Switzerland BAG coverage — 12 month update

Thank you, that case reference is exactly what my doctor needs. I'm going to bring this to my next appointment and have her reference it in the Widerspruch.

Quick question — during the 6-month Basisprogramm, were you able to start any medication, or did you have to complete the programme completely drug-free first? My Adipositologe suggested starting Orlistat during the programme to show "I've tried everything" before the Wegovy Antrag.

No medication during the Basisprogramm — that was a specific requirement from TK. They wanted to see "conservative therapy failure" documented over 6 months. I lost 3kg during the programme, then regained 5kg in the 2 months after. That documented rebound was actually helpful for the approval — it proved that lifestyle intervention alone was insufficient.

The Basisprogramm itself included:

• 12 sessions of Ernährungsberatung (nutritional counselling)
• 24 sessions of supervised Sporttherapie
• 6 sessions of Verhaltenstherapie (behavioural therapy)
• Monthly Arztgespräch (doctor consultation) with documentation

It was actually quite good — I learned a lot about Ernährung (nutrition). But let's be honest, it was also a 6-month hoop-jumping exercise to satisfy the bureaucracy.

For anyone considering the private health insurance (PKV) route instead of GKV: most private insurers have been covering Wegovy without the elaborate Adipositas-Programm requirement. I'm with DKV (private) and got approval in 2 weeks with just a letter from my Internist documenting BMI and comorbidities.

The irony of the German system: if you're wealthier (and therefore more likely to have PKV), you get faster and easier access to the drug. If you're on statutory insurance (GKV), which covers ~87% of the population, you face months of bureaucracy.

Hopefully the Gesundheitsministerium will address this inequality. There was talk of including Adipositas treatment in the next GKV-Modernisierungsgesetz but nothing concrete yet.