The weight of the wait: GLP-1 boom hits PBS roadblock

More than one million Australians have been dispensed a GLP-1 receptor agonist over the past five years, accelerating the emergence of an exclusively private obesity-treatment ecosystem as bariatric surgery has declined significantly. Yet efforts to secure subsidised access to Novo Nordisk’s Wegovy through the Pharmaceutical Benefits Scheme (PBS) remain stalled, with price negotiations between the government and the pharmaceutical company deadlocked over cost and patient-cap volumes.

The impasse comes as obesity has overtaken tobacco as Australia’s leading modifiable risk factor, accounting for 8.3% of the nation’s total disease burden and imposing an estimated $45 billion annual economic cost through healthcare expenditure and lost productivity.

Federal Health Minister Mark Butler said the Department of Health has been working with Novo Nordisk to reach an agreement on a PBS price, but negotiations had yet to produce an outcome. He also acknowledged the broader pricing pressures affecting the global medicines market, linking them to the Most Favoured Nation (MFN) pricing policies taken by the US administration.

“This new class of drugs must be put onto the PBS. There are too many benefits for too many Australians to have it available only to those who are able to find $5000 or $6000 a year for it,” said Minister Butler. “There’s hard work ahead of us, but I’ve made my position clear on behalf of the government and on behalf of Australians that this drug must be on the PBS at some point.”

While the pricing negotiations pertain to the weekly injectable formulation of Wegovy, Novo Nordisk’s oral formulation is expected to be approved by the Therapeutic Goods Administration (TGA) early next year.

The commercial landscape has also shifted beyond weight loss alone.

Novo Nordisk and Eli Lilly are competing on comorbidity platforms as well as weight loss, with Wegovy becoming the first approved GLP-1 receptor agonist for metabolic dysfunction-associated steatohepatitis (MASH), while Mounjaro became the first approved for obstructive sleep apnoea.

An IQVIA analysis of healthcare professional verbatims from more than 2,000 interactions found that Wegovy sales representatives placed greater emphasis on cardiovascular benefits, while Mounjaro representatives focused more heavily on efficacy and comparisons with Wegovy. The positioning likely reflects findings from the SURMOUNT-5 head-to-head trial, with obstructive sleep apnoea emerging as a further point of differentiation for Mounjaro.

The competitive pressure is expected to intensify as a rapidly expanding R&D pipeline introduces therapies with increasingly differentiated mechanisms, formulations and dosing schedules.

Boehringer Ingelheim has already challenged the Novo Nordisk-Lilly duopoly, releasing topline Phase 3 obesity data for its glucagon/GLP-1 dual agonist survodutide in April 2026, with additional data expected throughout the year.

Amgen’s MariTide (maridebart cafraglutide) is anticipated to report pivotal results in early 2027. The first-in-class antibody-peptide conjugate functions as a bispecific molecule combining GLP-1 receptor agonism with GIP receptor antagonism. Its dual mechanism is designed to deliver durable weight loss and is being investigated for both obesity and type 2 diabetes. MariTide is also being developed with a dosing interval that could distinguish it from current once-weekly GLP-1 receptor agonists, ranging from once monthly to once every three months for long-term weight maintenance.

With almost 200 obesity medicines currently in development, the next phase of competition is likely to extend to comorbidity indications, formulation, dosing convenience and the ability to sustain weight management over the long term.

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