also covers patients with type 2 diabetes, with different criteria for each.
For obesity, the protocol sets out two categories of eligible patients. The first is adults with a body mass index (BMI) of 40 or above. The second is people with a BMI of 35 to under 40 who also have established atherosclerotic cardiovascular disease and/or moderate to severe obstructive sleep apnoea. Supporting medical documents are required in both cases, and the protocol also provides for other assessments.
“Coverage of Mounjaro for obesity will not be unlimited,” Sofia Petridou, the HIO officer responsible, told Phileleftheros. Under the protocol, patients must lose at least 5 per cent of their starting body weight in the first six months of treatment, and at least 10 per cent after one year, she said. A new assessment will be needed to continue treatment, and reimbursement for obesity will last a maximum of two years, provided patients still meet the criteria.
Existing approvals
Patients who already have approval through the Named-Patient Drug Requests Committee (EOAF) or other relevant bodies do not need to take any action for now, Petridou said. Their approvals remain valid, and when they expire, continued treatment will be assessed under the new protocol.
Requests already submitted to the EOAF that have not yet been answered do not need to be resubmitted. The HIO will automatically forward them for assessment under the new procedure.
Ozempic
A revised protocol for prescribing Ozempic to patients with type 2 diabetes also comes into force on Thursday. Ozempic will continue to be available from private pharmacies and will also require electronic pre-approval based on set criteria.
Mounjaro will continue to be dispensed by hospital pharmacies until further notice.
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