England subsurates drugs such as reempmic to lose weight. Can Australia take place?

People with high body weight live in England can now access subsidized slimming drugs treat their obesity. This is included in Wegova (dose of slimming ozempic or semaglutduide) and Mounjaro (one of Tirrzepatide brands).

These drugs, known as GLP-1 agonists, can Improve health people who are overweight or obese and are not able to lose weight and not stop him with other approaches.

The government in Australia subsidizes costs semaglutide (ozempic) for people with diabetes.

But also subsidizing semaglutide (Wegova) in the pharmaceutical benefits program (PBS) to lose weight.

This happens despite the Australian regulator approval of GLP-1 agonists For people with obesity and for overweight people with at least one weight associated with weight.

This leaves Australians who operate Wegovya to pay slimming About USD 450-500 from your pocket per month.

But can Australia follow the leader of England and replace drugs such as Wegova or Mounjaro on PBS to lose weight? It can bring a price until USD 31.60 (7.70 USD license).

Australia has already rejected Wegovya for a subsidy

The Advisory Committee for Pharmaceutical Benefits (PBAC) reviews the reports of the pharmaceutical company so that their medical therapies are subsidized via PBS.

In the case of each such recommendation, PBAC publishes a public document that summarizes the evidence and reasons for recommending that the medicine should be added to PBS – or not.

In November 2023, PBAC checked Notification of Novo Nordisk. He proposed, including semaglutide on PBS for adults with the initial BMI 40 or higher and a diagnosis of at least two weight -related states. At least one of these related states had to be an obstructive sleep apnea, osteoarthritis of knee joints or pre -closes.

However, PBAC stated that the semaglutide should NO be subsidized via PBS, because he did not find as profitable medicine at the proposed price.

PBAC referred to evidence for long -term benefits from weight loss in people with an increased risk of developing heart disease, diabetes or stroke. However, he did not take into account these effects in his calculations when estimating the profitability of semaglutide.

The Committee suggested that future submission can focus on patients with previously existing cardiovascular (heart), type 2 diabetes or at least two markers of “high cardiometabolic risk”. This may include hypertension (high blood pressure), high cholesterol, chronic kidney disease, liver fat or pre -stem.

What did England decide?

The National Institute for Health and Care Excellence (Nice) has a similar role to PBAC, informing about decisions about subsidizing drugs in England.

As a result Nice recommendationSemaglutide is subsidized in England for adults with at least one weight and BMI associated with 30 or more. Patients must be treated by a specialist weight management service, and prescriptions last a maximum of two years.

Recently, Nice approved another GLP-1 agonistTirrzepatid, for adults with at least one weight associated with weight and BMI 35 or higher.

This approval did not limit prescriptions for people treated in the Specialist Service Service. However, only 220,000 out of 3.4 million, which meet the eligibility criteria will receive a tiRZEPATID In the next three years. It is not clear how 220,000 patients will be selected.

The boundaries of the tirpatide will reduce the impact of GLP-1 agonists on the health budget. It is also aimed at informing wider implementation to all qualifying patients.

Both in the case of semaglutide and girls, Nice noticed that clinicians should consider stopping treatment if the patient loses less than 5% of body weight after six months of operate.

Why did they make such different decisions?

Nice assessed the operate of GLP-1 agonists for a wider population than PBAC: people with one condition associated with weight and BMI 30 or more.

Another difference was that the analysis of Nice profitability included estimates of long-term benefits of these drugs in reducing the risk of diabetes, cardiovascular disease (heart), stroke, knee exchange and bariatric surgery.

The proposed prices of GLP-1 agonists in England and Australia are not reported. We can only observe the estimated health benefits. They are represented as an additional number of “years of corrected life” (Qaly) related to the operate of drugs. One qaly is the equivalent of one extra year of life in the best -imaginable health.

Committees estimate the number of additional expenses on the health required to obtain qalys to check if it is worth the public investment. Looking at the estimates of slimming drugs committees (without a two -year maximum):

• PRETTY reported an boost of 0.7 qalys per patient receiving semaglutide for the target population with BMI of 30 or more

• PBAC reported an boost of 0.3 qalys, but for the population with BMI 40 and more.

Part of the explanation of the difference in the estimated profits of Qala is that PBAC did not take into account the reduced risk of future weight -related conditions, but an impact on existing conditions.

On the other hand, Nice referred to significant cost shifts due to the reduced conditions related to weight, in particular because some patients would avoid the development of diabetes.

Time to think about the concentration of PBAC?

Both Nice and PBAC are clearly concerned about the influence of GLP-1 agonists on the health budget.

PBAC tries to limit access to a narrow pool of people with the greatest risk. It is also more conservative than nice to estimate the expected benefits of GLP-1 agonists. This would require producers to lower the price to make PBAC consider these drugs.

Perhaps this approach will work, and the Australian government will pay less for these drugs when it considers public financing next time.

However, GLP-1 agonists are not in the agenda of the upcoming PBAC meetings, so there is no schedule when GLP-1 agonists can be financed in Australia due to weight loss.

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