The South Korean government is considering bringing obesity drugs such as Wegovy and Mounjaro into its managed benefit scheme, a system that places costly treatments under health insurance pricing and prescribing rules. The review comes as concerns mount over indiscriminate prescribing and misuse of the drugs, adding an insurance-based control to prescribing guidelines and on-site enforcement already under way. The government has also begun field inspections of hospitals with high volumes of obesity drug prescriptions.
Health and Welfare Minister Jung Eun-kyeong said on the 27th that the ministry would "include obesity drugs in the review framework for the managed benefit scheme," responding to a request from Rep. Nam In-soon of the Democratic Party of Korea at a comprehensive parliamentary audit held by the National Assembly's Health and Welfare Committee.
The managed benefit scheme brings non-reimbursed items at risk of overtreatment into the national health insurance system so that prices and treatment standards can be managed. It sets the patient co-payment rate at 95%, aiming to curb indiscriminate use of medical services while minimizing the burden on insurance finances. Whether obesity drugs will be included, which drugs would be covered, and the scope and timing of any application have not yet been decided.
Nam asked whether the drugs would be covered by health insurance, arguing that side-effect monitoring, patient education and a long-term management system are needed. Jung said she understood that pharmaceutical companies had already applied for reimbursement, and noted that some countries abroad provide insurance coverage for patients with severe obesity. When Nam asked the ministry to consider including the drugs in the managed benefit scheme even for patients without severe obesity, Jung said she would review the proposal.
Nam said about 40% of people who underwent national health screenings had a body mass index of 25 or higher, and 7.7% had a BMI of 30 or higher, arguing that coverage should be expanded in light of the socioeconomic costs of obesity. She also cited public insurance coverage for obesity drugs in countries including the United States, France and Japan.
The scale of indiscriminate prescribing also came under scrutiny. "Nearly 97% of prescriptions for obesity drugs override alerts from the Drug Utilization Review system," Nam said. "Prescriptions were issued despite warnings against use in pregnancy in 32.8% of cases."
Data submitted to Rep. Suh Young-suk of the Democratic Party by the Health Insurance Review and Assessment Service showed 70,018 cases in which prescriptions for GLP-1 obesity drugs proceeded despite alerts flagging duplicate prescriptions of the same active ingredient between October 2024 and August this year. Cases through August this year alone totaled 38,466, up 23.4% from 31,164 for all of last year.
The Drug Utilization Review system displays an alert on a physician's prescribing screen when a patient's medication overlaps in ingredient and dosing period with a drug prescribed at another medical institution. But a blind spot remains: no alert appears when obesity drugs with different active ingredients are prescribed concurrently, because obesity drugs are not included in the system's checks for duplication within the same therapeutic class. A patient taking Wegovy, for example, would trigger no duplicate-prescription alert when prescribed Mounjaro at another hospital. How often such prescribing actually occurs is also unknown.
The need to manage side effects was also raised. Nam said 104 patients in South Korea had been identified as receiving treatment for optic neuropathy after being prescribed obesity drug injections. She noted, however, that a causal link between the drugs and optic neuropathy has not been established, as the patients' underlying conditions have not been sufficiently taken into account.
Nam called for stronger oversight, saying that the ministry sent a letter to the medical community in November 2024 asking physicians to confirm patients' conditions thoroughly before issuing prescriptions, but that no substantive enforcement followed.
Jung said the Ministry of Food and Drug Safety is moving to designate obesity drugs as medicines prone to misuse, and that the health ministry is consulting with the medical community on misuse guidelines and voluntary measures to improve prescribing practices.
Separately, the ministry said it had begun field inspections of the 20 medical institutions with the highest prescription volumes over suspected illegal in-house sales of obesity drugs. It plans to focus on whether any institutions violated the principle separating prescribing from dispensing, such as by preparing and selling the drugs directly.