In 2018, the cost component of Iceland Health was 163 million ISK for drugs of this type, and this year the cost has reached 1.9 billion ISK by the end of November. Almost 15% of total Medicare spending on medicines is subsidizing blood-sugar-lowering medicines, other than insulin, but diabetes medicines that are also used for weight control are the main component of that cost.

What medicines are they?

Medicinal products used in diabetes and for weight control can be divided into two groups, based on their active ingredient:

Semaglutide preparations:

• Ozempic and Rybelsus for people with diabetes II

• Wegovy for non-diabetic weight control

Liraglutide preparations:

• Victoza for people with diabetes II

• Saxenda intended for non-diabetic weight control

Ozempic, which was launched in 2019, is only intended by the manufacturer's package leaflet for people diagnosed with diabetes II, but Wegovy is a new drug that was launched in Iceland in early November this year and can be used for weight control without a diagnosis of diabetes.

Increase rapidly

In 2019, nearly 1700 individuals were prescribed these types of drugs (semaglutide and liraglutide) with the payment participation of Iceland Health. By 2023, the number of individuals has reached more than 8000. In addition, there are an additional 4000 people who take the medicines but do not meet the requirements for payment participation. It is therefore clear that demand for the medicines is high and that Ozempic is lacking.

For Iceland Health to bear the cost of Ozempic, an individual must be diagnosed with diabetes, but other anti-diabetic drugs must also have been tried. If they are insufficiently effective or if the patient does not tolerate them due to side effects, he/she may receive a payment contribution for Ozempic. Analysis of the data from Iceland Health shows that 58% of the group that received Ozempic approval for the first time last June had only released one package of other diabetes medicines with a general payment participation shortly before applying for a pharmacy certificate for Ozempic. This raises the question of whether the increase in type II diabetes causes increased use of the medicine or whether it is being prescribed for weight control alone. In many cases, the dosage exceeding the recommended daily diabetic dose may be observed.

Changed rules on payment participation

Iceland Health is the legal function of allocating public funds, as determined in the budget, in the best possible way to provide health services to the public. In light of this dramatic and unexpected increase in expenditure that has occurred in recent years, Iceland Health has had to find ways to respond.

It was decided to review the rules and criteria for payment participation by Iceland Health in the medicinal products in question, and in this assessment the rules in neighboring countries were considered, in addition to basing this on a health economic assessment from Norway, which is stipulated by the Health Insurance Act, that decisions of this kind shall be based on such an assessment. The dissertation emphasizes that medication in relation to weight control is part of a comprehensive treatment like in Iceland. For example, Sweden and Finland have no payment participation for Wegovy and Denmark and Norway have stricter conditions than Iceland. Health economics evaluation of benefits indicates that the effectiveness of pharmaceutical treatment alone is too low in relation to cost. There are no studies yet on the long term effects of this treatment. However, research suggests that there is a high likelihood of weight gain when the medicine is discontinued. Parties who continued to receive follow-up after use of the medicine maintained a weight loss of about 5%.

Iceland Health needs to do all it can to ensure access to medicines and other health services for those who are in greatest need. In order to meet these obligations, the rules on payment participation have been changed and conditions have been clarified, underlining that Ozempic is only for those diagnosed with diabetes.

Who receives subsidised medicines today?

New rules on payment participation for semaglutide and liraglutide drugs took effect in early November. In short, the following are now the following:

Ozempic, Rybelsus and Victoza: Diagnosis of diabetes II should be made in addition to the individual having tried other types of diabetes medicines at full doses for six months or longer. An explanation needs to be provided as to why those drugs are not suitable. If the person in question is unable to take other medications because of contraindications, i.e. diseases or complications, a certificate must be attached to the identity of the person. If the individual also has a very serious life threatening illness, it is sufficient to meet the criteria for a diabetes diagnosis but not otherwise.

Wegovy: That the administration is part of a comprehensive treatment for obesity. The person should have a BMI index of 45 or above and life threatening weight-related complications, e.g. hypertension or diabetes that has not been treated with different medicines in general payment participation over the last 6 months. Individuals can furthermore receive financial contribution if they have BMI 35 and a very serious life threatening illness.

Saxenda: Participation in payments by Iceland Health has ceased and people have been advised to move to Wegovy instead under the conditions, as studies have shown poorer results than Wegovy, and it is more expensive.

With new rules and guidelines, Iceland Health wants the medicinal products in question to be sent to those who need them first and the funds available to them to be managed wisely.