GLP-1 RA prescribing checks flagged

Matt Woodley

16/05/2023 4:42:49 PM

GPs may soon need Services Australia approval prior to prescribing the diabetes medications, following evidence of ‘high use’ outside of PBS restrictions.

GP seeking authority to initiate GLP1-RA script
Under the changes, GPs wanting to start patients on PBS-subsidised GLP-1 RAs will need to first need to gain written or phone approval from Services Australia or the Department of Veterans Affairs.

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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Dr Tom Mcgowan   17/05/2023 7:49:52 AM

Are PBAC not considering the unmeasured cost of type 2 diabetics not losing weight?

The recommendation for sglt2 over glp1 on financials grounds in the first place limits our clinical decision making - ie that someone with a BMI >35 with type 2 diabetes is clearly going to benefit from the coexisting weight loss benefits of GLP-1. Obviously the cost of obesity in these patients is high - poorly controlled diabetes/bariatric surgery/osa

I think pbac need to consider this outside the purely hba1c lowering effects and medicine cost

Boris   17/05/2023 7:53:57 AM

Lets stop pretending this is anything other than a cost saving measure.
The increased BB incentive...the government was always going to take from the left pocket to give to the right.

Dr Roger   17/05/2023 9:41:06 AM

Stop prescribing Ozempic for non-diabetics for weight loss. There are other options for the patients.

Dr Bradley Arthur Olsen   17/05/2023 10:45:42 AM

Maybe we could ring up for EVERY script , book all patients 20 min appointments , charge 36 . Think of the FEDERAL COST SAVINGS .The rest of the people will go to the local STATE emergency dept for $1500-$4500 but thats not out of our budget

Chris M   20/05/2023 7:30:03 AM

Almost all prescriptions for GLP1-RAs for weight loss that I’ve observed have been on private prescriptions- especially for online prescription stores who will provide medications to just about anyone - changing the authority type would only punish those doctors appropriately using the PBS-subsidised pathway for diabetic patients.

Dr RM   20/05/2023 11:44:00 AM

Is this change related to overall cost savings for the PBS for diabetes? or a way to crack down on potentially doctors prescribing on the PBS using a stream line code for non diabetics?

I wouldn’t think that there are doctors that use the stream line code inappropriately as we can write private scripts for this medication for non-diabetic patients.