Presentation (CTI)

OBJECTIVES: European pharmaceutical pricing, reimbursement and market access (PRMA) systems rely on payer-funded access supported by health technology assessment (HTA) and cost-effectiveness evaluation. Increasing demand for glucagon-like peptide-1 (GLP-1) therapies for obesity has seen growing patient willingness to self-fund treatment. This study explored whether rising out-of-pocket (OOP) payment represents a shift away from payer-mediated access models.
METHODS: A targeted literature and policy review across the EU4+UK (France, Germany, Italy, Spain and the United Kingdom) between 2018 and 2026 assessed OOP payment for semaglutide and tirzepatide in obesity. Sources included publications, HTA reports, reimbursement policies, market analyses, and pricing and prescribing data. Evidence was synthesised to evaluate OOP utilisation, drivers of self-pay demand, payer access restrictions, and implications for PRMA frameworks.
RESULTS: Private GLP-1 utilisation increased substantially across all five markets. Across the EU4, limited or absent obesity reimbursement suggests reliance on self-funded access. In the UK, an estimated 1.5-1.6 million adults used GLP-1 therapies for obesity by 2025, with over 90% accessing treatment privately. Monthly OOP costs ranged from €136-400 across the EU4 and £165-360 in the UK, representing 5-21% of median monthly disposable income. As of June 2026, obesity reimbursement remained unavailable in Germany, Italy and Spain. France and the UK restricted reimbursement to patients meeting stringent criteria, with an estimated 20-30% of adults with obesity meeting reimbursement criteria in France and approximately 6-7% of adults with obesity eligible during the initial rollout in the UK.
CONCLUSIONS: Rising OOP payment for GLP-1 signals more than affordability pressure for healthcare systems, pointing to a transition toward hybrid access models combining public reimbursement with consumer-funded care. As patients increasingly act as co-purchasers, future market access models will need to account for consumer decision-making, private healthcare channels, and mixed funding pathways that blur the boundaries between public and private values.