Private health insurer HBF tightens belt on weight-loss drug coverage

A raft of weight-loss treatments will be stripped from health coverage by one of the country’s biggest private insurers.

HBF told its policyholders on Wednesday that it would no longer pay benefits under its non-PBS pharmaceuticals extras cover for injectable medication Saxenda and pills Contrave and Duromine.

It said there would also be no coverage for highly popular once-a-week semaglutide injectable Wegovy, which has been registered in Australia but is not currently available for distribution.

Benefits for any other medication listed on the Australian Register of Therapeutic Goods with an approved use of weight management or reduction would also no longer be covered.

Wegovy’s so-called GLP-1 slimming jab was launched in the US in 2021, and alongside Ozempic, has become a global blockbuster treatment for people wanting to shed kilos.

But diabetes sufferers have been battling to access limited supplies of Ozempic as it became the drug of choice for weight loss. Drug developer Novo Nordisk has for months been struggling to expand global production and keep pace with extraordinary demand.

HBF said it was also cancelling benefits for compounded weight-loss medicines that include active ingredients: semaglutide; stradiol; minoxidil; liraglutide; tadalafil; finasteride; phentermine; alprostadil; drospirenone; and naltrexone hydrochloride and bupropion hydrochloride.

HBF, on its website, said the changes — due to take effect from July 9 — were made following a regular review.

“Our priority is to remain a sustainable, member-focused organisation that continues to provide affordable and valuable health insurance products for all our members,” it said.

“Our recent review has shown that our extras pharmaceutical coverage needs to change to remain sustainable and keep future premium increases to a minimum.”

Those customers already undergoing treatments will not see a change in their benefits until August 1. HBF noted there would be no changes in premium prices to reflect the reduced coverage.

Depending on a customer’s level of coverage, benefits will also be reigned in for pre-made medications which contain semaglutide, dulaglutide, exanatide, liraglutide and tirzepatide.

A spokesman for HBF said the insurer’s pharmaceutical benefits had nearly doubled since 2021, with 40 per cent of those paid to just 3 per cent of policies relating to GLP-1 medications “that are increasingly being used for weight loss”.

“As a not-for-profit health insurer, we’ve undertaken a review to ascertain how we balance the pharmaceutical benefits we pay for these medications and anticipated growth in these medications against the impact this will have on future premium increases for our membership as a whole,” he said.

“As a result of this review, we are removing benefits for certain medications while reducing others to a 50 per cent benefit, such as the active ingredient in Ozempic.

“By maintaining a percentage benefit, HBF is seeking to provide move value for its members claiming these drugs compared to the fixed dollar benefit more commonplace in the industry.”

The insurer has a 7.3 per cent share of the Australian market, with the majority of members in Western Australia.

Bloomberg predicts that by 2030 global annual sales of weight-loss medications will reach a staggering $124 billion, putting them among the biggest classes of drugs in history.