GLP-1 scripts doubled despite PBS restrictions — PBAC to review

What just happened

The Pharmaceutical Benefits Advisory Committee will scrutinise GLP-1 prescribing patterns at its upcoming meeting, following new data showing semaglutide (Ozempic) prescriptions more than doubled in a single year — despite the explicit intent of prior authority tightening introduced in June 2024.

The numbers are striking. PBS semaglutide scripts rose from 1,158,378 in the June 2024–May 2025 period to 2,332,440 in the subsequent 12 months. That is a compound doubling on a prescription base that was already substantial. RACGP NewsGP reported this week that the PBAC referral is a direct response to prescribing volumes that have exceeded the expected impact of the authority restrictions.

Two GLP-1 receptor agonists are currently PBS-listed for type 2 diabetes management: dulaglutide (Trulicity, June 2018) and semaglutide (Ozempic, July 2020). The authority criteria are intended to restrict PBS-subsidised access to patients with confirmed type 2 diabetes meeting defined clinical thresholds — not to people seeking GLP-1 agents for weight loss without a diabetes diagnosis.

---

Both-and

Why prescriptions doubled despite the restrictions

There are several readings of this data, and they are not mutually exclusive.

The most straightforward: the evidence base for GLP-1 receptor agonists in type 2 diabetes has strengthened substantially since 2020. Cardiorenal protection data — including the SUSTAIN, LEADER, and REWIND trials — has made GLP-1 agents a reasonable early add-on therapy for people with established cardiovascular disease or high cardiovascular risk who have type 2 diabetes. More GPs reaching for these agents early in the treatment pathway, for appropriate patients, would produce exactly this prescription growth.

A second reading: the weight-loss effect of semaglutide generates significant patient demand from people who do not have a diabetes diagnosis but want access to PBS pricing for what is, at private-prescription prices, an expensive medication. Whether that demand has found its way into PBS scripts through diagnostic characterisation that stretches existing criteria is precisely what the PBAC review will seek to understand.

A third reading, offered by Dr Gary Deed, Chair of RACGP Specific Interests in Diabetes: other drug classes with comparable or stronger evidence for specific outcomes are being underused relative to GLP-1 agents. SGLT2 inhibitors — empagliflozin, dapagliflozin — have strong evidence for renal protection and heart failure outcomes that GLP-1 agents do not uniformly replicate. The enthusiasm for GLP-1 agents, shaped partly by their visible and rapid weight-loss effect, may be displacing appropriate consideration of agents whose evidence profile is at least as strong for specific diabetes-related endpoints.

The authority system tension

The RACGP has consistently argued that the PBS Authorities system creates administrative burden without proportionate clinical benefit. “The PBS Authorities system is onerous. It is a complex administrative process that takes time away from GPs delivering care to patients,” the college stated publicly in 2024. That position reflects a genuine tension: the authority system is the mechanism that is supposed to constrain prescribing to approved indications, but doing so imposes real costs on GP time that are difficult to absorb in a standard consultation.

If the PBAC’s review finds that the authority criteria are not effectively limiting prescribing to intended populations, the response may include tightening documentation requirements, narrowing eligibility criteria, or introducing complex authority criteria requiring specialist co-sign. Each option has different implications for GP workflow and patient access.

The safety layer

This prescribing story arrives alongside the TGA’s recent class-wide safety update for GLP-1 receptor agonists, which added non-arteritic anterior ischaemic optic neuropathy (NAION) as a potential rare adverse effect — estimated at 2–18 additional cases per 100,000 users annually. Access scrutiny and safety counselling are arriving simultaneously for these agents.

Patients currently on GLP-1 agents should be aware of both developments: their access pathway under PBS criteria may be reviewed, and they should report any sudden vision changes to their GP or an ophthalmologist without delay.

---

My two cents

The doubling of semaglutide prescriptions in one year against relatively stable diabetes incidence is either a sign of guideline-concordant evidence translation into practice — which would be a positive development — or a sign that the authority criteria are being applied more broadly than intended — which is what the PBAC is going to investigate.

Dr Gary Deed’s advice for GPs is worth restating: reinforce lifestyle and dietary counselling, consider the full range of PBS-eligible agents for type 2 diabetes rather than defaulting to GLP-1, and seek input from a credentialled diabetes educator for complex cases.

For prescribers: documenting clinical eligibility clearly now is better than doing it retrospectively. For patients: if your GP is prescribing semaglutide for type 2 diabetes within current PBS authority criteria, your access is not at immediate risk. If you are on a private prescription for weight management, the PBAC review does not change your situation today. This is a watch-this-space story — the review is underway, and no decision has been made.

Verdict: maybe — PBAC review signals scrutiny of a PBS semaglutide prescribing surge; outcome will determine whether access pathways change.

---

Sources cited

1. Attwooll J. PBAC to assess tougher GLP-1 prescribing restrictions. RACGP NewsGP, 27 July 2026. https://www1.racgp.org.au/newsgp/professional/pbac-to-assess-tougher-glp-1-prescribing-restricti