Irina Ernstberger, 66, patient of doctor Thomas Horbach, a specialist in surgery, visceral surgery and nutritional medicine, poses in her garden in Haar, Munich, Germany. Reuters

Ludwig Burger and Maggie Fick, Reuters

Frustrated after countless failed diet and exercise attempts, 41 year-old Jessica Lenth from Hamburg has started putting money aside for a drug that she sees as a possible door to a life without obesity. Interviews with seven doctors and two other potential users of Wegovy from Germany, where Novo Nordisk’s weight-loss drug will become available at the end of July, show the office administrator isn’t alone.

“It’s a bit like a last hope I cling to. I’ve just learnt the price. For now, I’ll be saving a bit of money before I try to get it,” Lenth told Reuters by telephone. The doctors say they are hearing a similar message from hundreds of obese or overweight patients and expect high demand for Wegovy prescriptions even though public health insurance plans covering about 90% of Germans will not foot the bill.

The interviews suggest many patients will be prepared to pay themselves for the weekly injection, at an initial cost of about 170 euros ($190) a month but just over 300 euros longer term.

For the 10% of Germans with private health insurance, coverage will depend on contract terms. Allianz says it will pay if a physician diagnoses a medical need while Debeka said its plans exclude weight-loss treatments.

Patient advocates and physicians welcomed the arrival of Wegovy in Germany, where 18.5% of adults are obese, more than the European Union average of 16%. The Robert Koch Institute for public health says diseases linked to excess body weight pose a considerable burden on health and social security systems. Wegovy’s launch in Germany, its third European market and the region’s largest, comes as Novo is ramping up production to meet soaring demand in the United States, where the drug sells for as much as $1,350 a month.

The Danish drugmaker told Reuters it would closely monitor prescriptions in Germany to ensure that people with obesity can start and continue treatment. “Nevertheless, if demand is higher than expected, we cannot rule out the possibility of supply delays and shortages in the coming months,” it said.

Novo’s shares have rallied nearly 120% since Wegovy debuted in June 2021, making it Europe’s second-most-valuable listed company after LVMH. In Germany, Wegovy will be administered with the same injection pen used in Norway and Denmark, not the one used in the United States to avoid hitting supplies there. A swift uptake could nevertheless further strain Novo’s ability to meet demand.

Wegovy’s introduction in Germany is likely to stir the debate over what constitutes a medical need in a nation that doctors said often sees obesity as a “lifestyle choice” rather than a chronic disease. Dr. Sylvia Weiner, who runs an obesity clinic at Sana Klinikum Offenbach near Frankfurt, has fielded questions about Wegovy from several dozen patients in the past few months and anticipates many more. “We are really waiting for Wegovy,” she said. “Patients are so desperate in Germany that they will pay out of their pocket for the medication.”

Used alongside diet and exercise changes, Wegovy has been shown to help obese people lose about 15% of their bodyweight.

But clinical trial data shows people regain weight after they stop taking it. Reuters reported last week that most US patients stopped using weight-loss drugs within a year. Dr. Karl Rheinwalt, an obesity specialist at St Franziskus-Hospital Cologne, reckons the cost will limit uptake in Germany.

But Munich-based Dr. Thomas Horbach — who like Weiner and Rheinwalt performs gastric bypass and other bariatric surgeries — says some of his patients who are overweight but not diabetic already pay for Ozempic, a diabetes drug also made by Novo, themselves. Using the same active ingredient at a lower dose, Ozempic costs less per milligram of active substance than Wegovy. “My experience is that people will be able to pay for it out of (their own) pocket,” said Horbach. He said the ban on reimbursement by public health schemes under a 1980s law that categorises weight-loss therapies as lifestyle drugs, discriminates against people with low incomes. Novo said prescription drugs in Germany were generally excluded from rebate or coupon promotions.

Some specialists say the lifestyle drug classification reinforces a widely held view that those with obesity and related conditions such as diabetes or high blood pressure have themselves to blame. “Patients suffer enormously from the stigma because they feel isolated, because it’s a visible disease that has been unfairly associated with attributes such as laziness,” said Dr. Juergen Ordemann, another surgeon and head of obesity at Berlin’s Vivantes hospital chain. Without public health insurance for obesity drugs, and very limited payments for obesity-specific psychotherapy, treatment in Germany often means surgery for the most severe cases, with a BMI of around 50.

All the doctors interviewed by Reuters said they intend to prescribe Wegovy alongside structured diet and exercise programmes. Many worried that supplies would be further strained by non-obese people seeking “vanity” prescriptions — a concern reflected in a Novo statement last week saying physicians should “prescribe responsibly”. Doctors say they will primarily consider Wegovy for patients who are at the early stages of obesity, with a BMI of around 30 or slightly higher, and not recommended for surgery.

Severely affected patients would still require surgery but they could use the drug to prepare for their procedures and help them maintain a lower weight afterwards. Michael Wirtz, a civil engineering project manager from Winsen an der Luhe in Lower Saxony, had gastric bypass surgery in 2011 that helped him lose 70 kg. He has since regained 25 kg, however, and is considering Wegovy alongside lifestyle changes.

“Without it, I would probably have to think about changing my job to ease the stress level, but that would of course mean a lower income,” said Wirtz, adding that he might cancel some subscriptions to help afford the cost.

Irina Ernstberger, a 66 year-old retiree, said she considers Wegovy a fallback option after she lost weight to well below the obesity threshold with the help of Ozempic.

Speaking to Reuters at her house in Munich, Ernstberger said she is on the right track, having maintained her weight for three months even after getting off Ozempic, which she paid for herself. The investment was worth it. “Sure, it costs a lot, not just the medicine itself, but also a completely new wardrobe. But buying new clothes was fun,” she said.