Insurers split on Ozempic rebate as drug shortages hit Australia

Insurers split on Ozempic rebate as drug shortages hit Australia | Insurance Business Australia

Life & Health

Insurers split on Ozempic rebate as drug shortages hit Australia

HBF cuts back while other insurers uphold support

Life & Health

By
Mav Rodriguez

As demand for the diabetes and weight loss medication Ozempic surges globally, Australia’s leading private health insurers are adjusting their rebate strategies.

The decisions come at a time when Ozempic faces nationwide shortages due to its growing popularity as a weight management solution. Western Australia’s top insurer, HBF, has announced significant cuts to its rebates for Ozempic, citing an unsustainable rise in claims related to the drug, which is also popular for its weight loss benefits.

While HBF has decided to reduce coverage, other prominent Australian insurers remain committed to subsidizing the medication. Companies like Bupa, Medibank, and NIB continue to support access to Ozempic under specific insurance plans.

The disparity in coverage policies underscores a broader debate among insurers about the role of such medications in preventive healthcare. HBF’s move to slash benefits for weight loss drugs like Wegovy and Saxenda—both containing the active ingredient semaglutide—has marked a stark contrast to the approach of other insurers.

HBF also revealed that weight loss medication accounted for 40% of off-schedule pharmaceutical claims since 2021, although only 3% of its customers are prescribed these drugs.

On the other hand, insurers like NIB are focusing on the long-term benefits of preventing obesity-related health issues. NIB’s chief medical officer Rob McGrath emphasized the importance of supporting access to life-changing medications.

“We believe we can improve that health and wellbeing by supporting access to life-changing medications, [such] as Ozempic,” McGrath said, adding that claims by NIB policyholders have increased 35% annually since 2019.

In addition, the Therapeutic Goods Administration (TGA) is planning to ban compounding pharmacists from producing their versions of injectable weight loss drugs, citing safety and efficacy concerns. This regulatory shift is likely to influence how medications like Ozempic are used and covered.