Pharmacy Daily | Equity challenges in obesity

THE use of glucagonlike peptide1 receptor agonists (GLP1 RAs) for the treatment of obesity has the potential to impact onethird of Australians, with implications for funding and models of care to ensure equitable access, wrote experts in the Medical Journal of Australia.

At the moment, only Wegovy (semaglutide) and Saxenda (liraglutide) are currently indicated for treating obesity, with Ozempic (semaglutide) used off label.

None are listed on the PBS for obesity, and multiple applications for listing from the manufacturers have been knocked back based on cost considerations and unknown long-term cost effectiveness.

"The Australian health system is an important test bed for how to strike a balance between addressing obesityrelated health concerns, while maintaining the financial sustainability of health care systems given the uncertain health economics of GLP1 RAs for obesity," wrote the authors.

"This represents a timely case study on how we design, develop and implement new models of health care service delivery to meet the changing care needs of the Australian population."

Obesity disproportionately affects people from low socioeconomic status groups, with 38% of those living in the lowest socioeconomic status areas affected, compared with 25% in the highest.

The medications are expensive, and may increase health inequity, the authors noted.

Bariatric surgery, an effective treatment for obesity, largely occurs in the private system, again disadvantaging those without means.

Long cost horizons have led to some health insurers in the US abandoning GLP-1RAs for obesity.

However, the authors suggested, "if funded by insurers, GLP1 RAs could provide an avenue for patients to engage in holistic wraparound weight management services rather than surgical options", adding that it should be offered as a hospital substitution option for selected high risk patients, rather than under "extras" (general treatment) cover.

If funded by the PBS, duration of subsidisation would be an issue, with overseas models generally limiting treatment to two years.

The authors also considered who should prescribe the medicines, with primary carers preferred over telehealth or specialists routes, offering continuity of care and supervision of its positive and potentially negative health effects.

Workforce education is critical, with community pharmacists having an integral role in educating patients about delivery and titration of GLP1 RAs, they said.

You can read the full paper HERE.