News
RACGP opposes GLP-1 RA prescribing restrictions
Changing the authority type for initiating the diabetes medication will make it difficult for ‘already burdened’ GPs to negotiate, the PBS has been told.
New restrictions would mean GPs need to contact Services Australia or the Department of Veterans’ Affairs prior to initiating a GLP-1 RA PBS prescription for type 2 diabetes.
A recent PBAC recommendation to upgrade the authority type required for PBS-subsidised glucagon-like peptide 1 receptor agonists (GLP-1 RAs) has been called into question by the RACGP.
At its most recent meeting, the advisory committee said the PBS listing for GLP-1 RAs should be changed to ‘Authority Required (telephone/electronic)’, meaning GPs would need to contact Services Australia or the Department of Veterans’ Affairs prior to initiating new prescriptions.
However, in recently published feedback provided to the PBS, the RACGP ‘strongly recommends’ they remain as ‘Authority Required (streamlined)’.
‘The PBS Authorities system is onerous,’ the college feedback states.
‘It is a complex administrative process that takes time away from GPs delivering care to patients.
‘The restrictions that have been proposed for dual therapy with insulin and triple combinations across the SGLT2 inhibitors, DPP4 inhibitor combinations and GLP-1 RAs therapy, will [also] make this authority listing difficult to negotiate for busy and already burdened GPs.’
In addition to recommending a more stringent authorising process for initiating GLP-1 RAs, the PBAC also updated the clinical criteria for prescribing the medication.
According to the committee, their use in all type 2 diabetes mellitus (T2DM) indications should be restricted to patients who are contraindicated, intolerant or inadequately responsive to sodiumglucose cotransporter 2 (SGLT2) inhibitors, but the college believes this new criteria is open to ‘clinical misinterpretation’.
‘While the intent of the criteria … is clear, it may lead to problematic clinical situations when “switching” therapeutic approaches may be required,’ the feedback states.
‘Examples include:
- inadequate glycaemic responses to SGLT2 inhibitor use in that patient
- significant metabolic disorders requiring intervention such as metabolic syndrome where diabetes goals require greater attention to factors affected by elevated body mass index.’
The college also recommended that an alternative criterion stating that the patient ‘must not have achieved a clinically meaningful glycaemic response with an SGLT2 inhibitor’ be removed.
‘If utilised, it needs to be defined by the PBS so that it is clear to all prescribers how to implement this criterion and what is meant by this term,’ the RACGP said.
‘Furthermore, the clinical criteria [stating that] “The treatment must not be prescribed in combination with each of: an SGLT2 inhibitor, a DPP4 inhibitor, another GLP-1 [RA]” is too broad and in contrast to the
national and
international diabetes management guidelines.
‘The RACGP recommends that it would be less confusing to GPs and other prescribers if the statement was aligned to other wording used to describe diabetes in the PBS.’
Aside from questioning some of the proposed criteria for GLP-1 RA prescribing, the college also provided feedback for updated clinical requirements related to SGLT2 Inhibitors, DPP4 inhibitors and changing pioglitazone to a Restricted Benefit listing for type 2 diabetes mellitus.
Log in below to join the conversation.
diabetes GLP1RAs glucagon-like peptide 1 receptor agonists PBAC PBS
newsGP weekly poll
What is your chief concern with role substitution?