RACGP opposes GLP-1 RA prescribing restrictions

Matt Woodley

30/05/2023 4:52:44 PM

Changing the authority type for initiating the diabetes medication will make it difficult for ‘already burdened’ GPs to negotiate, the PBS has been told.

GP on the phone to Services Australia
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.
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Dr Milton Arthur Sales   31/05/2023 8:53:32 AM

This smells like the Fluticasone saga. The confusion being required to change long term medication in patients well controlled and waiting to find they are inadequately maintained and then going back to the original meds will be a burden. Operating under financial penalty threat if we prescribe in error is onerous. Choosing an authority item with a long description of criteria is also confusing.

A.Prof Christopher David Hogan   31/05/2023 12:52:11 PM

So the Feds want every health professional to work at the peak of their skills but NOT GPs!

Dr Mark Raines   31/05/2023 6:12:06 PM

"The PBAC recommended that the authority type for GLP-1 RAs, for therapy initiation for all indications, be changed from Authority Required (STREAMLINED) to Authority Required (telephone/electronic), but that continuing access should be via a streamlined authority."

I think this is a hurdle but a little one and only for new patients. Continuing supply is streamline. There is a concern that GPL-1 are being diverted to manage obesity only, and by introducing this means that doctors will consider whether this is the right drug for the indication. You can still write a private script for obesity.

Dr Jane Elizabeth Christiansen   31/05/2023 11:54:01 PM

Completely agree with A.Prof Hogan.

Just allow us to get on with providing appropriate care for our patients ( treatment and preventative) - cost saving in the long term.

I’m sick of trawling through ambiguous detail to check if patients fulfil criteria for funded medication which don’t always meet best practice recommendations or phoning to access authority for a medication which the person at the end of the phone can’t even spell . I’m not sure of the necessity of this system when I’ve been made aware ( through other avenues) that some patients through this system have continued to receive medication when they shouldn’t have, while others it’s just plain meaningless red tape!