If we plan it right, up to a third of Australians could be positively impacted by equitable access to GLP-1 RAs.
GLP-1 RAs, including weight-loss wonder drugs such as semaglutide, could impact the health of the 32% of Australians classified as obese, presenting a pressing need to plan for future funding strategies, systems and models of care, according to authors writing in the Medical Journal of Australia.
At this stage, only liraglutide and semaglutide are indicated for obesity in Australia.
No medications are subsidised by the PBS for obesity, while multiple PBS listing applications (Novo Nordisk in 2022 and Eli Lilly in 2023) have been rejected based on cost considerations and unknown long-term cost effectiveness.
This week the TGA has approved one pharmaceutical company’s semaglutide as an adjunct drug for patients with cardiovascular disease and high BMI without diabetes, though the drug remains to be listed for any indication on the PBS.
The MJA authors, who include Christopher Kanellis from Juno Healthcare and Dr Rachel David, CEO of private insurance peak body Private Healthcare Australia, said the high cost of GLP-1 RAs may increase health inequity “with access limited to those self-funding or those with insurance coverage”.
“Obesity disproportionately affects low socio-economic status groups in Australia with differences in obesity rates of 13% between the lowest (38%) and highest socio-economic areas (25%),” they wrote.
“Populations with lower socio-economic status are more likely to suffer from obesity-related health complications and cost taxpayers more through the public health system compared with those of higher socio-economic status.
“However, Australians of lower socio-economic status (defined by postcode) with type 2 diabetes were significantly less likely to be prescribed GLP-1 RAs.
“The way the Australian health care system funds or reimburses these agents will need to become more nuanced to include these medications in our treatment armamentarium.
“If we are to have equitable access, this may require smaller pilots in targeted populations for defined time periods, such as pre-transplant, pre-cancer treatment or pre-surgery.”
The authors suggested that if GLP-1 RAs were funded by health insurers they could provide an avenue for patients to “engage in holistic wraparound weight management services rather than surgical options”.
At the moment, 90% of bariatric surgery occurs in the private health sector with very limited access in the public sector.
“Private health insurance could fund these agents as part of preventive health care programs where funding is divested from other health subscriptions and redistributed to a larger cohort of patients at risk of weight-related conditions,” wrote Kanellis and coauthors.
“Or GLP-1 RAs could be prescribed as an alternative to bariatric surgery with access and funding reflecting the current system.”
Related
The authors suggested that telehealth digital services had potential to provide access to GLP-1 RAs, “particularly where there is a lack of health care access”, if criticisms of such services for asynchronous prescribing, perceived lack of clinical governance, potential breaches of the advertising code, and use of compounded agents could be addressed.
“Additionally, digital services may provide avenues to meet demand for medical weight loss services that cannot be met by conventional models,” wrote Kanellis and coauthors.
“There are safeguards required to restore trust in telehealth, including the TGA’s ban of compounded GLP-1 RAs from 1 October 2024.”
Kanellis and coauthors concluded that the GLP-1 RAs “should come with due consideration and planning for future funding strategies, systems and models of care … to ensure sustainable implementation for the right patients, at the right time, and with appropriate levels of clinical governance and ancillary wraparound services”.
“This represents a watershed moment in how Australian payers unravel and manage compounding barriers to health equity with weight management as a worthy case study.”