Mounjaro added to GHS list with reimbursement criteria
From Thursday, October 15, patients meeting set criteria can receive Mounjaro through the General Health System without a named-patient request, the Health Insurance Organisation says.
As of Thursday, October 15, Mounjaro is part of the General Health System's pharmaceutical list, according to the Health Insurance Organisation (HIO). The drug, prescribed for type 2 diabetes and chiefly for obesity, will no longer require a named-patient request filed by the treating doctor.
Instead, doctors will seek coverage through the GHS pre-approval process, with each application checked against one approved protocol. Separate criteria apply to obesity and to type 2 diabetes.
For obesity, adults with a body mass index of 40 or above qualify, as do those with a BMI of 35 up to 40 who also have established atherosclerotic cardiovascular disease and/or moderate to severe obstructive sleep apnoea. Medical documents must back both cases. Coverage is not open-ended: patients have to shed at least 5 per cent of their starting weight within six months and at least 10 per cent by one year, with a fresh assessment needed to carry on, and reimbursement capped at two years.
“Coverage of Mounjaro for obesity will not be unlimited,” said Sofia Petridou, the HIO officer responsible.
Those already cleared by the Named-Patient Drug Requests Committee (EOAF) keep their approvals for now and will be reassessed under the new protocol once these lapse. Pending EOAF applications need no resubmission — the HIO will pass them on automatically. A revised Ozempic protocol for type 2 diabetes patients also takes effect the same day; it stays available in private pharmacies and will need electronic pre-approval. Mounjaro continues to be dispensed by hospital pharmacies until further notice.
What it means for residents
For patients on the island, the change removes a bureaucratic hurdle but replaces it with a strict checklist. If you are already covered, nothing needs doing right now; if you are starting out, the weight-loss targets and the two-year limit are the numbers to watch, because failing them means paying privately or stopping.
- Check your status. Existing EOAF approvals stay valid until they expire, so keep track of the expiry date and expect a review under the new protocol afterwards.
- Prepare paperwork. Applications for obesity need documented BMI and any cardiovascular or sleep apnoea diagnosis — gather these before your doctor submits the pre-approval request.
- Plan the timeline. Reimbursement for obesity runs for a maximum of two years and depends on hitting the 5 per cent and 10 per cent weight-loss marks, so regular monitoring is part of staying covered.
This text is written from the source article and is not a translation of it.
