The GLP-1 RA boom: Trends in publicly subsidised and private access in Australia, 2020-2025

ObjectivesTo quantify population-level trends in publicly subsidised and private access of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in Australia. DesignLongitudinal descriptive study using routinely collected data. SettingNational pharmaceutical sales and Pharmaceutical Benefits Scheme (PBS) dispensing claims for GLP-1 RA listed for type 2 diabetes (T2D), May 2020-April 2025. Main outcome measuresWe measured GLP-1 RA use according to the total number of units sold/dispensed and defined daily dose (DDD)/1000 population/day. We used sales data to quantify total population use, and PBS dispensings to quantify subsidised access. We estimated private access as the difference between total sales and PBS dispensings. ResultsSince May 2020, total sales of GLP-1 RA in Australia increased almost 10-fold, reaching approximately half a million units sold each month in 2024/25, despite significant disruptions to access during shortages. Most growth was in private access, driven initially by semaglutide then rapid uptake of tirzepatide following its market approval. In the year May 2024-April 2025, over 6 million units of GLP-1 RA were sold, predominantly semaglutide (63.3%) and tirzepatide (30.7%); 47.8% of all GLP-1 RA were accessed via the private market, including 26.9% of semaglutide and all tirzepatide. In this period, GLP-1 RA use was estimated to cover 18 out of every 1000 Australians at a standard daily maintenance dose, with 6 out of every 1000 accessing these medicines privately. ConclusionsAustralian sales of GLP-1 RAs increased dramatically over the past five years. Half of GLP-1 RA in 2024/25 were accessed in the private market, with an estimated 180,018 to 239,724 Australians accessing GLP-1 RAs privately each month. Our findings underscore the substantial pressures on health systems in meeting the growing demand for these medicines, including rapidly shifting markets, significant demands outside of subsided care, and the need to ensure equitable access and outcomes of use. Summary boxO_ST_ABSWhat is already known on the topicC_ST_ABSNovel GLP-1 RA medicines have significant cardio-renal benefits, including weight loss for people with type 2 diabetes and obesity. There is strong consumer demand for health systems to subsidise these treatments for obesity, yet subsidised access in high-income countries has generally been limited to people with type 2 diabetes. The extent of private market use is largely unknown. What this study addsAlmost half of GLP-1 RA medicines indicated for type 2 diabetes in Australia are accessed on the private market, most likely for weight loss. There were rapidly shifting trends within subsidised and private markets, with disruptions from global shortages and listing of new medicines. Our findings quantify the potential scope of expanding indications and highlight health system challenges for managing equitable use outside of subsidised healthcare.