How Weight Loss Drug Claims Are Changing SA Insurance

As of 7 October 2026, more South Africans are claiming for GLP-1 medicines, and medical aids have to decide how to pay for them. Bloomberg reported on 1 October 2026 that the number of people claiming for these drugs through Discovery, which administers the country's largest private health plan, almost tripled to 61,200 members in the three years through 2025. But the plan has no dedicated chronic-medicine benefit for these drugs when they are used specifically for obesity. Patients have to use day-to-day benefits, including medical savings, or pay themselves.

What the Discovery numbers show

Two figures in the Bloomberg report stand out. The first is the growth: almost three times as many members claimed for GLP-1 medicines in the three years through 2025. The second is how long people claimed for: members claimed for the drugs for an average of just 5.4 months.

The report does not say why people stop claiming after a few months.

Bloomberg describes these as expensive treatments that may need long-term use. According to the report, insurers, drugmakers and start-ups are looking for ways to make paying for them financially sustainable.

Why cover for weight loss drugs is hard to design

The main problem for insurers is time. A 2025 review in the journal Biomolecules says that a big disadvantage of these medicines is the high rate of weight regain when people stop taking them. A US analysis by the Employee Benefit Research Institute (EBRI), published in October 2025, makes a similar point. It says studies show people regain weight after stopping, and that improvements in heart risk factors move back towards where they started. That suggests the drugs may need to be taken indefinitely, which would add to cost pressure.

The EBRI study used a computer simulation to estimate how covering GLP-1s might affect employer health insurance premiums in the United States. Its main findings were:

• Using real-world drug prices, premiums rose by between 5.3% and 13.8%, depending on assumptions about how consistently people take the drug, co-payments and who qualifies.
• With a hypothetical lower-priced GLP-1 costing $200 a month, the increase fell to between 1% and 3.9%.
• A $90 co-payment cut premium increases by 1 to 2 percentage points but did not cancel them out.
• Covering people who are overweight, as well as those with obesity or diabetes, pushed premiums up notably more.

EBRI also said the drugs may eventually reduce some other medical costs. But those savings would not appear straight away, and there is no evidence that they would fully cover the price of the drugs. These are US figures.

How other countries handle the cost

South Africa is not alone in struggling with this. A 2025 editorial in the journal Cureus on GLP-1 access and inequality sets out how different systems respond:

• The UK's NHS limits GLP-1 prescriptions for obesity to a maximum of two years.
• Germany, Italy and Denmark offer no public reimbursement for these medicines for weight loss.
• In the United States, Medicare does not cover medicines for obesity. Only 13 of the 50 states give limited Medicaid cover to a small group of patients.

The same editorial warns that people who lose access after cover ends, or when they can no longer afford private prescriptions, may regain weight. It also notes that, in the US, lower income is linked to more people stopping GLP-1 treatment for diabetes.

How many South Africans are interested

Interest is growing, but it is still early. MedicalBrief, reporting on TimesLIVE coverage of research by consumer data company Worldpanel by Numerator, said one in 20 people is already taking or thinking about treatments like Wegovy, Ozempic and Mounjaro. The same report also gives a figure of about 13% of South Africans in this group. These two numbers do not match, and the report does not explain the difference.

The research found that only 37% of South Africans are familiar with GLP-1 medicines, compared with 47% globally, and 63% have never heard of injectable weight loss medicines. The report said uptake is expected to rise as key drugs get close to patent expiry, which is likely to widen access and lower costs over time.

A 2025 review in the Journal of Obesity also says that the arrival of generic liraglutide and changes in insurance cover are reshaping access and affordability.

What this means for people in South Africa

If you are thinking about these medicines, a few points are worth knowing:

• Check your plan's rules. According to Bloomberg, Discovery's plan has no dedicated chronic-medicine benefit for GLP-1 drugs used specifically for obesity. Ask your own scheme what it pays for, and from which benefit.
• Know what is registered for what. Ozempic (semaglutide) is registered in South Africa for type 2 diabetes. Wegovy (semaglutide) and Mounjaro (tirzepatide) are registered for weight management. All of them are prescription medicines.
• Know the legal price. Each medicine has a single exit price (SEP) set by law. Pharmacies may add a dispensing fee, which is also capped by law. You can compare Ozempic prices at registered pharmacies before you buy, and read how we score and rank pharmacies.
• Avoid unregistered products. SAHPRA warns against buying unregistered weight-loss injections online. The Cureus editorial notes that compounded GLP-1 products have been linked to medication errors, contamination, side effects and hospital admissions.
• Plan for the long term. Because weight often comes back after stopping, think about whether you could keep paying if your cover changes.

Results differ from person to person. Whether to start treatment is a decision for you and your doctor. Please read our medical disclaimer, and follow our latest Ozempic and semaglutide news for updates on cover and prices.