Western Australia’s largest private health insurer will cut rebates on weight loss drugs including Ozempic, saying rising claims have become unsustainable.
HBF, which dominates the health insurance market in Western Australia with 53 per cent of all policies in the state, said growth in claims for weight loss drugs had prompted it to take the decision to reduce profits.
For members who currently have drug coverage, benefits will be completely reduced for some drugs, including Wegovy and some compounded drugs.
The benefits of other medicines will be cut in half, including those containing semaglutide, the active ingredient in Ozempic.
The changes come into effect from August for HBF members undergoing existing treatments.
Popularity leads to scarcity
Ozempic, which was originally developed to help people with diabetes, has surged in popularity as a weight-loss drug since it hit the market in 2021, causing a worldwide shortage.
People taking Ozempic for weight loss are prescribed ‘off-hours’, meaning it is not used for the purposes listed on the Pharmaceutical Benefits Scheme (PBS) and cannot be accessed through the PBS rate $41 per month or $6.60 for concession card holders.
A one-month supply of Ozempic with a private prescription usually costs between $130 and $200 in Australia.
“We’ve made the decision after its increasing after-hours use to reduce the benefit we pay for this drug, based on the cost to HBF and our members and looking at the long-term trajectory for the cost. We’re incurred,” said HBF chief executive Lachlan Henderson.
“HBF pays about $9 million a year in out-of-hours pharmaceuticals and this amount has doubled since 2021.
“These [weight loss] drugs account for around 40% of this expenditure and are only prescribed for around 3% of our policyholders.”
The health benefits of the drug are recognized
However, Dr Henderson acknowledged that although they were prescribed after-hours, the weight-loss drugs had real health benefits for patients.
“I think these drugs are really good drugs, and I think we always have to calculate the cost versus the benefit for individuals and the community at large,” he said.
“As a former GP for over a decade, I saw a range of patients who tried many different ways to lose weight and we used medication as a last resort.
“As an insurer, we are very interested in the health and well-being of our members.
“We want to keep our members well and out of hospital because ultimately that also reduces our claims in the future, and we can use our members’ money to support them in other ways.”
“The cost to my health would be enormous”
For ABC Radio Perth listener Max, who has been able to take Ozempic to lose weight and claim a discount from HBF, the decision was a huge disappointment.
He described taking Ozempic and being able to lose weight as life changing.
“My BMI [body mass index] I think I was about 32 at the time,” Max told Jo Trilling on ABC Radio Perth.
“Over the course of six months I lost about 25 kilos and my BMI went from the beginning of morbidly obese to just above healthy.
“I stopped snoring, I slept better, my mental health was better.
“In general, I was living and being healthier because I had it [Ozempic]and for me it is for me private healthcare, to improve.”
He asked why a health insurer would treat weight loss differently than other available treatments such as remedial massage or dental care.
After losing 20 percent of his body weight, Max said he had recently been unable to access the drug due to supply issues and could already see the impact on his weight and appetite.
“I can slowly see things creeping up, the late night chocolate cravings are back,” she said.
Despite the lower markdowns, Max said he would still pay for Ozempic if he could access the supply.
“The cost to my health of going off this weight loss medication would be enormous,” he said.
“But I think paying a premium for a health insurance service and then not having it live up to expectations is pretty tough.”
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Image Source : www.abc.net.au