Belgium Rejects Wegovy Reimbursement Over Cost Concerns

Belgian Federal Health Minister Frank Vandenbroucke has refused to reimburse the weight-loss drug Wegovy (semaglutide), following the advice of the country’s Medicines Reimbursement Committee. The decision, reported by VRT NWS, blocks public coverage for the Novo Nordisk-produced obesity treatment, which costs patients approximately €300 per month out of pocket.

The Decision and Its Rationale

Vandenbroucke, who serves as Federal Minister of Health and Social Affairs, justified the refusal on multiple grounds. Reimbursement could cost billions of euros per year if all eligible patients were treated, potentially exceeding half of Belgium’s total medicines budget. The minister warned that such spending would “crowd out other essential care for other patients, without any certainty as to what health benefits we would gain for the population in return.”

A key medical concern is that weight typically returns after treatment cessation, meaning Wegovy would essentially require lifelong use. Common side effects include nausea, diarrhea, and vomiting, while long-term efficacy data beyond five years remains limited.

A Precedent for a Drug Class

Vandenbroucke also expressed concern that reimbursing Wegovy would set a precedent for an entire class of GLP-1-based anti-obesity medications, including Mounjaro (tirzepatide) and others in development. This forward-looking approach considers not just one drug but the cumulative financial impact of multiple similar treatments seeking reimbursement.

According to Sciensano, nearly half (49%) of the Belgian population aged three and older is overweight, with 18% classified as obese. Obesity costs the Belgian healthcare system an estimated €4.5 billion annually.

Multidisciplinary Care Over Medication

Rather than relying on pharmaceutical intervention, Vandenbroucke advocates for a multidisciplinary approach to obesity treatment. “You can only sustain chronic treatment by putting patients first and surrounding them with appropriate forms of support, through collaboration between different healthcare disciplines,” he said. “Not just medication, but also intensive support from physiotherapists, dieticians, psychologists and, quite simply, a healthy lifestyle.”

This philosophy aligns with expert medical opinion. Prof. David Nocca, president of France’s Ligue contre l’obésité, told TF1 Info that “the medication won’t solve everything,” warning of a potential rebound effect in patients who lose weight quickly without addressing underlying eating habits and psychological factors.

Current Reimbursement Landscape

While Wegovy will not be covered for obesity, GLP-1 analogues such as Ozempic, Rybelsus, Trulicity, Victoza, and Xultophy remain reimbursed for type 2 diabetes. However, conditions were tightened on 1 February 2026, requiring prior approval from health insurance funds. An exception has long been in place for Mounjaro.

The Franco-Belgian Contrast

Belgium’s decision stands in stark contrast to France, which is set to become the first EU country to reimburse Wegovy and Mounjaro from mid-June 2026. As reported by BFM TV, France will reimburse the drugs at 65% (often 100% for patients with chronic conditions), with strict eligibility criteria including a BMI of 35 or higher after documented nutritional failure. Initial prescriptions will be restricted to specialized obesity centers.

Novo Nordisk praised France’s decision, with CEO Mike Doustdar calling it a sign of the “maturity” of the French healthcare system. The estimated annual cost to France’s health system is approximately €100 million, targeting up to one million patients.

Equity Concerns and Criticism

Novo Nordisk has criticized the Belgian decision, arguing that the lack of reimbursement “leads to inequalities,” as only wealthy patients can afford the €300 monthly cost. This raises questions about equitable access to innovative treatments within Belgium’s universal healthcare system, effectively creating a two-tier system where those who can afford it gain access while others must rely on lifestyle interventions alone.

Analysis and Implications

The decision reflects a fundamental tension in healthcare policy: the desire to provide access to innovative treatments versus the need to maintain financial sustainability. Belgium’s cautious approach may prove prescient if costs spiral in France, or it may be seen as overly conservative if France successfully manages access within budget constraints.

Vandenbroucke has previously taken a cautious stance on expensive new treatments, tightening conditions for Ozempic reimbursement for diabetes and pursuing public health measures on tobacco. His decision on Wegovy signals that Belgium will prioritize healthcare system sustainability over expanded access to costly new pharmaceutical treatments for now.

What to Watch For

France’s implementation of Wegovy and Mounjaro reimbursement will serve as a real-world experiment that Belgium and other European nations will closely monitor. If France demonstrates that strict controls can manage costs effectively while improving patient outcomes, Belgium may reconsider its position. Conversely, if costs exceed projections or misuse becomes widespread, other countries may follow Belgium’s more cautious path.

The broader debate over how societies should allocate limited healthcare resources—between expensive pharmaceutical interventions and multidisciplinary lifestyle approaches—is far from settled, and Belgium’s decision marks a significant contribution to that ongoing conversation.