An important change that is expected to facilitate patient access to Mounjaro, the drug used to treat type 2 diabetes mellitus and especially obesity, is implemented from tomorrow.
The Health Insurance Organization now includes Mounjaro in the List of Pharmaceutical Products of the GHS, putting an end to the need to submit new nominal requests for its administration.
In practice, this means that patients who meet the specified conditions will be able to secure their medicine through the pre-approval process of the GHS, on the basis of single, approved protocols without the need for their doctor to submit a nominal request which must then go through the process of competent Committees.
Specifically, until today, access to Mounjaro through the GHS was linked to the examination of nominal requests by the competent committees.
From October 15, the process changes. The drug is included in the official list of the System and its reimbursement will be based on specific criteria set by the HIO.
The attending physician will submit a relevant request which will be examined in accordance with the relevant protocol.
The new procedure mainly concerns patients with obesity but also patients with type 2 diabetes, but with different conditions.
To address obesity, the protocol provides for specific categories of beneficiaries:
· The first concerns adults with a Body Mass Index (BMI) equal to or greater than 40.
· The second concerns people with a BMI of 35 to less than 40, who also have established atherosclerotic cardiovascular disease and/or moderate to severe obstructive sleep apnea.
In these cases, the relevant medical documents are required, while the protocol provides for other evaluations.
As the competent officer of the OAU, Sofia Petridou, pointed out speaking to "F", "Mounjaro's coverage for obesity will not be unlimited".
"According to the protocol, in the first six months of treatment, a loss of at least 5% of the initial body weight is required, while in one year the percentage must reach at least 10%. A new evaluation will be required for the continuation of treatment, while the maximum duration of compensation for obesity is set at two years, as long as the conditions are still met."
What applies to those who already have approval
According to Ms. Petridou, "patients who have already secured approval through the Committee on Nominal Requests for Medicines or other competent bodies do not need to take a new action at this stage. Their approvals remain valid and, when they expire, the continuation of treatment will be considered based on the new protocol."
At the same time, those requests that have already been submitted to the EOAF and have not received a response do not need to be submitted again since the HIO will automatically forward them for evaluation with the new procedure.
Changes for Ozempic as well
Along with the changes in the way Mounjaro is secured, the revised protocol for the administration of Ozempic for patients with type 2 diabetes mellitus will also be implemented tomorrow.
Ozempic will continue to be available from private pharmacies, while electronic pre-approval is also provided for this based on the established criteria. As for Mounjaro, it will continue to be available from hospital pharmacies until further notice.
