The German Diabetes Society (DDG) is calling on statutory health insurers to reimburse modern obesity medications for people at elevated health risk, ad-hoc-news.de reported on Thursday. The professional association points to clinical trial data showing cardiovascular benefits, including in patients who have already had a heart attack or stroke. Under current rules, the statutory system treats weight-loss drugs primarily as a lifestyle intervention rather than a regular medical treatment.
Why it matters
Germany has one of Europe's more restrictive reimbursement regimes for anti-obesity medicines. Section 34 of the Fifth Book of the Social Code (SGB V) currently rules out coverage, so patients generally pay for the drugs themselves. According to ad-hoc-news.de, the DDG argues that this stance no longer fits the evidence for a group of patients whose weight carries serious medical consequences.
The scale of the condition adds weight to the debate. The society says nearly one in five adults in Germany has obesity. Structured care has also lagged: a disease management programme (DMP) for obesity has existed since July 2024, but according to ad-hoc-news.de it was not offered in any federal state through the end of August 2026.
What the approval rules allow
Medicines in this class are authorised for people with a body mass index of 30 or above, or from 27 up to 30 when relevant accompanying conditions are present. That regulatory approval, however, does not oblige the statutory insurers to pay. The DDG's demand is therefore aimed at the coverage gap between what regulators have approved and what the insurance system will fund.
The association bases its case on results from incretin-based therapies. According to ad-hoc-news.de, these agents lower body weight by an average of 15 to 21 percent, against 2 to 3 percent in placebo groups. Newer oral GLP-1 receptor agonists such as orforglipron have shown average weight loss of up to 12.4 percent in studies, the report adds.
Cardiovascular data at the centre of the argument
Beyond weight, the DDG leans on trials that measured heart outcomes. In the SELECT study, semaglutide reduced the risk of heart attacks, strokes and cardiovascular deaths over roughly three years to 6.5 percent, compared with 8 percent in the placebo arm, according to ad-hoc-news.de. The SUMMIT study found that tirzepatide was associated with 38 percent fewer cardiovascular deaths and fewer worsening of existing heart failure.
Manufacturer-run trial programmes were also cited. For Novo Nordisk's Wegovy, the STEP-5 study recorded a 15.2 percent weight reduction after 104 weeks, against 2.6 percent with placebo. The OASIS-4 study reported a 13.6 percent reduction after 64 weeks for an oral Wegovy tablet, versus 2.2 percent for placebo. For the older Saxenda, also from Novo Nordisk, weight fell by about 8 percent after 56 weeks, compared with 2.6 percent in the control group.
Eli Lilly's tirzepatide, sold as Mounjaro, was examined in the SURMOUNT programme. In SURMOUNT-1, the highest dose produced a 20.9 percent reduction after 72 weeks, while the placebo group reached 3.1 percent. The Lilly-funded SURMOUNT-5 comparison, involving 751 participants, found a 20.2 percent reduction with tirzepatide against 13.7 percent with semaglutide, ad-hoc-news.de reports.
Cost remains the sticking point
Money is the central obstacle. The DDG is asking for full reimbursement by statutory insurers such as the AOK. According to ad-hoc-news.de, an AOK estimate puts annual treatment costs at around 4,000 euros per patient.
Separately, the report notes that a statutory sugar levy is planned from July 2027, with charges of 26 cents per litre for drinks containing at least 5 grams of sugar and 32 cents per litre at 7 grams or more per 100 millilitres. The measure is presented as a complementary approach alongside therapeutic options rather than a substitute for them.
What to watch: whether the DDG's push translates into a change to Section 34 SGB V, and whether the obesity DMP finally becomes available across the country.
