Health insurance does not have to pay Mounjaro

Court decides

The health insurance company does not pay for this medication

Weight loss injections are popular, but health insurance companies only pay for the treatment in a few cases. However, a current ruling from Lower Saxony shows that a hormonal disorder is not one of them.

Statutory health insurance does not have to pay for the weight loss injection if it is prescribed because of a hormonal disorder. The legal regulations are final, as the Lower Saxony-Bremen State Social Court in Celle explained on Monday. It was about the drug Mounjaro with the active ingredient tirzepatide. The health insurance companies can currently only cover the treatment costs for diabetes.

In the urgent proceedings from Celle, a 24-year-old woman who has a hormonal disorder and is very overweight sued. Her gynecologist recommended Mounjaro for weight and symptom control because previous medications had been unsuccessful. But the health insurance company didn’t want to pay.

The court now agreed with the fund in its decision. The weight loss injection remains a lifestyle medication. There is no room for any other consideration or for a case-by-case examination.

It is also not a life-threatening emergency. Health insurance companies do not have to pay for everything that is available for health.