Getting a weight loss injection prescribed: eligibility and insurance

Weight loss injections are prescription-only

The substances meant by weight loss injection, semaglutide and tirzepatide, are prescription-only. In Germany they may only be dispensed by a pharmacy on a doctor’s prescription. This is not red tape but protection: treatment is powerful, has contraindications and side effects and needs months of follow-up. Approved for weight management are semaglutide 2.4 mg, known by the brand name Wegovy, and tirzepatide, known by the brand name Mounjaro; their product information in the EMA assessment reports sets out for whom and how they are used.

Any licensed doctor may prescribe them; no specific specialty is required. In practice, GPs, internal medicine, diabetes and endocrinology practices, obesity clinics and telemedicine services prescribe. What matters is not who prescribes but how: with a careful check, information and follow-up.

Who may be eligible

Both are approved for weight management in adults with a body mass index of at least 30, or at least 27 with at least one weight-related condition such as high blood pressure, prediabetes or type 2 diabetes, abnormal lipids, obstructive sleep apnoea or cardiovascular disease. Semaglutide 2.4 mg is also approved for adolescents from 12 years under certain conditions. The German S3 guideline on obesity treats medication as one building block alongside diet, exercise and behaviour change. The trial figures were achieved with such a programme too: minus 14.9 per cent with semaglutide in STEP 1 and minus 15 to 21 per cent with tirzepatide in SURMOUNT-1, versus 2.4 and 3.1 per cent on placebo.

Criterion	Applies to
BMI 30 or more	adults, even without another condition
BMI 27 to under 30	only with at least one weight-related condition
Alongside diet and exercise	always
Adolescents from 12	semaglutide 2.4 mg only, under certain conditions

Who should not get it

They are not used in pregnancy and breastfeeding; if planning a pregnancy, semaglutide is stopped at least two months beforehand according to the product information. They are not recommended with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, or with known hypersensitivity, and usually not with severe digestive disorders such as gastroparesis. Particular care is needed after previous pancreatitis, with gallstones, diabetic eye disease and alongside insulin or sulfonylureas. Below the BMI thresholds, prescribing is not intended.

How the medical assessment works

It starts with a detailed consultation: weight, height, BMI and waist, conditions, all medicines, contraception and plans for children, previous attempts and your expectations. Current blood tests are useful: HbA1c or fasting glucose, lipids, liver and kidney values and thyroid function. Then come the explanations: how the medicine works, how the dose is increased, which side effects are common and which rare but serious, what happens after stopping and what it costs. Only then is a joint decision made. If the doctor concludes that treatment is appropriate, a private prescription is issued; there is no entitlement to one. How private prescriptions work is explained in Private prescription online.

Follow-up appointments are part of it: more frequent during escalation, later at longer intervals, with weight, tolerability, blood pressure and if needed blood tests checked and the dose adjusted. Anyone who has lost less than 5 per cent after three to four months on the maintenance dose discusses adjusting or ending treatment.

Preparing for the first consultation

Have these to hand: current weight, height and waist; a complete list of medicines including contraception; conditions and operations, especially of the pancreas, gallbladder, stomach and thyroid, and thyroid cancer in the family; recent blood tests and findings on blood pressure, heart, sleep apnoea or diabetes; previous attempts with diet and exercise; and your goals and questions. Honest answers about eating habits, alcohol and mood are for safety, not judgement.

Private prescription, statutory prescription and costs

For weight reduction a private prescription is used: German statutory health insurance may not reimburse medicines mainly for weight loss or appetite control, as § 34 (1) SGB V excludes them. Private insurers and civil servant subsidies decide according to the policy and medical justification. For type 2 diabetes, products with the same substances approved for diabetes can be prescribed at the insurer’s expense if criteria are met. Medical support for weight management is billed privately under the German fee schedule for doctors (GOÄ).

Getting it online: reputable or not

Reputable services let a named, licensed doctor speak with you, check eligibility and contraindications, inform you, issue a prescription for a pharmacy and plan follow-ups. Disreputable are offers promising a prescription after a short form without a consultation, selling medicines directly without a prescription or offering Ozempic for weight loss. The EMA warned in 2023 of falsified Ozempic pens at wholesalers. The safe rule: approved medicine, doctor’s prescription, pharmacy. Profiles are in Wegovy, Mounjaro and Ozempic, the overview in Weight loss injections.

When you need urgent medical help

Call 112 for severe upper abdominal pain radiating to the back, shortness of breath or swelling after the injection and loss of consciousness. For ongoing vomiting or dehydration outside surgery hours, call the German on-call medical service on 116 117 and pause the next dose until a doctor has assessed you.