People in England with a high body weight can now access subsidised weight-loss medications, including Wegovy (the weight-loss version of Ozempic, or semaglutide) and Mounjaro (a brand name for tirzepatide). These drugs, known as GLP-1 agonists, are designed to help individuals struggling with obesity or overweight conditions who have been unable to lose weight through other methods.
In Australia, the government already subsidises semaglutide (Ozempic) for people with diabetes. However, it has yet to approve subsidies for semaglutide (Wegovy) under the Pharmaceutical Benefits Scheme (PBS) for weight loss. This is despite Australia’s regulatory body approving GLP-1 agonists for obesity treatment and for overweight individuals with at least one weight-related condition. As a result, Australians using Wegovy for weight loss must pay around A$450–500 per month out of pocket.
Could Australia follow England’s lead and list drugs like Wegovy or Mounjaro on the PBS for weight loss? If approved, the cost could drop to 31.60(31.60perprescription(7.70 for concession card holders).
Australia Has Already Rejected Wegovy for Subsidies
The Pharmaceutical Benefits Advisory Committee (PBAC) evaluates submissions from pharmaceutical companies seeking to have their drugs subsidised through the PBS. For each decision, PBAC publishes a summary of the evidence and its reasoning.
In November 2023, PBAC reviewed a submission from Novo Nordisk, the maker of Wegovy. The company proposed subsidising semaglutide for adults with a BMI of 40 or higher and at least two weight-related conditions, such as obstructive sleep apnoea, osteoarthritis of the knee, or pre-diabetes. However, PBAC rejected the proposal, citing concerns about the drug’s cost-effectiveness at the proposed price.
PBAC acknowledged evidence of long-term health benefits, such as reduced risks of heart disease, diabetes, and stroke. However, it did not factor these benefits into its cost-effectiveness calculations. The committee suggested future submissions focus on patients with pre-existing cardiovascular disease, type 2 diabetes, or at least two markers of “high cardiometabolic risk,” such as high blood pressure, high cholesterol, chronic kidney disease, fatty liver disease, or pre-diabetes.
What Did England Decide?
In England, the National Institute for Health and Care Excellence (NICE) plays a similar role to PBAC. NICE recommended subsidising semaglutide for adults with a BMI of 30 or above and at least one weight-related condition. Patients must be treated by a specialist weight-management service, and prescriptions are limited to two years.
More recently, NICE approved another GLP-1 agonist, tirzepatide (Mounjaro), for adults with a BMI of 35 or above and at least one weight-related condition. Unlike semaglutide, tirzepatide prescriptions are not restricted to specialist services. However, only 220,000 of the 3.4 million eligible patients will receive the drug over the next three years. The selection process for these patients remains unclear.
NICE also recommended stopping treatment if patients lose less than 5% of their body weight after six months. These measures aim to manage the budget impact of GLP-1 agonists while gathering data for broader rollouts.
Why Did England and Australia Reach Different Decisions?
NICE assessed GLP-1 agonists for a broader population, including individuals with a BMI of 30 or above and at least one weight-related condition. In contrast, PBAC focused on a narrower group with a BMI of 40 or higher and multiple weight-related conditions.
Another key difference lies in their cost-effectiveness analyses. NICE included long-term benefits, such as reduced risks of diabetes, heart disease, stroke, knee replacement, and bariatric surgery. PBAC, however, only considered the impact on existing conditions, not future risks.
The estimated health benefits, measured in “quality-adjusted life years” (QALYs), also varied. NICE estimated a gain of 0.7 QALYs per patient for semaglutide, while PBAC estimated 0.3 QALYs for a more restricted population. These differences reflect PBAC’s more conservative approach, which may require manufacturers to lower prices for future submissions.
Time to Rethink PBAC’s Approach?
Both NICE and PBAC are cautious about the budget impact of GLP-1 agonists. PBAC’s strategy focuses on limiting access to high-risk groups and adopting a conservative stance on cost-effectiveness. This approach may pressure manufacturers to reduce prices.
However, GLP-1 agonists are not currently on the agenda for upcoming PBAC meetings. This means there is no clear timeline for when these drugs might be subsidised in Australia for weight loss.
As England moves forward with subsidising these medications, Australia faces a critical decision: will it follow suit and make weight-loss drugs more accessible to those in need? Only time will tell.
