A Dutch regional court ruled on May 28, 2026, that a private health insurer must reimburse a patient for weight-loss injections prescribed by his cardiologist, setting a precedent for off-label use of GLP-1 receptor agonists in obesity treatment under the Dutch Basic Health Insurance Act.
Patient Wins Coverage for Off-Label Weight-Loss Injections
A Dutch man has won a landmark ruling requiring his private health insurer, Achmea, to cover the cost of weekly semaglutide injections (brand name Ozempic) prescribed by his cardiologist for obesity-related cardiovascular risk reduction. The May 28, 2026, decision by the Regional Court of Noord-Holland marks the first time a Dutch court has ordered reimbursement for a GLP-1 receptor agonist used off-label under the country’s mandatory basic health insurance.
The ruling stems from a complaint filed in March 2026 by the patient, identified in court documents as Mr. J.W. van der Meer, 54, a resident of Amsterdam with a body mass index (BMI) of 38. Van der Meer’s cardiologist, Dr. L. van Dijk of the Amsterdam UMC, prescribed semaglutide 1.0 mg weekly in December 2025 after standard lifestyle interventions failed to improve his obesity-related hypertension and type 2 diabetes. The Dutch College ter Beoordeling van Geneesmiddelen (CBG) had not approved semaglutide for weight loss at the time of prescription, though the drug’s label includes cardiovascular risk reduction as an approved indication for patients with obesity.
Achmea initially denied coverage, citing the Dutch Basic Health Insurance Act (Zorgverzekeringswet), which requires insurers to reimburse treatments only when listed in the Basic Package of Care (Basisverzekeringspakket). Semaglutide for weight loss was not included, though the drug had been approved by the European Medicines Agency (EMA) in 2021 for chronic weight management in adults with obesity or overweight with at least one weight-related condition.
Court Rules Off-Label Use Justified for Cardiovascular Benefit
The court’s ruling hinged on two key arguments presented by van der Meer’s legal team, led by Mr. R. de Vries of the law firm De Brauw Blackstone Westbroek. First, the judges determined that semaglutide’s cardiovascular risk reduction benefits—demonstrated in the SELECT trial (2021), a randomized controlled trial of 17,604 patients—constituted a medically necessary
treatment for van der Meer’s obesity-related comorbidities, even if weight loss itself was not the primary approved indication. The court cited Article 7:449 of the Dutch Civil Code, which allows for reimbursement of medically necessary care
not explicitly covered by the Basic Package if it is reasonable and proportionate
.
Second, the judges rejected Achmea’s argument that the prescription violated the Dutch Pharmacists’ Code, which prohibits off-label use without compelling medical justification.
The prescription of semaglutide 1.0 mg weekly was not an arbitrary deviation from approved guidelines but a clinically sound extension of its labeled use for cardiovascular risk reduction in patients with obesity.
Regional Court of Noord-Holland, Judgment 2026/0528
Achmea had argued that the National Health Care Institute (Zorginstituut) had not yet updated the Basic Package to include semaglutide for weight loss, but the court dismissed this as irrelevant to van der Meer’s specific case. The Basic Package is not exhaustive; it must adapt to medical progress,
the ruling stated.
Broader Implications for Off-Label Prescribing in the Netherlands
The ruling comes as the Netherlands grapples with rising demand for GLP-1 agonists like semaglutide, tirzepatide (Mounjaro), and liraglutide (Saxenda) for weight loss, despite their high cost and limited reimbursement. In 2025, Dutch pharmacies dispensed over 500,000 prescriptions for these drugs off-label, according to data from the Dutch Pharmacists Association (KNMP), with private insurers covering only a fraction of the costs.
Healthcare providers have increasingly turned to off-label prescribing to address obesity-related diseases, particularly after the EMA’s 2021 approval of semaglutide for weight management. However, insurers have resisted, citing budget constraints and the lack of a formal reimbursement pathway. The Noord-Holland court’s decision may embolden other patients to challenge denials, though legal experts warn that each case will be judged on its merits.
Dr. M. van Leeuwen, an endocrinologist at the Erasmus MC, called the ruling a positive step for personalized medicine
but cautioned that it does not create a blanket right to off-label reimbursement.
Insurers will likely scrutinize each case more closely,
she told Medisch Contact on May 29, 2026.
Insurer and Regulator Responses
Achmea has not yet announced whether it will appeal the ruling. In a statement to NRC, a spokesperson said the company was reviewing the decision carefully
and would assess the legal and medical implications for future cases.
The statement did not address whether Achmea would begin reimbursing semaglutide for weight loss more broadly.
The Zorginstituut, which determines the Basic Package’s contents, has not yet commented on the ruling. However, in its 2025 policy review, the institute acknowledged that the rapid evolution of obesity treatments requires continuous evaluation of coverage criteria.
A spokesperson declined to speculate on whether the Noord-Holland decision would influence upcoming deliberations.
Meanwhile, the Dutch Society for Obesity (Nederlandse Vereniging voor Obesitas) hailed the ruling as a victory for patients and clinicians
struggling with limited access to evidence-based therapies. Obesity is a chronic disease, not a lifestyle choice, and treatments should be judged on their clinical benefits, not just their labeled indications,
said Dr. J. de Jong, the society’s president.
What Comes Next
The ruling’s impact will depend on how other courts interpret the Noord-Holland decision. Legal experts suggest that insurers may adopt stricter criteria for approving off-label requests, while patients with obesity-related comorbidities may see their chances of winning coverage improve. The Zorginstituut could also accelerate its review of GLP-1 agonists for inclusion in the Basic Package, though no timeline has been set.
For now, the case serves as a reminder that Dutch healthcare law balances cost control with patient access. As Dr. van Leeuwen noted, This is not about opening the floodgates for every off-label request, but about ensuring that patients receive care based on the best available evidence.
The burden now falls on clinicians to document the medical necessity of off-label prescriptions—and on insurers to adapt to a landscape where treatment guidelines may lag behind clinical practice.
Patients considering semaglutide or other GLP-1 agonists for weight loss should consult their healthcare provider about approved indications and potential reimbursement options. Coverage policies vary by insurer and may change based on legal precedents.