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Thiqa reimbursement policy for obesity
medications
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Document Title: Thiqa reimbursement policy for obesity medications
Document Ref. Number: DoH/Policy/TRP-OMM/HPS/V1/2025 Version: V 1
New / Revised:
New
Publication Date:
June 11, 2025
Effective Date:
June 11, 2025
Document Control: DoH Strategy Sector
Applies To: - DoH licensed Healthcare Providers of Weight Management Services
- Thiqa’s TPA.
Owner: Healthcare Payers Sector
Revision Date: September 2025
Revision Period: Every 3 months after approved date for deployment for the 12 months, then annually
Contact: Healthcare Payers Sector: HealthSystemFinancing@doh.gov.ae

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1. Policy Purpose and Brief
Purpose
The primary objective of this policy is to regulate the coverage for pharmacological therapies
medically prescribed and used in obesity management within the Thiqa. This policy delineates the
instances and conditions under which patients who benefit from obesity treatments are eligible for
coverage of their medications. Furthermore, the policy outlines a system to promote and ensure
healthier lifestyles for patients, while mitigating risks such as medication waste, misuse, and
suboptimal health outcomes due to non-compliance. This document is not a guideline on a clinical
management system, and it in no way replaces the clinical judgement of the clinician.
For clinical management, this document refers to “Standard for non-surgical management of
obesity”

Intended results
The intended result of this policy is to provide coverage for effective weight management amongst
patients with obesity, and particularly patients with multiple obesity-related complications,
enhanced overall health outcomes resulting from that, improved adherence to obesity
management medications (incl. GLP-1 agonist treatment regimens), and an equitable prioritization
of healthcare resources.

Additionally, the policy aims to ensure that the coverage is regulated efficiently and effectively,
ensuring patient safety and deterring non-compliance from the coverage. Regular monitoring and
evaluation will be conducted to assess the effectiveness of the policy and make necessary
adjustments to optimize its impact.

Benefits of regulating the coverage
• Improved adherence: Encourage patient adherence and compliance with the prescribed
drug treatment regimen and activity requirements.
• Patient Safety: To ensure the prescribed drugs treatment are monitored by trained health
care professional for tolerance and side effects.
• Optimized health outcomes: Promotes improved lifestyle, regular exercise and better
management of obesity-related complications.
• Cost efficiency: Only patients who remain compliant are entitled to avail the coverage for
obesity medication.
• Accessibility: Anchored in primary care model, ensuring broad access through obesity
certified primary care physician.








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2. Definitions and Abbreviations
No. Term / Abbreviation Definition
2.1 AHI Apnea-Hypopnea Index (severity scoring)
2.2 BMI Body Mass Index
2.3 GLP-1 agonist Glucagon-like peptide-1 receptor agonists
2.4 HCP Healthcare Practitioner
2.5 Malaffi Abu Dhabi’s Health Information Exchange
2.6 MDT Multidisciplinary team for weight management
2.7 OMM Obesity Management Medication
2.8 PCOS Polycystic Ovarian Syndrome
2.9 Sahatna Application by Department of Health that helps residents track
their health, access medical records, and connect with healthcare
providers
2.10 Thiqa Comprehensive health program offered by the Abu Dhabi
government to eligible UAE nationals and likened in the Emirate of
Abu Dhabi


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3. Policy Content
3.1 SCOPE
3.1.1 Thiqa patients will be covered for OMM where it is determined they have satisfied the
requirements stated in the Standard for non-surgical management of obesity, and the
criteria stated in this policy.
3.1.2 This policy only applies to the adult population (aged 18 and above).
3.1.3 The eligibility criteria apply for all OMM available, including, but not limited to, GLP-1
agonists and phentermine-topiramate combination therapies.

3.2 ELIGIBILITY CRITERIA FOR COVERAGE OF OMM
3.2.1 Patients diagnosed and treated in line with requirements set in Standard for non-surgical
management of obesity.
3.2.2 BMI: Equal to or greater than 30, with specified requirements for obesity-related
complications based on BMI level:
3.2.2.1 BMI 30.0-34.9 must have one of the following complications:
• Cardiovascular & ischemic heart disease
• Asthma, severe (confirmed by pulmonologist)
• Arthropathy, disabling
• Dyslipidemia (severe, as demonstrated by high lipid levels)
• Hypertension
• Non-alcoholic fatty liver disease and steatohepatitis
• Obesity syndrome hypoventilation (Pickwickian syndrome)
• Obstructive sleep apnea, severe (as demonstrated by AHI > 30)
• PCOS with infertility (confirmed by gynecologist)
• Urinary incontinence, severe (confirmed by urologist)
3.2.2.2 BMI 35.0-39.9 must have one of the following complications:
• Cardiovascular & ischemic heart disease
• Asthma (confirmed by pulmonologist)
• Arthropathy, disabling
• Dyslipidemia
• Hypertension
• Non-alcoholic fatty liver disease and steatohepatitis
• Obesity syndrome hypoventilation (Pickwickian syndrome)
• Obstructive sleep apnea
• PCOS with infertility (confirmed by gynecologists)
• Urinary incontinence, severe (confirmed by urologist)
• Vascular disease
• Severely reduced quality of life (determined by obesity multidisciplinary team)

3.2.2.3 BMI 40.0 or above – no complications required
3.2.2.4 Age: 18yrs & above
3.2.3 Prescriber: To ensure compliance with eligibility criteria and coverage requirements, the
prescription must be issued by one of the following physicians
3.2.3.1 Primary care physician (family medicine physician) & Internal medicine with obesity
management certification approved by DoH.

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3.2.3.2 Specialist physician with training and certification in obesity management (e.g.,
endocrinology, diabetology or similar)
3.2.4 Cross check for effective treatment
3.2.4.1 To assess the effective treatment and coverage, that patient should fulfil the following:
• Maintained weight loss: >5% weight loss compared to baseline (pre-treatment)
weight.
• Sustained physical activity in line with best practice: Patient is mandated to meet any
of the criteria below, unless there is a medical reason to lower or adjust the criteria
temporarily.
o 75 min vigorous exercise per week on average, defined as 70-85% of the
individual’s maximum heart rate
o 150 min moderate exercise per week on average, defined as 50-70% of the
individual’s maximum heart rate
o 10,000 steps per day on average
o Individualized training or activity programs as mandated by physician or
multidisciplinary team, in collaboration with other relevant healthcare
professionals (only in cases where the patient’s medical condition does not
allow to meet the bar set of the above criteria)
• Exceptions: The prescribing physician may apply exceptions to weight loss >5% criteria
for each period, (e.g., conditions which drive weight gain independently from caloric
intake such as increase oedema), and activity criteria exception may apply if a medical
reason hinders the patient from being active (e.g., hospitalization, bone fracture,
severe arthrosis etc.).
• Compliance: Physicians must encourage patients to download the SEHANTA app (or
any other compatible fitness application that synchronizes with SEHANTA) and utilize
wearable devices to automatically report physical activity. The synchronized tracking
report within the Malaffi portal is mandatory, ensuring documented evidence of
effective treatment and securing continued program enrolment.
• If a patient is exempt or if the physical activity criteria are adjusted, these
modifications must be reported either manually or automatically. Proper
documentation and supporting evidence are required to maintain compliance.
• Additionally, further investigation criteria will be implemented to ensure adherence
to compliance requirements, supporting continuous monitoring and policy
enforcement.
3.3 Obesity Program
3.3.1 Registration: Once a patient has fulfilled the criteria under section 3.2 and indicates
willingness to enroll in the obesity program, the prescriber will register the patient in the
program and provide a one-month trial treatment
3.3.2 Baseline: Prior to initiating OMM therapy, patient’s baseline (pre-medication) body
weight is measured and applied for later audit of treatment effect and adherence. If the
patient has already been using OMM, the baseline will be the pre-medication weight
recorded in electronic health records.
3.3.3 Treatment: Patients are encouraged to counsel with licensed healthcare professionals
(e.g., physiotherapist, doctor, nutritionist), within their regular health service providers as
they see fit, to facilitate lifestyle change. Refer to Standard for non-surgical management
of obesity.
3.3.4 1-month initial trial: Upon initiating OMM therapy for eligible patients (see 3.2), patients
are to be prescribed the selected medication for one month of supply (for coverage

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reimbursement refer to section 3.4)
3.3.4.1 The purpose of this trial period is to ensure that the patient can tolerate the medication,
with regards to the common side and adverse effects (e.g., nausea) which frequently
cause patients to drop-off.
3.3.5 Enrolment: following the completion of the trial, the patient may be prescribed up to a 3-
month supply by the prescriber, provided both the patient and prescriber agree to
continue the treatment if it proves effective. (for coverage reimbursement, refer to
section 3.4)

3.4 REQUIREMENT FOR COVERAGE
3.4.1 Cross-check of eligibility for coverage:
3.4.1.1 At the end of the first 4-months of the program enrolment period, the prescriber will
evaluate the effectiveness of the treatment. If it is effective, the patient will be covered
and reimbursed for the dispensed OMM cost under the obesity program and subsequent
treatment will be covered on direct billing. The effectiveness will be assessed based on
the criteria (refer to 3.2.4).
3.4.1.2 Initial 4 Months:
3.4.1.2.1 If the patient loses more than 5% of their initial body weight but has not complied
with lifestyle changes condition:
• No reimbursement for the OMM for the initial 4 months dispensed.
• OMM will still be prescribed and covered for another 3 months on direct billing and
the patients should comply with criteria (refer to 3.2.4)
3.4.1.3 Subsequent 3 months
3.4.1.3.1 If the patient still doesn’t meet all conditions (refer to 3.2.4):
• The patient will not be covered for OMM for subsequent months.
• The patient will be considered as having opted out due to ineffective treatment.
3.4.2 Submission: All eligible patients who meet the coverage requirements of the Obesity
program are required to apply to the Thiqa app, to receive their reimbursement of OMM
cost as mentioned 3.4. This ensures continuous support and adherence to the program’s
requirements for effective obesity management.
3.4.3 Non-eligibility for coverage: If the criteria outlined in 3.4 are not met (not including
exceptions outlined in the policy) the patient will not receive coverage as per the period
mentioned above.

3.5 MAINTENANCE, MONITORING AND DROP-OFF
3.5.1 Continuation: Once the patient is enrolled in the program, their coverage for OMM will
continue as it was at the time of initiation, if the patient maintains the weight loss & BMI
improvements and compliance with lifestyle changes i.e. effective treatments.
3.5.1.1 Patients are eligible to continue receiving coverage of OMM cost for the maintenance
dose, even if their BMI reaches 24.9 or below.
3.5.1.2 Continuation of treatment to be determined at the discretion of the prescriber every 3
months and as per effectiveness criteria.
3.5.2 Stopping criteria: To be determined at the discretion of the prescriber if the treatment is
not effective.
3.5.3 Drop-off: coverage of OMM costs necessitates a long-term commitment to ensure
effective treatment. If a patient withdraws from the Obesity program without a valid
medical reason or guidance from healthcare professionals, they will be opted out of the

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obesity program. However, patients may re-enroll in the program at any time, but they
will have to start again from the beginning of the obesity program.

3.6 MAIN REQUIREMENTS AND KEY SUCCESS FACTORS FOR EFFECTIVE TREATMENT
3.6.1 Clear communication: Ensure that patients are fully informed about the treatment
effectiveness criteria, coverage and reimbursement, lifestyle requirements, and
consequences of non-compliance. This responsibility lies with all clinical parties involved.
3.6.2 Measurement and Monitoring tools
3.6.2.1 Activity criteria are recommended to be measured through a wearable device that
monitors steps and heart rate (e.g., smartwatch, fitness tracker). It is expected that the
patient, as advised by the prescriber, will connect the wearable device or health app to
SEHATNA. This ensures tracking compliance with activity and lifestyle changes and
enables monitoring of health metrics progression to ensure treatment effectiveness and
enablement of coverage.
3.6.2.2 For patients who do not have access to required technologies, and are particularly
medically constrained, exceptional circumstances may be granted. These include manual
monitoring of weight and food intake registration, and enrolment to weight management
program which should have a monitoring scheme.
3.6.2.3 The prescriber must provide clear justification based on patient assessment.
3.6.3 Data collection: A robust data collection method to track patient adherence and
outcomes are crucial for the success of the program.
3.6.4 Data privacy and security: Ensure data collected through Sahatna app and other
monitoring tools is securely stored and complies with data privacy regulations. Patients
should be informed about how their data will be used and protected.
3.7 CONSIDERATIONS
3.7.1.1 If pharmacogenomics genotype report is available at the point of prescription, make sure
to check the updated literature regarding pharmacogenomics.
3.7.1.2 Ensure the Patient has signed and understood the content of the patient’s consent, as per
the newly developed standard. Please refer to the DoH relevant documents.
4. Policy Roles and Responsibilities
Stakeholder name Stakeholder Key Role
Department of Health To ensure policy remains updated on developments and
amend accordingly.
Healthcare providers To uphold the criteria stated by the policy in clinical
practice

Licensed Healthcare Professional: All DoH licensed
healthcare professionals certified in Weight
management must provide clinical services in
accordance with the requirements of the Standard for
Non-Surgical Management of Obesity, and the relevant
DoH Standards associated.
The weight management services can be provided
through the multidisciplinary team (MDT) for weight
management which includes licensed physician,
dietitian/nutritionist, exercise physiologist, behavioral
therapist/psychologist, nurse/nurse practitioner and

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Exclusions and Limitations of the obesity management medications Policy for Non-Compliance

Non-Applicable Cases:
1. Non-Medical Use: The policy does not apply to the use of OMMs for non-medical purposes, such as cosmetic
weight loss or enhancement. These medications are strictly regulated for medical use in managing obesity and
related complications.
2. Unapproved Indications: The policy excludes the use of OMMs for indications not approved by relevant health
authorities. Off-label use is not covered under this policy unless supported by robust clinical evidence and
sanctioned by regulatory bodies.
3. Pediatric Patients: The policy does not apply to pediatric patients unless specific guidelines and approvals are
established for this age group. The current focus is on adult patients with obesity.
4. Pregnant or Nursing Women: The use of OMMs in pregnant or nursing women is excluded due to potential risks
to the mother and child. Alternative weight management strategies should be considered for these populations.
5. Patients with Specific Contraindications: Patients with known contraindications to specific medications, such as a
personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, or a
personal history of pancreatitis are excluded from this policy.
6. History of intolerance to OMMs: Previous experience of adverse effects on a previous OMM of the same class

Event or Place-Specific Exclusions:
1. Emergency Situations: The policy does not apply in emergency medical situations where immediate weight loss
intervention is not the primary concern.
2. Non-Healthcare Settings: The policy is not applicable in non-healthcare settings such as fitness centers, wellness
spas, or other non-medical establishments.


7. Enforcement and Compliance (Consequences/sanction of not applying policy by related
stakeholder)

Non-Compliance Consequences:

DoH-licensed providers who have eligible prescriber and Thiqa’s TPA must comply with the terms and requirements of
Thiqa’s rules & regulations & the provisions of this Policy.

DoH may impose sanctions in relation to any breach of requirements under this Policy in accordance with the
other allied healthcare professional to comprehensively
address the complex nature of obesity,
Provider should self-report compliance and KPIs
mentioned in the Standard for Non-Surgical
Management of Obesity, and the relevant DoH
Standards associated.

Thiqa TPA To ensure compliance with the policy
Patient Patients will do their best to meet the enrolment criteria
for effective treatment and coverage.



5. Policy Scope of Implementation

This Policy applies to Thiqa and all DoH licensed Weight Management providers within the Emirate of Abu Dhabi.

6. Exempted from Policy Scope

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Disciplinary Regulations of the Healthcare Sector.

8. Monitoring and Evaluation (Key success factors)

DoH has put in place clear monitoring mechanisms to assess the policy.
Performance will be evaluated based on mechanisms such as:
• Enrolment of patients (within scope of coverage)
• Rate of adherence to prescribed treatments
• Clinical outcomes, such as weight loss and reduction in obesity-related complications

9.Relevant Reference Documents
No. Reference Date Reference Name Relation Explanation / Coding / Publication Links
1 May 03, 2024
Obesity in adults:
Prevalence,
screening, and
evaluation

Obesity in adults: Prevalence, screening, and
evaluation - UpToDate
2 July 2023
Obesity:
identification,
assessment and
management
Obesity: identification, assessment and management
(nice.org.uk)
3 June 2024
Obesity National
clinical
management
guidelines

https://www.researchgate.net/profile/Noora-Al-
Shihi/publication/381291045_Obesity_National_clini
cal_management_guidelines/links/6665b94a85a4ee
7261b2e6ea/Obesity-National-clinical-management-
guidelines.pdf?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFn
ZSI6InB1YmxpY2F0aW9uIiwicGFnZSI6InB1YmxpY2F
0aW9uIn19

4 Sep 2024
Obesity in adults:
Overview of
management
Obesity in adults: Overview of management -
UpToDate
5 2023
Standard for the
Principles and
Procedures
Governing the
Recovery of
Payment for
Healthcare
Services under
the Health
Insurance
Scheme
https://www.doh.gov.ae/-

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6 2011
HAAD Standard
for Medical
Billing Services in
the
Emirate of Abu
Dhabi
HAAD Standard for Medical Billing Services in the
Emirate of Abu Dhabi