Why isn't Ozempic on Australia's Pharmaceutical Benefits Scheme for weight loss? And should it be?

The Guardian

27-01-2025

Drugs marketed to treat type 2 diabetes such as Ozempic have also been found to be effective in helping users lose weight.
Those who have taken the drugs for weight management say the constant 'food noise' disappears, resulting in improvements to mental and physical health.
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However, cost and supply issues have prompted health experts and advocates to call on governments to intervene and subsidise the drugs for obese people with health-related risk factors. In the UK, some of these drugs are available on the NHS for dangerously overweight people, who have a secondary medical condition linked to their obesity.
Here are the factors the government is taking into account.
Drugs known as GLP-1 RAs mimic the hormone that stimulates the digestive system, essentially telling the body it is full after eating. They work to suppress a person's appetite by making them feel satiated.
In Australia, three main GLP-1 RAs are available – Ozempic, Wegovy and Mounjaro.
The Danish pharmaceutical company Novo Nordisk produces Ozempic and Wegovy. They contain the same active ingredient, semaglutide, but are marketed differently – for type 2 diabetes treatment and weight-loss, respectively.
The US company Eli Lilly produces Mounjaro, which again is marketed as diabetes treatment but can also be used for off-label purposes.
All the drugs have been in short supply in Australia. The Therapeutic Goods Administration has warned that the shortages, caused by high demand and the drugs' specialised manufacturing requirements, will continue into 2025.
The drugs are also expensive.
Ozempic is approved on the Pharmaceutical Benefits Scheme – meaning the government subsidises the cost – only for diabetes treatment.
With that subsidy, a weekly dose costs $31.50.
With a private prescription – that is, for anything other than diabetes treatment – the price could range between $75 and $150 for the same dose.
Prices for the other GLP-1 RAs vary between pharmacies and suppliers, but are typically similar to that of Ozempic.
For a drug to be placed on the PBS, a company needs to put in a submission to the independent expert body, the Pharmaceutical Benefits Advisory Committee.
The PBAC meets three times a year and makes recommendations based on each drug or vaccine's clinical effectiveness, safety and cost-effectiveness. The committee has so far rejected two submissions from Novo Nordisk to place Wegovy on the scheme for Australians with severe obesity.
Eli Lilly has said it will make a submission this year to place Mounjaro on the PBS and explore 'all feasible pathways that might enable equitable access' to the drug.
The company's Australian and New Zealand manager, Tori Brown, said there was 'increased understanding' within the federal government about the benefits of such drugs.
The Global Obesity Observatory has estimated the economic impact of overweight and obesity in Australia at $40bn – or 1.9% of GDP. The observatory estimates the impact will increase to $252bn by 2060, or 3.5% of GDP.
Jonathan Karnon, a health economics professor at Flinders University, says the drugs could have a positive impact in reducing other health problems associated with severe obesity.
'There's a wide range of diseases that are predicted will be reduced if these weight-loss drugs are made [more] available across the population,' he says.
So far, the federal government has not revealed whether it supports taxpayers subsidising the drugs for those in need of pharmacotherapeutical support for weight management.
The health minister, Mark Butler, has said the introduction of GLP-1 RAs was going to be 'a really big challenge for authorities to deal with'.
'There's the cost. There is the number of people who are going to be taking them, [and] whether they're on the PBS or not,' the minister said on the ABC's Q&A program in October.
Tim Gill, a health nutrition professor and the chief executive of Obesity Collective, says they should be placed on the scheme but restricted to those most in need.
'We want some equity in the way healthcare is delivered,' he says.
'Obesity is a serious chronic condition, regardless of whether you consider it a disease … it results in enormous ill health.'
Terri-Lynne South, a spokesperson for the Royal Australian College of General Practitioners, says the drugs should not be seen as the simple solution to improving obesity outcomes.
South says people should aim for a 'comprehensive and holistic healthcare plan' for weight-loss.
'That way, your entire long-term health outlook will improve, not just your waistline,' she says.
'It's also vital that these drugs are available for patients who need them for other conditions, including diabetes.'