GLP-1 RA rules tighten

Rachel Fieldhouse DOCTORS prescribing GLP-1 receptor agonists now require phone or electronic authority when initiating therapy for any PBS indications .

On 1 June , health officials tightened the rules for semaglutide ( Ozempic ) and dulaglutide ( Trulicity ) to crack down on prescribing outside of the PBS rules while also removing restrictions for other type 2 diabetes ( T2DM ) drugs .

The listing for GLP-1 receptor agonists ( RAs ) was changed to authority required for new patients , with streamlined authority only for continuing treatment .

Subsidised access to GLP-1 RAs was also restricted to patients who were contraindicated , intolerant or did not have a “ clinically meaningful glycaemic response ” to SGLT-2 inhibitors — and only in combination with metformin , a sulfonylurea or insulin .

Combination with an SGLT-2 inhibitor was only allowed in cases where the gliflozin was indicated for another condition — such as heart failure or kidney disease — and the patient had suboptimal glycaemic control .

However , AMA vice-president and GP Dr Danielle McMullen told Australian Doctor that these new requirements would add to the administrative burden for doctors .

“ We know that phone and online authorities are not the preferred option for prescribers , but at least , for this one , it is just for the initial prescribing of GLP-1 RAs ,” she said .

Tasmanian GP Associate Professor Gary Kilov , who has a special interest in diabetes , added that the changes were “ regrettable , if understandable ”.

“ I would have hoped for a broadening of subsidies to include an

SGLT-2 inhibitor plus weekly injectables rather than the tightening of restrictions and reduction of access ,” he told Australian Doctor .

“ Increasingly , patients will have to self-fund one or more medications to achieve optimal guideline-recommended therapy .”

In other PBS changes , DPP-4 inhibitors can now be used in combination with insulin or SGLT-2 inhibitors , while the pioglitazone

‘ Increasingly , patients will have to selffund one or more medications .’

— Associate Professor Gary Kilov

Scott Gelston © The Examiner / ACM listing has been changed to restricted benefit for T2DM without any clinical criteria .

DPP-4 and SGLT-2 inhibitors are also subsidised for quadruple therapy in combination with each other , plus metformin and insulin .

The PBAC proposed stricter access to GLP-1 RAs following its March and July 2023 meetings , based on a review of PBS criteria for T2DM medications .

Neurologist will repay $ 1.5m : PSR

Antony Scholefield A NEUROLOGIST must repay $ 1.5 million in Medicare rebates after the Professional Services Review found he had altered EEG referrals to claim higher rebates and inaccurately reported nerve conduction tests .

The watchdog said he had routinely claimed MBS item 11003 for an EEG of at least three hours , with a schedule fee of $ 358 , without clinical indication or after failing to complete the procedure in a “ clinically appropriate way ”.

“ In some instances , a standard EEG was requested and the referral was amended to a prolonged EEG on what appeared to be a financial , rather than a clinical , basis ,” it said in its latest update .

It also found that the doctor had repeatedly billed a $ 247 MBS item for nerve conduction studies without adequately supervising the technicians . In addition , there were claims for the specialist consultation item 110 ($ 169 schedule fee ) without having documented a history , examination results or recommendations .

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Australian Doctor 14th June Issue | Page 2

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