Should governments subsidise drugs like Ozempic for weight loss? We asked five experts

You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.

Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.

Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).

Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?

Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.

In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?

Yes, governments should subsidise drugs like Ozempic (semaglutide or Wegovy) for obesity treatment once the drug is consistently available in Australia.

Research shows treating people with obesity with 2.4 mg of semaglutide improves health. A study in people with obesity and existing heart disease found the drug lowered the risk of heart attacks, non-fatal strokes and death from heart disease over three years.

Body weight reductions are consistently 6–12% greater than placebos (dummy drugs) or alternative interventions.

A recent review of cost-effectiveness research found two studies from the United Kingdom and Canada reported semaglutide was cost-effective compared to diet and exercise alone. A study from the United States also reported it was cost-effective compared to other medications.

Along with the prescription of semaglutide, other treatment components – such as seeing a dietitian, physical activity or psychological support – should be monitored to identify which ones help improve individuals' weight-related health and well-being long term. This data should inform updates to clinical treatment guidelines and resource allocation so effective treatment is available to all those eligible.

Yes. Weight-loss drugs aren't a silver bullet. And the conversation around them is still problematic and rooted in diet culture. But they shouldn’t become yet another example of a tool just for rich people.

Subsidies could also reduce some risks. Current access for injectable weight-loss drugs is often through telehealth companies focused on consumer weight loss. They don’t necessarily provide the support needed to ensure the patient's nutritional and psychological needs are met.

Worse still, stories have emerged of black-market access through non-regulated sources.

A subsidy should make it more likely that people can make this decision with their GPs and supported by other service providers such as dietitians. Subsidies for these services should be expanded too.

Access to healthy eating and the tools to develop a healthy relationship with food should not be dependent on disposable income.

Yes, so long as the government can buy these drugs at a reasonable price.

A reasonable price reflects opportunity costs, unmet need, equity effects and budget impact.

Opportunity costs are the health benefits foregone as a result of buying weight-loss drugs rather than funding other forms of health care. To address opportunity costs, we have estimated an additional one year of life in perfect health should be generated for every $28,000 of net spending on a new drug.

New approaches to managing obesity are clearly needed, a factor that can increase the "reasonable price".

Similarly, social determinants of health are strongly associated with inequalities in obesity. And health inequity will increase if the government does not fund weight-loss drugs.

The estimated cost to the Commonwealth government is more than $400 million per year. This is a significant impact on the health budget that reduces the "reasonable price".

When supplies are up, the government might be best negotiating a total price for access to drugs like Ozempic for weight loss, similar to the more than $1 billion price it negotiated to fund open access to new hepatitis C medicines.

No. The biggest factor in whether a drug gets onto the PBS is whether it provides a public good that is bigger than the financial cost. That is, the reduction in weight for patients from taking Wegovy results in a significant reduction in other weight-related conditions, such as reducing the chance of heart disease or having a stroke.

At the moment, Wegovy is not subsidised in the United Kingdom, New Zealand or Canada. In fact, in 2022 the Canadian government rejected an application for the subsidy of Wegovy. It concluded that even though patients treated with Wegovy lost body weight, there was no evidence to show this weight-loss translated to a reduced chance of weight-related health conditions such as heart disease or stroke, or conditions such as arthritis or sleep apnoea.

So, in the absence of new data that shows broader financial benefit, and the current availability of other drugs for weight related diseases that are already on the PBS, at this time I wouldn’t support subsidisation.

Yes. We must not conflate celebrities' and influencers' well-publicised misuse of these medications for quick weight loss with their clinical use to improve health.

Obesity is a complex, chronic disease that can seriously impair health and wellbeing.

Several effective, evidence-based medications are approved, and recommended in Australian (and international) guidelines, for obesity management.

But, since none are listed on the PBS, only people who can afford to pay hundreds of dollars per month can use them.

Making access to these medications more equitable via PBS listing will not be simple. Their high cost is a major barrier because of the large number of people who are eligible to be prescribed them (more than one-third of Australian adults, although not all will want or need medications).

Finding a fair, sustainable solution will require prioritisation and compromise from pharmaceutical companies, regulators, prescribers and patients.

This article was originally published on The Conversation as: When supplies resume, should governments subsidise drugs like Ozempic for weight loss? We asked 5 experts. It was written by Associate Professor Nial Wheate, from the Sydney School of Pharmacy; Professor Clare Collins and Dr Emma Beckett, from the University of Newcastle; Professor Jonathan Karnon from Flinders University, and Associate Professor Priya Sumithran from Monash University.