GLP-1 RA prescribing checks flagged

The Pharmaceutical Benefits Advisory Committee (PBAC) has recommended changing the authority type required for initiating glucagon-like peptide 1 receptor agonists (GLP-1 RAs) via the PBS.
 
The advice, issued following its most recent meeting, would require GPs wanting to start patients on GLP-1 RAs to first gain written or phone approval from Services Australia or the Department of Veterans Affairs prior to prescribing the medication.
 
‘In making this recommendation, the PBAC considered the high use of GLP-1 RAs outside of the PBS restrictions, their high cost versus comparator treatments, and the administrative burden on prescribers associated with telephone/electronic authorities,’ the meeting outcome states.
 
‘Continuing access [to GLP-1 RAs] should be via a streamlined authority.’
 
Aside from changing the authority required to initiate prescriptions, the PBAC further recommended that the use of GLP-1 RAs in all type 2 diabetes mellitus (T2DM) indications be restricted to patients who are contraindicated, intolerant or inadequately responsive to sodiumglucose cotransporter 2 (SGLT2) inhibitors.
 
‘The PBAC noted that both SGLT2 inhibitors and GLP-1 RAs were PBS-listed based on a series of non-inferiority comparisons originating from insulin … [and] that the price reduction to SGLT2 inhibitors in 2015 meant that SGLT2 inhibitors were now more cost-effective than GLP-1 RAs,’ the recommendation states.
 
‘Relevant clinical groups [should] be consulted on the proposed T2DM medicines restriction wording prior to implementation to ensure the restrictions are simple and clear.’
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP the new recommendations align with the Living Evidence in Diabetes Guidelines, which suggest the prioritisation of SGLT2 inhibitor therapy before considering a GLP-1 RA.
 
‘The new proposed listing also means we are not using sulphonylureas as a comparator, plus there would be more effort to prescribe them with the need for telephone authority,’ he said.
 
‘This is a bit of a change for GPs as there was a push to consider GLP-1 RA as early therapy choices after metformin failure, especially for subgroups such as those with significant issues of weight impacting their diabetes.
 
‘However, some of the PBAC response aligns to their observations that even on the prior restrictions, GLP-1 RA scripts were not aligned to necessary PBS criteria on a significant number analysed.
 
‘The change will mean more work and education for GPs about these authority restrictions and also what place GLP-1 RAs have in diabetes management.’
 
Aside from the new authority listing, the PBAC recommended removing the requirement for contraindication or intolerance to metformin for patients to use dipeptidyl peptidase 4 DPP4 inhibitors, SGLT2 inhibitors and GLP-1 RAs in dual therapy with insulin.
 
The proposed authority changes come amid reports of online telehealth companies increasingly prescribing GLP-1 RAs, such as liraglutide (sold as Saxenda), for weight loss via private prescriptions, often with what has been described as ‘scant’ patient verification or confirmation of clinical need.
 
Other GLP-1 RAs, such as semaglutide and dulaglutide, have also had their supplies impacted over the past 12 months due to their increasing use as weight loss medication.
 
The PBAC has indicated that it would be ‘useful’ to review the utilisation of T2DM medicines again in 12–24 months.
 
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diabetes GLP-1 RAs PBAC PBS SGLT2 inhibitors