Drug access top of the 2023 agenda for endocrinologists

Access to diabetes medications is set to be a major issue for endocrinologists in 2023, with many patients with type 2 diabetes still unable to obtain semaglutide due to ongoing supply problems.

The GLP-1 agonist’s popularity as a “Hollywood” weight loss drug has continued to explode over the new year, prompting calls for the Federal Government to step in to ensure availability for patients with T2D.

Last week, the AMA went public arguing for the government to make plans to requisition supply when a new shipment arrives in March.

“Logically, it could be approached by saying we know there are x number of people who get prescriptions for Ozempic that meet the PBS criteria and require it for medical prescriptions and then we quarantine their supply and the rest is first in first served,” its president Professor Steve Robson told reporters.

“It’s a really bizarre phenomenon that it’s been promoted as a celebrity weight loss treatment.”

“But dealing with influencers promoting this product is something we’ll all need to address – GPs, the TGA and the government.

Australian Diabetes Society president Professor Anthony Russell agreed action was necessary to address the issue.

He said at Melbourne’s Alfred Hospital, where he was director of diabetes and endocrinology, it was now a rarity for patients to be using the medication.

“I’m actually surprised when a patient says they are still on it. The access issue is real,” he said.

Professor Russell said there may be a case for a temporary TGA ban on off-label prescribing by doctors other than specialist endocrinologists.

Such a move would be rare but not unprecedented, with the agency prohibiting non-specialist doctors, as well as GPs, from prescribing hydroxychloroquine outside its registered indications during the COVID-19 pandemic.

“Ozempic 1mg is currently not indicated by the TGA for weight loss, so that would have an impact,” he said.

“I think that would be a reasonable way to ensure access for our patients with T2DM until supplies were available to cover everything,” he said.

A higher dose formulation branded Wegovy had been approved by the TGA for weight loss, but was not currently being stocked in Australia, Professor Russell added.

Looking ahead, he said the issue was likely to also effect Eli Lilly’s much-hyped antidiabetic tirzepatide (Mounjaro), which was registered in Australia just before Christmas.

Once-weekly treatment with the GLP-1–GIP receptor agonist was shown in a study published last year to significantly reduce body weight and improve important cardiometabolic measures in overweight or obese adults, with the results described as “astounding” in an NEJM editorial.

“It’s going to be a groundbreaker as well, so we need to make sure we are not in the same position, which is looking very likely” he said.

Professor Russell added: “With these drugs for weight loss, we are creating a divide in society between those who can access and afford treatment versus those who can’t.”

“This is going to be a problem and I can’t see the PBS subsidising weight-loss drugs in the near future. SO it will then fall back to public hospitals to determine whether they’re will to pay.


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