PBAC to assess tougher GLP-1 prescribing restrictions

The impact of GLP-1s for treating type 2 diabetes will come under the microscope at the next Pharmaceutical Benefits Advisory Committee (PBAC) meeting, including whether tightened restrictions introduced in June 2024 have worked.
 
The agenda for its November meeting shows plans to ‘review the use of GLP-1 medicines for type 2 diabetes, including assessing whether the restriction changes have been effective in limiting GLP-1 use to the recommended population’.
 
There are two GLP-1 medications currently listed on the Pharmaceutical Benefits Scheme (PBS) for type 2 diabetes treatment alone: dulaglutide (sold as Trulicity) and semaglutide (sold as Ozempic), which were first listed in June 2018 and July 2020 respectively.
 
Type 2 diabetes patients are eligible to receive the treatments on the PBS if they are ‘contraindicated, intolerant or did not achieve a clinically meaningful glycaemic response to [sodium-glucose co-transporter 2 inhibitors] SGLT2i’.
 
Following a rise in prescriptions, tighter prescribing arrangements came into force in June 2024, after the PBAC recommended upgrading the authority type for GLP-1s to ‘Authority Required (telephone/electronic)’.
 
The change, which the RACGP opposed at the time, means GPs need to contact Services Australia or the Department of Veterans’ Affairs before starting new prescriptions.
 
‘The PBS Authorities system is onerous,’ the college said ahead of the reforms.
 
‘It is a complex administrative process that takes time away from GPs delivering care to patients.’

However, the level of PBS prescribing for GLP-1s to treat type 2 diabetes has increased since, with the most widely prescribed treatment rising by more than 100% in the most recent 12 months for which data is available.
 
The 1.34 mg/mL injection Ozempic medication rose from 1,158,378 prescriptions on the PBS and Repatriation Schedule of Pharmaceutical Benefits from June 2024 to May 2025 to 2,332,440 over the following year.
 
For Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, it is ‘imperative’ GPs choose medications that are individualised to treat each patient’s type 2 diabetes.
 
‘There is emergent evidence to support the clinical utility of GLP-1 in managing diabetes, but noting there are other classes of oral agents that work in reducing risks and complications such as SGLT2i,’ he told newsGP.
 
‘There are guidelines that support the combination of GLP-1 and other classes such as SGLT2i, but the cost of these combinations is the basis of the PBAC review.’
 
He said the closer scrutiny is due to the significant number of people with type 2 diabetes which ‘means there are large costs when utilising these expensive combinations’.
 
He also noted the potential for ‘newer agents’ to come onto the market for diabetes treatment and that technology, including continuous glucose monitors, ‘is being heavily advocated for’. 
 
Dr Deed said he expects the PBAC review will give ‘a helicopter view’ on where costs are shifting and how diabetes can be managed better economically.
 
He also advised GPs to adhere to current PBAC advice when prescribing PBS-funded diabetes treatments.
 
‘Reinforce lifestyle and dietary advice and seek advice from allied health like a credentialled diabetes educator to optimise your patients’ diabetes treatment,’ he said.
 
Currently GLP-1s are not subsidised through the PBS for weight loss, although the PBAC last year recommended a PBS listing for semaglutide (sold as Wegovy) as an obesity treatment for eligible patients with cardiovascular disease.
 
No listing is yet in place.
 
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