The Paradigm Shift in Cardiovascular Prevention
In a landmark decision released in late 2025, the Pharmaceutical Benefits Advisory Committee (PBAC) issued a positive recommendation for the subsidisation of semaglutide (Wegovy) on the Pharmaceutical Benefits Scheme (PBS). This move, endorsed by Health Minister Mark Butler in January 2026, signals a fundamental shift in regulatory policy: the recognition of weight management pharmacotherapy as a cornerstone of secondary cardiovascular prevention.
For General Practitioners, this recommendation introduces a new therapeutic avenue for high-risk patients but comes with stringent eligibility criteria designed to target those with the highest absolute cardiovascular risk while managing the Commonwealth’s fiscal exposure.
The “Triple Lock” Eligibility Criteria
Unlike the broader TGA-approved indications for weight management, the PBAC recommendation is highly restrictive. To access the subsidy, patients must meet a specific intersection of anthropometric and clinical requirements.
Based on the November 2025 outcomes, eligibility will likely require the simultaneous presence of:
- Established Cardiovascular Disease (eCVD): The patient must have a documented history of a major cardiovascular event. Primary prevention (high risk without a prior event) is currently excluded. Qualifying events typically include:
- Prior Myocardial Infarction (STEMI or NSTEMI).
- Prior Stroke (Ischaemic or Haemorrhagic).
- Symptomatic Peripheral Arterial Disease (see definition below).
- Body Mass Index (BMI) Thresholds:
- General Population: Initial BMI ≥ 35 kg/m² (Class II Obesity).
- High-Risk Ethnicities: Initial BMI ≥ 32.5 kg/m² for patients of Asian, Aboriginal, or Torres Strait Islander descent.
- Standard of Care: The therapy is intended as an adjunct to optimal medical therapy (statins, antiplatelets, antihypertensives) and lifestyle modification.
Defining “Symptomatic Peripheral Arterial Disease”
GPs should be aware that “symptomatic PAD” for PBS Authority purposes is historically defined more rigidly than in general clinical practice. Based on precedents with other cardiovascular listings (such as PCSK9 inhibitors), subjective reports of claudication or an Ankle-Brachial Index (ABI) < 0.90 alone are often insufficient for approval.
It is anticipated that the authority application will require evidence of:
- Prior revascularisation: Angioplasty, stenting, or bypass surgery; OR
- Amputation: Non-traumatic amputation due to vascular disease; OR
- Objective Imaging: Angiography or duplex ultrasound demonstrating significant stenosis (typically ≥ 50%) in a major peripheral artery alongside ischaemic symptoms.
Administrative Governance and Prescribing
The listing will be implemented under Authority Required (Telephone/Online) arrangements. This classification serves as a checkpoint to ensure prescribers verify the specific date of the qualifying CV event and the patient’s BMI before initiation.
Managing the Diabetes Interface
A critical administrative detail involves the “flow-on” changes to existing GLP-1 receptor agonist listings for Type 2 Diabetes Mellitus (T2DM). The PBAC has indicated a need to segregate the supply and authority streams. It is expected that patients will be “locked in” to a specific indication pathway.
- Patients initiating semaglutide under the T2DM listing (Ozempic) will likely continue under T2DM criteria.
- Patients initiating under the new CVD/Obesity listing (Wegovy) will be restricted to that pathway.
- Switching between indications to bypass dose caps or supply shortages will be administratively restricted.
Cost and Timeline
Following the January 1, 2026 reduction in PBS co-payments, eligible patients will pay a maximum of $25.00 per script (General) or $7.70 (Concessional).
While the Health Minister has prioritised the listing, the negotiation regarding price and the Risk Sharing Arrangement (RSA) is complex. Based on standard post-PBAC timelines, GPs might anticipate the listing to become active in the middle of 2026.
Summary
- Indication: Semaglutide (Wegovy) is recommended for PBS listing specifically for secondary prevention in patients with established cardiovascular disease.
- BMI Criteria: Restricted to BMI ≥ 35 kg/m² generally, or ≥ 32.5 kg/m² for Asian and Indigenous patients.
- Documentation: GPs should ensure discharge summaries or imaging reports confirming the CV event are coded in the patient file to facilitate Authority applications.
- Differentiation: This listing acts as a cardiovascular intervention; patients seeking cosmetic weight loss or those without prior CV events remain ineligible for the subsidy.
