On 1 June 2024, changes were made to the PBS restrictions for several type 2 diabetes medicines. These changes include authority requirements and restrictions for GLP-1 RAs, including semaglutide, and were based on a PBAC review and consultation with stakeholders, including relevant consumer and prescriber groups.
Changes to PBS authority and restrictions for GLP-1 RAs
Starting GLP-1 RA therapy now requires approval via phone or electronic means, rather than streamlined authority. Continued access is via streamlined authority. To receive PBS-subsidised GLP-1 RA therapy, a consumer must be contraindicated, intolerant, or must not have achieved a clinically meaningful glycaemic response (determined by the prescriber) to SGLT2 inhibitors.
GLP-1 RAs are subsidised only when used with metformin, sulfonylurea, or insulin. GLP-1 RAs are not subsidised when used with DPP4 inhibitors or with SGLT2 inhibitors, except if an SGLT2 inhibitor is prescribed for another condition (e.g., heart failure or kidney disease) and the consumer did not achieve a clinically meaningful glycaemic response to the SGLT2 inhibitor.
Consumers previously prescribed GLP-1 RAs under the PBS can continue access via the streamlined listing without requalifying. Before 1 June 2024, PBS restrictions required consumers to be contraindicated or intolerant to a combination of metformin and sulfonylurea to use GLP-1 RAs.
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