Game-Changer or Costly Burden: Will Insurance Cover the Highly Anticipated Obesity Treatment Drug Wigobi
Wigobi Obesity Treatment: Will It Be Covered by Actual Loss Medical Insurance?
The question of whether or not to apply actual loss medical insurance to the ‘miracle obesity treatment’ Wigobi, scheduled to be released domestically next month, is gaining attention. This product, developed by the Danish pharmaceutical company Novo Nordisk, became a hot topic when Tesla CEO Elon Musk introduced it as his secret to managing his weight.
The domestic insurance industry currently excludes obesity treatment from the scope of actual loss insurance, and Wigobi is expected to be no exception. Most domestic insurance companies are excluding obesity-related treatment from the scope of actual loss insurance. The first-generation actual loss insurance (subscribed from October 2003 to July 2009) does not cover obesity treatment, and the second-generation (subscribed from August 2009 to March 2017), third-generation (subscribed from April 2017 to June 2021), and fourth-generation actual loss insurance (subscribed after July 2021) do not cover non-covered obesity treatment.
Wigobi is a drug that received product approval from the Ministry of Food and Drug Safety in April of last year, and is used for obese patients with a body mass index (BMI) of 30 kg/㎡ or higher, or overweight patients with a BMI of 27-30 kg/㎡ and weight-related concomitant diseases such as hypertension and dyslipidemia. However, even if Wigobi is prescribed for the purpose of treating obesity, it seems difficult to receive compensation through actual loss insurance.
The insurance industry’s position regarding whether actual medical expenses are covered is that it is difficult to pay actual medical expenses for patients with a body mass index of 30 kg/㎡ or more because treatment for obesity itself is exempt. However, overweight or obese patients with cardiovascular disease may be eligible for compensation. This is because Wigobi was additionally approved to reduce the risk of death due to cardiovascular disease in overweight or obese patients with cardiovascular disease.
An insurance industry official stated that compensation is possible up to the prescription medical expenses limit when purchasing at a pharmacy through an outpatient prescription, but the limit is usually 50,000 won. Whether or not it is an indication and whether or not it is compensated when benefits are applied may vary depending on whether or not the National Health Insurance applies benefits, and therefore, continuous review is necessary in the future.
Wigobi is available as a prefilled injection, administered once a week at an initial dose of 0.25 mg, which is then increased to a maintenance dose of 2.4 mg after 16 weeks. According to Novo Nordisk, participants who took high-dose Wigobi for 68 weeks in a clinical trial lost an average of 15% of their body weight, which was significantly better than Saxenda, which lost an average of 7.5% over 56 weeks.