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‘A wake-up call’: GPs issued warning over semaglutide prescribing
The DoHAC has delivered ‘education letters’ to more than 1000 doctors found to be prescribing the medication under the PBS, but failing to follow the criteria.
The education letters have been sent to the top 10 % of prescribers whose patients have no prior history of T2DM.
More than a thousand GPs across the country received a letter on Friday, 7 March, from the Department of Health and Aged Care (DoHAC) raising concerns about their prescribing history of semaglutide.
‘Our data shows that you have repeatedly prescribed semaglutide to patients who have no PBS history of any other T2DM medicines,’ the letter, sighted by newsGP, reads.
‘This suggests that you have prescribed semaglutide outside its PBS listing restriction criteria.’
As it stands, semaglutide is only listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of Type 2 Diabetes Mellitus (T2DM) when certain strict conditions are met.
The ‘education letter’ encourages GPs to familiarise themselves with the PBS listing restriction criteria and only prescribe PBS medicines for patients ‘where those criteria have been satisfied’.
‘Prescribing semaglutide on the PBS where the requirements are not met undermines medicine availability for T2DM patients and contravenes the legislation,’ it reads.
‘If a patient does not meet the PBS restriction criteria, they must be issued a private prescription.
‘Your dedication to patient care and the sustainability of the PBS is greatly appreciated, and we trust that you will continue to support the appropriate prescribing of PBS medicines.’
The DoHAC, which oversees the PBS and related compliance activity, has a history of issuing GPs with ‘education letters’ to flag any issues with their prescribing habits – and, in the past, not all doctors have taken kindly to the approach.
However, Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP he does not see anything threatening about the language used in the letter, and instead it should be seen as a ‘wake-up call’.
‘It isn’t associated with any current penalty,’ he said.
‘It’s actually an encouragement to go back and look at your prescribing habits and prescribing processes to make sure you adhere to what the criteria is because there’s also changes since the data that this letter is based around; it’s become even a little bit more restricted as well.’
This data came from a 2022 review of medicines used to treat T2DM, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which was conducted by the Drug Utilisation Sub Committee of the Pharmaceutical Benefits Advisory Committee and revealed excess prescribing.
Dr Deed suspects there may be a number of contributing factors as to why some GPs have wrongly prescribed semaglutide under the PBS, including that previously, the initiation of semaglutide was a streamlined authority.
‘The software would just allow you to prescribe it without really looking at what restrictions are there,’ he said.
‘Also, some of the prescribing obviously occurred because there was a non-PBS indication for the use in management of overweight and obese patients, and so in attempting to prescribe that, maybe the prescribers weren’t aware.
‘So, there was that overlap with obesity and overweight.’
While shortages of semaglutide continue in Australia, Dr Deed said he does not see any correlation between the matter being raised by the DoHAC and supply issues.
‘I certainly wouldn’t put the shortages back on GPs or other specialists who’ve been prescribing this outside of the PBS,’ he said.
‘But, certainly, the issues around supply still remain and these new restrictions on prescribing are in place, so they haven’t really changed the problem of supply. Therefore, it’s not just overuse prescribing, it’s obviously supply chain, company-related issues.’
However, Dr Deed does believe that more needs to be done around making medications, such as GLP-1 RAs, more accessible for weight management.
‘Some of this would have been obviated by the PBS support for prescribing of semaglutide and other related medications, such as tirzepatide, for people who are overweight and obese here in Australia,’ he said.
‘Get some subsidies so GPs, in wanting to assist patients, would not get confused around the PBS criteria.
‘GPs ultimately want to help people and want to assist the health of anyone that comes to see them.’
This view is in line with the new position statement on obesity prevention and management, released by the RACGP earlier this week, in which the college called for increased Federal Government funding to help GPs treat the complex condition, including for medications.
While the DoHAC’s letter is aimed at the top 10% of prescribers of PBS scripts that do not fit the criteria, Dr Deed said it is important that all prescribers familiarise themselves with the PBS requirements of any medications they are prescribing.
‘Being a GP is complex,’ he acknowledged.
‘This sort of letter might seem to be adding complexity, but what it’s saying is adding comparative education around how to simplify dramas for yourself and also patients over time.
‘Just try to listen to the news, read the criteria – be aware of what your obligations are – and ask for help if you’re concerned.’
The DoHAC has welcomed GPs to provide their feedback on the matter, including any suggestions on how they can be better supported.
Currently, semaglutide is only listed on the PBS for treatment of T2DM when certain conditions are met. They are as follows for the first PBS prescription:
- Used in combination with at least one of metformin or a sulfonylurea or insulin; and
- At least one of metformin or a sulfonylurea or insulin have been trialled with inadequate response; and
- A sodium-glucose co-transporter-2 (SGLT2) inhibitor has been trialled and discontinued due a contraindication or intolerance or due to not achieving a clinically meaningful response; and
- The patient is not concurrently being treated with a PBS-subsidised SGLT2 inhibitor, dipeptidyl peptidase-4 (DPP4) inhibitor or another GLP-1 RA for their T2DM
For subsequent semaglutide PBS prescriptions, the patient must not be concurrently treated for T2DM with a PBS-subsidised SGLT2 inhibitor, DPP4 inhibitor or another GLP-1 RA.
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