Ozempic is forcing Australia's major private health insurers to rethink their rebates

ABC NEWS (Australia)

Private health insurers have entered the debate over using diabetes drugs for weight loss, with some removing rebates for the medications from their policies. It's left some people struggling with obesity-related health issues caught in the middle.

Transcript

00:00 Mitchell Peters falls into a grey area.

00:04 He's not a diabetic, but uses the drug Ozempic daily.

00:07 He thinks it's saved his life.

00:10 My liver functions improved, my cholesterol's gone right down to a point where it's not

00:14 a concern anymore.

00:16 My blood pressure was kind of sitting in that hypertension range.

00:19 The use of Ozempic, developed to help people with diabetes, exploded as a weight loss drug

00:24 in 2021.

00:26 Mr Peters' doctor prescribed it to him to prevent obesity-related health problems.

00:30 She was concerned about my overall health, my weight.

00:32 I was sitting in the obese category.

00:34 But because he's not a diabetic, he has to rely on his private health insurance.

00:39 He can't access rebates under the pharmaceutical benefits scheme.

00:42 Private health insurer, HBF, has limited or removed rebates for medications containing

00:48 semaglutide.

00:49 It says 40% of off-schedule pharmaceutical claims since 2021 were for the weight loss

00:54 medication prescribed to just 3% of policyholders.

00:58 But some of the bigger private insurers like Bupa, Medibank and NIB are taking a different

01:03 approach, either keeping rebates the same or making them accessible under certain coverage

01:08 plans.

01:09 NIB believes health insurers can play a crucial role in preventative treatment.

01:14 Medications are changing the way that we think about diabetes and weight management, but

01:18 also cardiovascular risk management.

01:21 There's also a lot of emerging evidence for application in other health areas, so we're

01:25 watching that with great promise.

01:27 Mr Peters hopes Ozempic will become more widely available, offering early intervention for

01:32 potentially fatal health issues.

01:34 (laughs)

01:36 [BLANK_AUDIO]

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