EXPERTS say it isn’t fair or accurate to blame people with obesity for the current shortage of semaglutide (sold as Ozempic).
The Therapeutic Goods Administration (TGA) recently advised that there will continue to be shortages of Ozempic until March 2023.
The glucagon-like peptide 1 receptor agonist (GLP1-RA) medication is supplied by pharmaceutical company Novo Nordisk. It’s approved by the TGA and subsided by the Pharmaceutical Benefits Scheme (PBS) for the treatment of type 2 diabetes when certain conditions are met.
However, it has been prescribed off-label on a private prescription to treat other conditions, including obesity.
In a statement to InSight+, the TGA wrote:
“The TGA does not have the power to regulate the clinical decisions of health professionals and is unable to prevent doctors from using their clinical judgement to prescribe Ozempic for other health conditions.”
Dr Priya Sumithran, an endocrinologist at Austin Health and Group Leader of the Obesity Research Group at the University of Melbourne, doesn’t believe that’s accurate.
“A lot of the reporting has blamed people with obesity who were using the medications for weight management. But I don’t think that’s fair or accurate. Social media is obviously important in raising awareness of certain available treatments. But ultimately, doctors are prescribing these medications to their patients, where they are considered the best treatment to improve that person’s health,” she said.
The supply ran out quicker than expected because demand is high.
“I don’t think that we can just blame TikTok for the demand. The demand is high because there’s a whole lot of people, whether they have diabetes, whether they have obesity without diabetes, that really need effective treatments. These effective treatments came on to the market and people are using them,” she explained.
Should Ozempic be prioritised for patients with diabetes?
There have been calls to prioritise access to patients with diabetes, but Dr Gary Deed, Chair of the Royal Australian College of General Practitioners (RACGP) Specific Interests Group on Diabetes, doesn’t believe one group should have priority over another.
“All patients deserve prioritising on an individual basis, and it’s a hard call to objectively place preferences over one group of patients when each may be deserving of having access to quality medicines.
“Obesity is a disease that we have paid lip service to for too long. Diabetes is a complex illness that needs careful stewardship to support patients’ quality of life and prevent complications. So, each group deserves to have equitable access,” he told InSight+.
There are PBS-supported options for people with diabetes, but those are also rapidly dwindling in supply.
The RACGP have been advised that twice daily exenatide (sold as Byetta; AstraZeneca) will also be unavailable.
The GLP1-RA Dulaglutide (sold as Trulicity; Eli Lilly), is also expected to have limited availability.
The RACGP has provided the following guidance:
- do not initiate new patients on either of these agents; and
- consider individualised approaches to people with diabetes such as the following:
- review the need for a GLP1-RA. If clinical response was limited, reconsider the need to prescribe and whether any replacement is required — switch to an alternative GLP1-RA; liraglutide is not subsidised by the PBS, is administered once daily, and has evidence of cardiovascular benefit;
- sulphonylureas or insulin (initiation or titrated doses) can also be considered, but they may lead to risks for hypoglycaemia and weight gain.
PBS-subsidised obesity options
Dr Sumithran highlighted that the popularity and effectiveness of these treatments raise the question about current therapeutic options available for people with obesity. There are only limited medications available and none of them are PBS-supported.
“Effective treatment options for obesity do need to be made available in a way that doesn’t perpetuate health inequities, and that means making effective treatments affordable for people who can’t afford to pay high out-of-pocket costs.
“The current pricing of the medications makes them inaccessible to all but a small proportion of people while they’re not subsidised by the PBS,” Dr Sumithran said.
However, as Dr Deed pointed out, economically, it would be a difficult proposition.
“Two-thirds of adult Australians are overweight or obese, an immense number. So getting a clear pathway to subsidisation may require some restricted access to some groups of people with obesity, to make the dollars balance up,” he said.
As InSight+ reported in June, the Pharmaceutical Benefits Advisory Committee considered semaglutide for obesity at its March 2022 meeting. However, it decided not to recommend the requested listing as doing so would have required “extremely high investment” with “very uncertain implications for the PBS and broader health budget,” the committee said.
Unfortunately, there are no easy answers, and with insufficient stock for both obesity and diabetes patients, there will be many months of uncertainty ahead.
“Every day, I have had to advise patients with changes to their treatment because of these shortages (and others). It adds time to choose different approaches and explain the choices and update the patients on specific aspects of risks and side effects with the changes. All of this causes distress and patient concern,” Dr Deed concluded.
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Caitlin Wright is a Sydney-based freelance journalist and 2022 Copywriter of the Year who writes for communities and organisations that care for others.
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