Mounjaro reimbursement in Belgium ruled out for obesity as diabetes cover stays

Belgium's health minister has said no to paying for Lilly's tirzepatide pen when it is used for obesity. The decision on Mounjaro reimbursement in Belgium, confirmed by the minister's office on 21 October 2026, leaves people with obesity paying the full pharmacy price, about €179 a month at the lowest dose. People with type 2 diabetes who meet the conditions keep their cover. The ruling follows a June refusal for Wegovy, so no obesity drug is now reimbursed for that use in the country.

What the minister decided and when

The decision came from Frank Vandenbroucke, the federal minister for public health and social affairs, of the Flemish Vooruit party. The business papers De Tijd and L'Echo reported it first on Wednesday 21 October, and his office then confirmed it to the public broadcaster, as reported in the VRT news report that morning. The ruling is narrow in one sense and wide in another. It does not touch diabetes care, where Mounjaro stays reimbursed under specific conditions. But it closes the only public payment route that people prescribed the drug for weight alone had been waiting on, and it repeats the line he took on Wegovy, the Novo Nordisk pen, in early June. In that earlier case VRT reported that he followed advice from the medicines reimbursement committee of RIZIV, the national health insurer.

The table sets out the main points in one place. Belgian reports on the decision give no start date for any change, because nothing that patients were receiving has been taken away. People who were already paying out of pocket for obesity treatment keep paying, and people with diabetes keep their current terms. What has changed is the outlook. Many doctors and patients had hoped that a reimbursement deal for obesity would follow the earlier debate on Wegovy, and the ruling now puts that off until at least the new care plans due in 2027. For readers who follow who pays and on what terms, this is a refusal rather than a cut, and that difference shapes who feels it first.

What people with obesity pay now

The money is the first thing patients will notice. VRT put the lowest dose of Mounjaro at about €179 a month, with higher doses costing up to about €300 a month. Because the drug is meant to be taken for the long term, that is a recurring bill rather than a single purchase. Twelve months at the starting price alone comes to more than €2,100, before any move to a higher dose. In a statement reported by the Belgian medical outlet Le Spécialiste, Lilly said that access in Belgium remains limited to patients who can pay for treatment themselves, and noted that no obesity medicine is reimbursed for that use in Belgium today. Doctors can still prescribe the drug for weight management within its approved label.

VRT put the lowest dose of Mounjaro at about €179 a month, with higher doses costing up to about €300 a month.

Type 2 diabetes is the exception that matters most for Mounjaro reimbursement in Belgium. People with diabetes who meet the reimbursement criteria keep paying only their normal share, and the ruling does not change those criteria. That split has a cost of its own for the system. According to RIZIV figures quoted by VRT, nearly 130,000 people had one of these diabetes medicines reimbursed last year, about four times the number in 2019. For pharmacists, the practical result is two very different prices for the same pen, depending on the diagnosis on the prescription. Clear records and careful checks of reimbursement status at the counter will matter more as cash buyers and covered patients share one shelf. The obesity figure is large too: Sciensano estimates that about 18 percent of Belgians live with obesity.

Why the government said no

The minister's office gave two reasons. The first is money. The cabinet told VRT that broad reimbursement for obesity would be too expensive and would push out other care that people need. The spending trend on the diabetes side shows the scale it has in mind: RIZIV outlays on these medicines rose from almost €30 million in 2019 to €122 million in 2025, and passed half a billion euros over the whole period. In June, explaining the Wegovy refusal, the minister had already warned that treating every eligible patient could cost billions of euros a year. On that occasion he also said that paying for one obesity drug would set a precedent for the others, which is how the Mounjaro ruling now reads.

The second reason is medical. According to Le Spécialiste, which cited L'Echo, the minister called large scale reimbursement irresponsible both for the budget and for patients, as long as people do not get support from several kinds of professionals. His office told VRT that medication alone is not enough, and that patients also need a healthy lifestyle and close support from dietitians, physiotherapists and psychologists. That framing leaves room for a later deal. The care pathways for adults with obesity that the government expects in 2027 could make room for drugs inside a structured programme, though the role of medication in those pathways is still under study. Nothing in the ruling sets criteria, a budget or a date for a new look at Mounjaro reimbursement in Belgium.

How Lilly and obesity doctors responded

Lilly said it regretted the decision. Frédéric Clais, who leads Eli Lilly Benelux, said the company understands the budget limits but believes the ruling does not reflect the real burden of obesity or the clinical value of tirzepatide, according to Le Spécialiste. Lilly said it would back care pathways that tie reimbursement to defined medical criteria, which it argued would target the patients most in need and keep the budget under control. Speaking to VRT, Clais called a well judged reimbursement an investment rather than a cost. The company also said it wants to keep talking with the authorities, doctors and patient groups. The Lilly statement reported by Le Spécialiste gives the same account of its proposal.

Doctors reached for one phrase. Bart Vanderschueren, an endocrinologist at UZ Leuven, told VRT he fears a form of two-tier medicine, and called for research into which patients have illnesses directly linked to their weight. Nathalie Esser, president of the Belgian association for the study of obesity, told RTBF she understands the budget limits but finds the decision regrettable, and warned that the people who need treatment most are often the least able to pay. The same split has shaped access elsewhere: British MPs recently said the NHS plan reaches few people while most pay privately. California's Medicaid plan dropped GLP-1 cover for weight loss while keeping it for diabetes.

Conclusion

The ruling on Mounjaro reimbursement in Belgium is a refusal, not a cut. People with type 2 diabetes keep their cover, while people prescribed the pen for obesity go on paying about €179 to €300 a month. The government cites cost and the lack of structured support. Lilly and obesity doctors warn of two-tier access. The next checkpoint is the adult obesity care pathways expected in 2027, which are the first place where reimbursement could be reconsidered.