Ozempic mills ‘challenging’, say private insurers

3 minute read

But diabetes management has bigger problems, an inquiry has heard, such as the ‘exorbitant’ cost of insulin pumps.

Private health insurers are finding pop-up telehealth outfits offering packaged weight-loss services “a little challenging”, says the sector’s peak body. 

Speaking at the federal inquiry into diabetes in Australia last week, Ben Harris, Private Healthcare Australia’s director of policy and research, said services such as Eucalyptus-owned Juniper and Pilot were providing a model it “did not wish to support”.  

When asked about the relationship PHA had with telehealth companies promoting packaged services for weight loss, including weight-loss drugs like Ozempic, Mr Harris told committee members the organisation did not support models of care focusing on one specific weight-loss intervention. 

“We are finding it a little challenging with all sorts of pop-ups at the moment offering bits and pieces,” Mr Harris said. 

“Where it’s a genuine wraparound service, then the health fund and the provider need [a] contract to fund that through a chronic disease management program, rather than the stuff we are seeing at the moment.  

“[But] it’s an emerging space. 

“The idea of a telehealth provider who does one thing – people self-select to get sent a drug in the mail – that is not a model that we wish to support at this stage.” 

Earlier, the inquiry was told insurers were limited in their capacity to offer services targeting chronic disease management as a result of prohibitive restrictions on the range of health professionals eligible to provide those services.  

“Funds are trying to do more to help people achieve a healthy weight and reduce weight if they’re at high risk of diabetes or already have diabetes, but there are limits on what funds can offer under the current regulations,” Mr Harris said. 

“We want health plans to be able to deliver a wider range of services to their members under the existing chronic disease management plans. 

“The current defined list of eligible health professionals was written in 2007. It’s out of step with best practice and exacerbating a shortage of healthcare options caused by Australia’s health workforce shortage. 

“The Private Health Insurance Act also currently restricts what insurers can find and provide for their members, including improving hospital substitution options, where treatment and monitoring can be provided safely and more cost effectively at home instead of in hospital.” 

Mr Harris said the federal government urgently needed to address the unnecessarily high market costs for insulin pumps, with Australians paying more than twice the amount as New Zealanders for the same device, due to the government’s prohibitive medical device funding system. 

“Despite private health insurance being one of the largest collective buyers of these devices, we are currently paying exorbitant prices for insulin pumps due to the Australian Government’s prescribed list for medical devices,” he said. 

“One of the most common pumps in Australia, the t:slim X2 insulin pump with basal IQ technology, costs Australians A$8574. The same device costs NZ$4500 for people in New Zealand, less than half the price. 

“There is no mechanism for prices to come down other than a quite a complex review system. And there is a long and detailed list of things on the prescribed list which are well overpriced compared to international benchmarks. 

“Insulin pump therapy can be life-changing for people with diabetes, and we need to stop health fund members overpaying for this essential technology.” 

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