Australians pay up to $2,000 a year for Ozempic—should the PBS cover it?

In the quest for health and wellness, Australians are constantly on the lookout for effective weight loss strategies. For some, like Jen*, a Sydneysider who has long struggled with morbid obesity and food addiction, the journey has been fraught with challenges and disappointments. That is until she discovered Ozempic, a drug that seemed to miraculously quiet the ‘food noise’ in her head.

Her experience with Ozempic was transformative, likening it to flipping a switch that changed her relationship with food overnight. However, this life-altering medication comes with a hefty price tag that could set users back nearly $2,000 a year, a cost that is currently not subsidised by the Pharmaceutical Benefits Scheme (PBS) for weight loss purposes. 

Ozempic, produced by Danish pharmaceutical company Novo Nordisk, belongs to a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These drugs mimic a naturally occurring hormone that signals to the brain when the stomach is full. 

While Ozempic and its counterpart Wegovy, which contain the same active ingredient semaglutide, are marketed for type 2 diabetes treatment and weight loss respectively, only the former is approved on the PBS for diabetes treatment.

This leaves individuals, like Jen*, who are not diabetic but could greatly benefit from the drug for weight loss, facing steep out-of-pocket expenses.

The financial burden of such a treatment is not lost on Jen*, who, despite holding a healthcare card that reduces the cost of her other prescriptions to around $6.90, must fork out $150 for Ozempic. The dilemma she faces is stark: endure the physical limitations imposed by obesity or suffer financial strain to afford the medication that could improve her quality of life. It’s a choice that weighs heavily on her mental health, as she grapples with the implications of both scenarios.

Recognising the potential benefits of semaglutide-based medications for obesity management, the Royal Australian College of General Practitioners (RACGP) has called for government support to subsidise these drugs on the PBS.

In its recent position statement on obesity prevention and management, the RACGP highlights the need for increased support for clinical services and supplementary therapies to address health inequity.

Dr Terri-Lynne South, chair of RACGP’s specific interest group for obesity management, points to a growing body of research that shows semaglutide medicines not only promote weight loss but can also improve related health conditions such as cardiovascular issues, sleep apnea, and knee osteoarthritis.

However, Dr South cautions that these medications are ‘not a magic bullet.’ She says the best outcomes are achieved when patients also commit to lifestyle changes, including improved nutrition and increased physical activity. She also emphasises that any PBS subsidies should be part of a comprehensive approach to obesity management that includes lifestyle support before, during, and after medication use.

The issue of social inequity is also at the forefront of this debate. Health outcomes are often affected by socioeconomic status, and obesity is no exception. Dr South argues that those who need the medication most are often the ones who can least afford it, calling for accountability from drug companies to set fair prices.

While competition may eventually drive down costs, this relief could be years away, she said.

In December, the Therapeutic Goods Administration (TGA) approved Wegovy for use in adults with cardiovascular disease and high body mass index to reduce the risk of heart attack, stroke, or death. Despite this new indication, the approval did not affect the drug’s cost. 

For a drug to be listed on the PBS, a submission must be made to the independent expert body, the Pharmaceutical Benefits Advisory Committee, which has so far rejected two submissions from Novo Nordisk to include Wegovy in the program for Australians with severe obesity.

Dr Fiona Willer, president of Dietitians Australia, underscores the importance of comprehensive care when prescribing weight loss medication. She insists that such prescriptions must be accompanied by a referral to an accredited practising dietitian to support nutritional needs and prevent malnutrition or eating disorders that could arise from changes in appetite due to the medication.

The story of Jen* and the potential of Ozempic to revolutionise weight loss treatment highlights a critical juncture in healthcare policy. As Australians seek to manage their health and well-being, the question remains: will the government step in to make life-changing medications like Ozempic more accessible and affordable through the PBS? 

The answer could have profound implications for the physical and financial health of countless individuals across the nation.

We invite you to share your thoughts and experiences with weight loss treatments and the impact of their cost. Have you or someone you know faced similar challenges with accessing medications like Ozempic? Join the conversation in the comments section.

Also read: Australia’s PBS means consumers pay less for expensive medicines. Here’s how this system works