In 2025, the Pharmaceutical Benefits Advisory Committee recommended that the weight loss drug Wegovy be listed on the Pharmaceutical Benefits Scheme for a tightly defined cohort of patients with established cardiovascular disease and a BMI of 35 or more. The Federal Government has since indicated it intends to progress that recommendation.
Health Minister Mark Butler has said around 400,000 Australians are currently paying market price for GLP-1 medications, at an annual cost of $4,000 to $5,000. A PBS listing could reduce per-script costs from more than $100 to around $25.
Public debate has largely focused on affordability and access. For healthcare businesses, however, the more immediate question is how a pricing shift of this scale may reshape demand, operating models and competitive dynamics across the system.
What cheaper access could change
At current private-pay price points, GLP-1 receptor agonist therapy has largely sat within discretionary or self-funded care. A PBS listing would significantly reduce out-of-pocket costs for eligible patients, lifting enquiry volumes and altering the economics of weight loss and metabolic care.
For operators, the impact is unlikely to be limited to higher prescription volumes. Pressure will concentrate around eligibility assessment, documentation, patient education, follow-up and long-term management. Increased demand without additional funded care time risks exposing capacity gaps across primary care, allied health and specialist services.
Macintyre Health founder and director Laura Zimmerman, a nurse practitioner and credentialled diabetes educator, cautions against viewing a PBS listing as a simple prescribing opportunity.
“Wegovy’s PBS listing should not be seen as a ‘script boom’ but rather as an opportunity for an increased cardio-metabolic pathway that will require multidisciplinary care to be delivered safely and sustainably at a larger scale with intention.”
Zimmerman says demand will rise well before any prescription is written.
“Even with narrow eligibility criteria, there’ll certainly be a surge in enquiries with people wanting to know if they’re eligible, what the process is, and what their options are if they’re not eligible. Inherently, this creates a real workflow pressure – and not just in reception. The pressure will continue in clinical work by multidisciplinary teams in the assessment, documentation and follow-up, regardless of prescription.”
Telehealth and private-pay weight loss models
For telehealth providers built around private-pay prescribing, a PBS listing introduces both opportunity and disruption.
Lower medication costs may expand the overall market, but they also weaken the competitive advantage of services built primarily around access to prescriptions. As GLP-1 medications become more accessible through general practice, prescribing-led platforms may face margin pressure, higher churn or increased competition from traditional primary care.
This is likely to accelerate a divide between prescribing-led platforms and care-led models.
“Where the biggest shift sits for healthcare businesses is the wrap-around care: structured follow-up, lifestyle support, and medication optimisation, delivered in partnership with a patient’s usual GP,” Zimmerman says.
Telehealth providers with integrated multidisciplinary teams, strong care coordination and established GP partnerships may be better placed to absorb higher volumes without compromising clinician workload or service quality. Others may need to reassess pricing, service mix and retention strategies as prescribing alone becomes less differentiating.
General practice and multidisciplinary care
For general practices, a PBS listing may drive higher consultation demand, increased administrative load and more complex care coordination. At the same time, it may reduce patient leakage to external weight loss providers, allowing GPs to manage more metabolic care within existing patient relationships.
Absorbing this demand requires more than longer appointment books. Clinics operating solely on throughput-based models may struggle as enquiries increase.
“Primary care businesses will need to invest most in systems and team-based care, not just appointments. Otherwise, demand will outpace clinical capacity,” Zimmerman says.
Bariatric and weight loss surgery providers
For bariatric surgeons and surgical clinics, the impact of a PBS listing is likely to be more nuanced.
Cheaper access to pharmacotherapy may delay surgery for some patients who choose to trial medical management first. However, the tight eligibility criteria confine PBS access to a cohort that already overlaps with traditional surgical candidates.
“The new listing for Wegovy on the PBS to assist with secondary prevention is welcome,” says Dr Nicholas Cocco, a Sydney-based bariatric surgeon.
“The listing confines use to a specific group of patients who have already experienced cardiovascular disease and are obese. This population would also be appropriate candidates to consider surgical intervention.”
From a business perspective, this points to a shift in referral timing rather than referral volume. Cost is only one factor in patient decision-making.
“When patients cease a medication such as Wegovy, weight regain is universal. It is currently common for patients to seek bariatric and metabolic surgery after six to 12 months of GLP-1 use due to side effects, weight regain or cost frustration.”
Over time, surgical referrals may increasingly involve patients who have already trialled pharmacotherapy. Rather than diminishing the role of surgery, a PBS listing may push it later in the care pathway, heightening the importance of multidisciplinary assessment and long-term metabolic planning.
Dr Cocco also highlights uncertainty around responsibility for wrap-around care.
“Bariatric and metabolic surgery is combined with multidisciplinary care, including psychologists and dietitians. It is not yet clear how patients receiving Wegovy through this pathway will access that care or who will be responsible for guiding them.”
Access constraints will continue to shape demand. While surgery remains a durable and effective intervention, limited access through the public system reinforces the need for informed patient choice across both medical and surgical pathways.
Overall, Cocco believes a PBS listing for a small subgroup is unlikely to materially change referral patterns. However, “It will likely open the door to conversation regarding weight management, which could increase the number of patients treated with medication and/or surgery, which can only be of benefit.”
Pharmacies and supply pressure
Pharmacies are likely to see increased dispensing volumes alongside tighter supply management and margin considerations. Workforce capacity, stock allocation, patient education and continuity of supply may become operational priorities, particularly during the early stages of a PBS rollout.
For pharmacy owners, operational efficiency and staffing resilience may prove as commercially significant as medication access itself.
A structural shift, not a single policy change
While eligibility criteria may limit initial uptake, the broader signal is clear. Weight loss pharmacotherapy is shifting from a discretionary purchase to a funded component of obesity and chronic disease management.
“We know this isn’t a short-term weight loss model, but chronic disease care at scale, especially in rural settings where workforce capacity is already stretched,” Cassandra Robertson, head of dietetics and health pathway development at Macintyre Health says.
For healthcare businesses, the strategic question is not whether demand will increase, but whether operating models are equipped to manage that demand sustainably.
Wegovy’s PBS listing embeds pharmacotherapy within long-term metabolic care. While eligibility is narrow today, it may widen over time. Organisations with scalable systems, multidisciplinary teams and clearly defined care pathways will be best positioned to adapt, expand and remain relevant.
Sources:
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