Ireland's managed access system for liraglutide approved about half of physician requests, targeting patients most likely to benefit cost-effectively and saving an estimated €2.4 million in the first year.
52.2% of 7,927 applications approvedIreland's managed access protocol for liraglutide used cost-effectiveness criteria to approve about half of physician requests, saving an estimated €2.4 million in the first year while maintaining access for patients most likely to benefit.
What the researchers found
Ireland's Managed Access Protocol (MAP) for liraglutide (Saxenda) approved 52.2% of the 7,927 physician applications submitted in its first year. By targeting reimbursement to the patient subpopulation most likely to benefit cost-effectively, the MAP contained spending to approximately €3.1 million in 2023 — compared to an estimated €5.5 million if all applications had been approved.
Approved patients differed from denied patients in key characteristics including age, HbA1c, and BMI, suggesting the MAP successfully selected a higher-risk subgroup where the drug offers the most value.
Why it matters
GLP-1 drugs for weight loss are expensive, and healthcare systems worldwide are struggling with how to pay for them. Ireland's MAP offers a real-world model for balancing patient access with fiscal sustainability — approving the drug for roughly half of applicants based on cost-effectiveness criteria rather than blanket coverage or blanket denial.
The numbers in context
7,927 applications · 52.2% approved · €3.1M actual spend · €5.5M projected without MAP · Year 1 data · Saxenda (liraglutide 3.0 mg)
How the study worked
Retrospective observational study analyzing two data sources: Ireland's national anonymized MAP database of liraglutide applications and the national reimbursed pharmacy claims database. Compared characteristics of approved vs. denied applications and actual vs. projected expenditure in the first year of the MAP.
Who was studied
7,927 physician applications for liraglutide (Saxenda) reimbursement in Ireland's public healthcare system in the first year of the Managed Access Protocol
What this study cannot tell us
Retrospective and observational design. Single-country study specific to Ireland's healthcare system, which may not generalize to other reimbursement models. Only captures the first year of the MAP. Does not directly measure clinical outcomes of patients who received vs. were denied liraglutide. Cost-effectiveness assessments rely on modeled rather than observed outcomes.
How to read the evidence
This is a retrospective observational study using national administrative data. While it provides valuable real-world evidence on healthcare policy implementation, it does not measure clinical outcomes and is limited to one country's healthcare system.
When this study was published
Published in 2025 using 2023 expenditure data. Highly current and relevant to ongoing global debates about GLP-1 drug coverage and affordability.
The bigger picture
As GLP-1 drugs become the dominant obesity treatment worldwide, healthcare systems face a common dilemma: the drugs work, but covering everyone who qualifies could bankrupt budgets. Ireland's MAP model demonstrates one approach to this problem — using health technology assessment to target coverage. Similar access frameworks are being debated or implemented across Europe, Australia, and other single-payer systems.
Questions still open
- Do patients denied access under the MAP have worse health outcomes than those approved?
- Will newer, potentially more cost-effective GLP-1 drugs like semaglutide change the MAP's cost-effectiveness calculus?
- Could similar managed access models work in countries with insurance-based rather than single-payer healthcare systems?
Common questions
How does Ireland decide who gets liraglutide covered for weight loss?
Why don't healthcare systems cover GLP-1 weight loss drugs for everyone?
Read the original research
A Managed Access Protocol for Liraglutide for Weight Management: A Retrospective, Observational Study in Ireland.
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 28(6), 844-851
Citation
Barrett, Rosealeen; Smith, Amelia; Gorry, Claire; Doran, Stephen; Barry, Michael; McCullagh, Laura. (2025). A Managed Access Protocol for Liraglutide for Weight Management: A Retrospective, Observational Study in Ireland.. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 28(6), 844-851. https://doi.org/10.1016/j.jval.2025.03.017