From Rejection to Reimbursement: Innovative Strategies for Access to Anti-Obesity Pharmacotherapy in Mexico

Background: Access to anti-obesity pharmacotherapy within publicly funded healthcare systems remains limited because of concerns regarding affordability, budget impact, and appropriate patient selection. This study describes the methodological and strategic process that enabled the incorporation and public reimbursement of anti-obesity pharmacotherapy for obesity management within the Mexican public healthcare system. Methods: A descriptive health policy and market-access analysis was conducted. The reimbursement strategy included five sequential phases: identification of reimbursement barriers, definition of a clinically prioritized target population through expert consensus, generation of local epidemiological evidence, development of pharmacoeconomic and budget impact analyses, and implementation of managed-access and risk-sharing mechanisms. Results: Initial reimbursement attempts were unsuccessful because of concerns regarding the large size of the potentially eligible population and projected budget impact. Sequential application of epidemiological, clinical, and healthcare utilization criteria reduced the potential candidate population from 32,392,801 adults with obesity to 20,412 eligible patients receiving care within public healthcare institutions. Pharmacoeconomic analyses demonstrated favorable cost-effectiveness, while budget impact analyses estimated an average annual investment of MXN $286 million, representing less than 1% of the national pharmaceutical budget over five years. These findings supported the development and regulatory approval of a managed-access strategy that subsequently enabled the incorporation of anti-obesity pharmacotherapy into the National Compendium of Health Supplies in December 2023. Conclusions: Combining local epidemiological evidence, population prioritization, pharmacoeconomic evaluation, and innovative reimbursement mechanisms enabled public access to anti-obesity pharmacotherapy in Mexico. This framework may serve as a model for improving access to obesity therapies in middle-income countries.