GPs’ central role in Wegovy’s PBS recommendation

Dr Remon Eskandar knows firsthand of the power of GPs to influence change.
 
In recent months he has been instrumental in amplifying the voice of GPs to government in a successful bid to have weight-loss drug semaglutide (sold as Wegovy) subsidised on the Pharmaceutical Benefits Scheme (PBS).  
 
As a GP with RACGP recognised extended skills in obesity management, Dr Eskandar has a passion for health equity and a firm view that obesity should be treated as a chronic and complex condition.
 
Practising at the Bendigo Healthy Weight Clinic, Dr Eskandar has seen patients ‘get a new handle on life’ once obesity has been controlled with support from weight loss drugs.  
 
‘There are a lot of lifechanging scenarios and stories that we see day-to-day,’ he tells newsGP.
 
‘Our patients are, for the first time in their lives, getting on with their life, improving their health and food connection, gaining an ability to exercise, and enjoying social activities, while having an ability to ensure they have fewer complications in the future.
 
‘All of these happen day-to-day in patients who have been trying to lose weight or control their chronic conditions over 10 and 15 years – they’ve tried everything, yet nothing has worked for them.’ 
 
But success comes at a cost, and with an annual price tag of around $4500 and even higher, it is out of reach for many. 
 
‘Wegovy, and similar medications, shouldn’t be a luxury item’, says Dr Eskandar, who is a member of RACGP Specific Interests Obesity Management.  
 
‘We see our patients who have been trying, and doing everything right with diet, exercise and behavioural change, but they are fighting against their own biology, and these private scripts can cost between $400 per month to up to $800 per month.’ 
 
This, Dr Eskandar says, creates ‘a massive health divide’ and it motivated him to act.
 
Advocacy in action 
Dr Eskandar was among a group of GPs who developed a health equity statement, and then got in touch with the health minister’s office communicating with them by email.
 
‘We arranged a couple of initial meetings, and from there, had multiple meetings with different stakeholders, including governments, both national and state,’ he said.
 
‘The main message was that obesity is a chronic, complex disease, not a lifestyle choice. 
 
‘This cannot be a luxury for the wealthy only, and investing in the PBS listing now will prevent a massive cost of future conditions related to obesity, such as heart disease, diabetes and obstructive sleep apnoea.’ 
 
The Australian Institute of Health and Welfare estimates that in 2022, 66% of adults were overweight or obese. 
 
Knowing that subsidising these weight-loss drugs would come at a huge ongoing cost to government, Dr Eskandar set his sights on the more achievable goal, suggesting the focus be on a target group of high-risk patients – those with cardiovascular disease and severe obesity. 
 
‘I was one of the main advocates suggesting that we start with a controlled condition, like cardiovascular disease, where we will be able to identify and define the criteria, and be able to convince the Government,’ he said.

‘There is real data evidence for improving the health conditions for these patients by decreasing cardiovascular complications and by decreasing the cost on national and state health budgets through avoiding hospitalisation.
 
‘Prevention we know is far better than cure. Why don’t we treat obesity as a disease, present access to treatment as a fundamental right to these patients to prevent further complications in the future. 
 
‘Let’s work together to ensure we decrease that division, that health inequity in Australia, to ensure we can utilise evidence-based medicine with clear benefits for our community and our patients for a long-term outcome.’ 
 
And it’s a message that sunk in, with a recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC) late last year for Wegovy’s inclusion on the PBS for patients who have already experienced a cardiovascular event.

The Federal Health Minister has confirmed he is now working with Wegovy’s manufacturer Novo Nordisk on the next steps. 
 
And that’s something Dr Eskandar and his colleagues are proud to have played a part in. 
 
‘Hopefully soon, when we get this PBS criteria for Wegovy, I would say our advocacy led to lifechanging and tangible progress,’ he said.  
 
‘For those who have never been able to afford it, now they can get this medication by us removing the financial barrier, and this will help them sustain their weight loss and reduce the measure of cardiovascular events.’ 
 
And Dr Eskandar already has his sights set on the next equity hurdle. 
 
There is evidence, he says, to build a case for Wegovy and similar medications to be funded on the PBS for other conditions, including for those with liver disease, renal issues, osteoarthritis and obstructive sleep apnoea. 
 
Influencing change 
Dr Eskandar believes GPs are in an ideal position to carry key messages through to decision makers. It’s hard work, he says, but enormously rewarding. 
 
‘The way I see it, GPs are well suited and uniquely positioned to advocate because we see the real-world impact of the policy decision on our patients,’ he said. 
 
‘We are not just sitting in a lab looking at data, we can actually see the effect of these decisions on our patients. 
 
‘So, when we band together through a submission to PBAC, through collective voices and using professional bodies ... writing these letters to ministers, we can drive change that directly improves lives. 
 
‘One GP is one doctor. But a collection of GPs working together, cooperating, and working with other stakeholders is a movement.’
 
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PBAC PBS Pharmaceutical Benefits Advisory Committee Pharmaceutical Benefits Scheme semaglutide Wegovy