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Health insurers respond to Ozempic’s popularity  

By Trudie McConnochie Reviewed and updated 24 June 2024

One private health insurer has reduced its cover for Ozempic amid a surge of popularity for the weight-loss drug. 

Last month, HBF, the largest health insurer in Western Australia, announced it was reducing rebates for Ozempic, saying the rise in claims had become unsustainable. So far, no other insurers have changed their position on the drug. 

The injectable drug, known generically as semaglutide, is subsidised on the Pharmaceutical Benefits Scheme (PBS) for people with diabetes but not if it is prescribed for weight loss. However health insurance rebates are available to people holding higher-level Extras Cover policies that include the Non-PBS Pharmaceuticals category. 

Private Healthcare Australia CEO Dr Rachel David said health insurers were investigating evidence-based ways to support the weight loss journeys of their customers over the long term. 

“Appropriate wraparound services can help with behavioural change that lasts even when people stop taking the medicines,” she told healthslips.com.au. “This could include services to help people with the psychology of overeating, support with meal planning and preparation, and assistance to exercise in a safe, sustainable way to build muscle and strength. 

“Ideally as the evidence improves, insurers will be able to offer these programs as a hospital substitution service to prevent or improve the outcomes of surgery, and to prevent diabetes. This is ultimately preferable to just passively funding the drug under Extras Cover.” 

Ozempic had the potential to significantly improve health outcomes for Australians, Dr David said.  

“But it’s not a quick fix,” she added. “We need to look at this comprehensively and make sure we have the right type of support for the right people at the right time.” 

Trudie McConnochie
Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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