RACGP backs GLP-1 review but warns against added red tape

The RACGP has backed a review of prescribing patterns for GLP-1 medicines, as authorities investigate whether restriction changes have been effective in limiting use to the recommended population.
 
At its November meeting, the Pharmaceutical Benefits Advisory Committee (PBAC) will review the use of GLP-1 medicines for type 2 diabetes, including assessing whether the 1 June 2024 restriction changes have been effective in limiting GLP-1 use.
 
Following a rise in prescriptions, tighter restrictions were introduced in June 2024, including upgrading the Authority Required listing for initiating PBS prescriptions for GLP-1s from ‘streamlined’ to ‘phone/electronic’, in a bid to ensure GPs are prescribing within approved criteria. Continuing treatment remained available under Authority Required (streamlined).

Writing to the PBAC as part of its consultation, RACGP President Dr Michael Wright said the college supports the review of prescribing and use patterns for GLP-1 medicines.
 
‘Consideration of how these medicines are being used in practice, and whether current PBS settings are achieving their intended purpose without creating unnecessary barriers to appropriate patient care, is important,’ he wrote.
 
Dr Wright added that there is also a need to explore use in the context of broader shifts in diabetes management.
 
‘These are very effective medications, but they can have serious side effects, so it is important that we monitor access to them. And we do need to make sure that they’re available for people who need them the most,’ he told newsGP.
 
‘However, we have to look at the costs of not just these medications, but the broader cost of diabetes care, because we’ve only got limited health budgets, so we do need to make sure that we’re getting value for money with these drugs, as they are very expensive.
 
‘We really want these medications to be available equitably, so we’ve just got to make sure that they’re providing value for money with every expansion.’
 
The process also needs to be practical for GPs, Dr Wright added.
 
‘When they do expand, we need to make sure that it’s as easy as possible for GPs to get them to the patients who need them,’ he said.
 
‘The streamlined authority process works very effectively, and we just need to make sure we don’t do anything that might place an additional burden, where we have to use telephone authorities or online approvals, which have proven really clunky and distract us from providing the care our patients need.’
 
The college submission emphasises that PBS restrictions for type 2 diabetes medicines should be ‘clear, clinically appropriate and practical to implement within general practice’.
 
‘Prescribing decisions should be individualised to each patient, guided by individual clinical need, patient circumstances, and current evidence-based guidance.
 
‘While there is evidence supporting the clinical utility of GLP-1 medicines, other classes of oral agents, such as sodium-glucose co-transporter 2 (SGLT2) inhibitors, also play a role in reducing diabetes-related risks and complications, and guidelines support the use of GLP-1 and SGLT2 inhibitor combinations.
 
‘Therefore, the RACGP recommends this review includes a broader look at where costs are shifting within diabetes management and, considers how type 2 diabetes can be managed more sustainably from an economic perspective.’
 
The college also reiterated its previous view that this PBS listing be Authority Required (streamlined).
 
‘Authority arrangements that require additional telephone or online approval processes impose significant time costs on general practitioners and patients, reducing time available for clinical care,’ Dr Wright wrote.
 
‘When reviewing restriction settings, the RACGP encourages the PBAC to consider both the policy objectives of the restrictions and the practical impact of administering those requirements in primary care.
 
‘While streamlined authority arrangements have less of an administrative burden compared with telephone or online approvals, GPs face considerable challenges choosing the appropriate indication when there are many approved indications available for a streamlined authority prescription.’
 
The RACGP submission also considers that GLP-1 medicines may be prescribed outside PBS-subsidised indications through private prescribing arrangements, including for overweight, obesity and obstructive sleep apnoea.
 
It recommends ‘consideration of the broader prescribing landscape would assist the PBAC in interpreting utilisation patterns and assessing the impact of PBS restrictions’.
 
‘Consideration of how these medicines are being used in practice, and whether current PBS settings are achieving their intended purpose without creating unnecessary barriers to appropriate patient care, is important,’ Dr Wright wrote.
 
‘The RACGP also notes the potential for newer agents and technologies, including continuous glucose monitors, to come onto the market.
 
‘Prescribing volumes and patterns have the potential to shift as these newer options become available, and therefore, current utilisation data should not be treated as a stable baseline for restriction settings.’
 
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