GLP-1 Adoption in New Zealand & Australia

Pharmac Wegovy decision, PBS prescription growth, and 2026–28 user forecast.

Table of Contents

1. Executive Overview
2. Australia: Prescription Volumes & Market Growth (2020–2025)
3. New Zealand: Prescription Volumes & Private Market Adoption
4. Australia: PBS Funding Status & PBAC Recommendations
5. New Zealand: Pharmac Funding Process & OTAG Recommendation
6. Drug Pricing — Australia and New Zealand
7. Demographic Profile of GLP-1 Users
8. Patient Persistence and Discontinuation Rates
9. Telehealth and Private Market Channels
10. Equity and Access Disparities
11. Adoption Forecasts 2026–2028
12. Innovation Pipeline

Section 1: Executive Overview

GLP-1 receptor agonist (RA) adoption in Australia and New Zealand has followed divergent but interlinked trajectories. Australia's total GLP-1 RA market expanded almost 10-fold from May 2020 to April 2025, reaching ~496,875 units/month and over 6 million units in the 12 months to April 2025, with nearly half of all volume now accessed via the private (self-pay) market.^[4][10] New Zealand, lacking any public funding, saw Wegovy launch in July 2025 and achieve what has been called "one of the fastest adoption rates in New Zealand history," with ~62,000 cumulative users by early 2026.^[29][32] Both countries face the same structural tension: demand vastly exceeds funded access, cost excludes lower-income populations most likely to be obese, and policymakers are racing to define sustainable funding models before private markets entrench inequity.

Key finding: 47.8% of all GLP-1 RA volume in Australia is now accessed via the private market — including 100% of tirzepatide — while in New Zealand every weight-loss GLP-1 prescription is out-of-pocket at NZD $370–$475/month, creating a de facto wealth filter on a drug eligible for 65%+ of the population by BMI.^[4][8]

Section 2: Australia — Prescription Volumes & Market Growth (2020–2025)

Total Market Volume and Milestones

GLP-1 RA total sales in Australia increased almost 10-fold from May 2020 to April 2025, driven by semaglutide's PBS listing for type 2 diabetes in July 2020 and a subsequent surge of off-label weight-loss demand that outstripped diabetes supply.^[4][10]

The 12 months to April 2025 saw over 6 million GLP-1 RA units sold in Australia.^[4][10][30]

Market Share by Drug (May 2024–April 2025)

In 2023, semaglutide accounted for 81.9% of all GLP-1 RA utilization. From mid-2023, semaglutide + tirzepatide combined exceeded 90% of total GLP-1 RA sales.^[30][4] Tirzepatide became the predominant private-market medicine from June 2024, displacing semaglutide in the self-pay channel.^[4]

PBS vs. Private Access Split

Private access trend over time

Population Penetration

• 18 out of every 1,000 Australians are using GLP-1 RAs at standard daily maintenance dose.^[4][6][3]
• 6 out of every 1,000 access GLP-1s via the private market.^[4][3]
• PBAC budgetary modelling: 482,788 to 501,907 Australians using GLP-1 RAs each month.^[9]
• ~400,000+ Australians are currently paying A$4,000–$5,000 annually for GLP-1 medications.^[19]

Shortage and Supply Crisis (2022–2023)

The TGA reported a semaglutide shortage from 15 April 2022, caused by "unexpected increase in consumer demand for off-label use for weight loss."^[10] A dulaglutide shortage followed on 27 June 2022 as patients switched.^[10] The shortage caused an 80–91% collapse in semaglutide dispensings and directly triggered off-label weight-loss demand overwhelming the diabetes supply chain.^[10][6]

PBS Prescribing Data (2023 — Official)

Prescriber Mix (2023 Initiations)

Key finding: Primary care dominates GLP-1 initiation in Australia — 81% of all new semaglutide starts in 2023 were GP-initiated — meaning any supply-side or access intervention must be GP-facing to reach the mass market.^[10]

Section 3: New Zealand — Prescription Volumes & Private Market Adoption

Market Entry Timeline

Volume Data: NZ Private Market (Post-Launch)

All current weight-loss semaglutide prescriptions in New Zealand are private/self-pay.^[8] The adoption trajectory has been described as "one of the fastest adoption rates in New Zealand history."^[29]

Key finding: New Zealand reached ~62,000 cumulative Wegovy users within roughly 8 months of launch — all entirely at private cost — in a country where 65–67% of adults qualify by BMI, suggesting demand would be orders of magnitude higher if funded.^[29][32][8]

NZ Obesity Burden and Eligible Population Scale

Section 4: Australia — PBS Funding Status & PBAC Recommendations

Current PBS Listings (as of May 2026)

PBAC Decision Timeline

November 2025 PBAC Recommendation — Details

The PBAC's November 2025 recommendation for Wegovy is narrowly scoped. The eligible population is adults with established cardiovascular disease (prior heart attack, stroke, or symptomatic peripheral arterial disease) plus BMI ≥35 (or ≥32.5 for Asian, Aboriginal and Torres Strait Islander populations).^[19]

Priority Populations Identified by PBAC

1. People with established cardiovascular disease^[3][14]
2. Aboriginal and Torres Strait Islander patients with obesity-related comorbidities^[3][23]
3. People with syndromic obesity^[3]
4. People with medication-induced obesity^[3]
5. Patients requiring weight loss to be eligible for surgery^[3]

Key PBAC policy positions:^[3][14][20]

• No mandatory wraparound services — compulsory allied health requirements would create access barriers
• "Slow and managed roll-out" recommended to manage leakage and long-term outcome uncertainties
• Broader obesity subsidy "would be difficult to achieve a cost-effective price" — wider prevention programs suggested outside the PBS framework
• Digital delivery models identified as potentially equitable mechanisms for monitoring and support

Consumer Consultation (PBAC)

Government Position and Stakeholder Response

Health Minister Mark Butler confirmed Australia will subsidize Wegovy: "It's incumbent on us as the government to negotiate a good price," describing GLP-1s as "a pretty extraordinary class of drugs" while acknowledging "a very big bill for taxpayers."^[19] RACGP welcomed the move while cautioning against reducing preventative health funding.^[19] Dietitians Australia expressed concern about malnutrition risks without mandatory nutritional support.^[19] RACGP Obesity Chair Dr Terri-Lynne South noted: "it's an extremely narrow patient cohort who would meet the current PBS recommendations."^[20]

Key finding: The PBAC's November 2025 recommendation covers only Australians with established CVD + high BMI — estimated to be a small fraction of the 400,000+ Australians already paying A$4,000–$5,000/year privately. The structural tension between the narrow clinical eligibility and wide population need defines the near-term PBS access gap.^[19][20]

Section 5: New Zealand — Pharmac Funding Process & OTAG Recommendation

Current Funding Status (as of May 2026)

Neither Wegovy nor Mounjaro is publicly funded in New Zealand.^[1][12][21] GLP-1 RAs currently funded for type 2 diabetes under Pharmac are limited to dulaglutide (Trulicity) and liraglutide (Victoza).^[12][21] Pharmac's official position: "We cannot say when or if any medicine will be funded."^[1][12]

Applications Under Pharmac Review

As of March 2026, Pharmac had not yet received an application for oral Wegovy.^[33]

OTAG: Composition and December 2025 Recommendation

The Obesity Treatments Advisory Group (OTAG) first convened in December 2024 as a new Pharmac advisory body specifically for obesity treatments; it reviewed the semaglutide weight-loss application at its December 2025 meeting.^[13][22]

Source: ^[2][13][22]

OTAG December 2025 recommendation (announced February 24, 2026):^[2][24] Provisionally recommended funding semaglutide for "chronic weight management in people with a high body mass index (BMI) and associated comorbidities, with a high priority."^[1][13][21] Full meeting record expected by March 2026.^[2][15]

Key caveat: The OTAG recommendation is provisional — not a guarantee of funding. Pharmac must weigh all funding requests across the health system. Special Authority criteria will restrict prescribing access.^[1][13][21] Pharmac's budget is fixed — any funded GLP-1 would displace other medicines.^[15][18]

Projected Funding Decision Timeline (NZ)

Budget Impact Modelling (NZ)

Dr Gerard McQuinlan: "funding Wegovy would save taxpayer money in the long run" — obesity is linked to 200+ diseases; reducing T2D incidence alone (risk elevated ~12× by obesity) could justify funding.^[8][18][32] However, Sweden elected not to subsidize Wegovy due to poor cost/benefit ratio and lax prescribing concerns — while maintaining GLP-1 funding for diabetes — as a counterpoint.^[18][33]

Political and Industry Dynamics

• Associate Minister of Health David Seymour publicly encouraging Pharmac to prioritize treatments that generate net savings.^[11][18]
• Novo Nordisk CEO Mike Doustdar in "continuous talks with Pharmac."^[33]
• Novo Nordisk CEO's public statement: "Pharmac owes it to taxpayers to fund weight loss drugs."^[11][33]
• Australia's subsidization decision creating trans-Tasman political pressure on Pharmac.^[11][18]

Key finding: New Zealand faces a structural affordability trap: full eligible population funding would exceed NZ$3 billion/year — greater than Pharmac's entire annual medicine budget in many years — yet unfunded access entrenchs obesity as a disease of affluence at exactly the point when effective treatment exists.^[11][18]

Section 6: Drug Pricing — Australia and New Zealand

Australia Pricing (as of early 2026)

New Zealand: Wegovy Dose-Dependent Pricing (effective March 16, 2026)

Source: ^[34][33]

Savings vs. old flat-rate pricing: up to NZD $375 over first 4 titration months; up to $130 saving in Month 1.^[34] The price reduction is partly attributed to competitive pressure from Mounjaro entering NZ in early 2026.^[33][34]

New Zealand: Mounjaro (Tirzepatide) Pricing

Cost-Effectiveness Comparison (NZ, Per Percentage Point of Weight Loss)

International Price Context

Key finding: PBS listing would reduce the effective patient cost of Wegovy from A$460/month to approximately A$25/script — a 94% reduction — while Pharmac funding in NZ would deliver a comparable shift from NZD $475 to an estimated ~NZD $5/month (based on standard Pharmac co-pay models), fundamentally reshaping who can access these medications.^[18][32]

Section 7: Demographic Profile of GLP-1 Users

NSW General Practice Data — Primary Source (Kuo et al. 2026 / Lumos Program)

The highest-quality AU/NZ demographic dataset is from the Kuo et al. Heart, Lung and Circulation 2026 study and the NSW Health Lumos program, analyzing 59,009 first GP prescriptions for semaglutide across 680 GP practices (~25% of NSW) from January 2020 to November 2023.^[27][35]

Growth in Semaglutide Initiators (NSW GP, 2020–2023)

Gender Profile

T2DM vs. Non-T2DM (Off-Label Weight Loss) Shift

Age Profile

BMI Profile at Initiation

Socioeconomic Profile

• T2DM initiators: more likely to reside in socioeconomically disadvantaged areas.^[27][35]
• Non-T2DM (weight-loss) initiators: more likely in less disadvantaged (higher-income) areas.^[27][35]
• A "substantial proportion of prescribing" occurred outside PBS criteria (off-label).^[35]

Broader Australian Demographic Signals

Clinical Eligibility Criteria (Australia)

• Adults ≥18: BMI ≥30 kg/m², or BMI ≥27 with ≥1 weight-related complication^[6]
• CVD indication: BMI ≥27 with established CVD^[6]
• Adolescents 12+: BMI ≥95th percentile (age/sex-specific) AND weight >60 kg^[6]

Key finding: The demographic split between PBS-funded (T2D, lower-income, disadvantaged areas) and private-pay (off-label weight-loss, higher-income, younger, mostly female) GLP-1 users in Australia creates two parallel markets with different demographics, retention challenges, and policy implications — and private users are already almost half the market.^[27][35][4]

Section 8: Patient Persistence and Discontinuation Rates

Note: No AU- or NZ-specific peer-reviewed studies on GLP-1 persistence have been published. Data below derives from US cohort studies, global clinical trials, and one Australian telehealth real-world cohort.^[7]

12-Month Discontinuation Rates (US Cohort, n=195,915)

Semaglutide Persistence Trends (Annual, US — Prime Therapeutics)

In a separate Gleason et al. JMCP 2024 cohort of 4,066 commercially insured adults with obesity and without diabetes: semaglutide primary 1-year persistence was 47.1% vs. liraglutide 19.2%. Median time to discontinuation: semaglutide (Ozempic) 279 days vs. liraglutide (Saxenda) 120 days.^[7]

Clinical Trial Discontinuation Data (SURMOUNT-5 Head-to-Head)

Australian Telehealth Real-World Cohort (Eucalyptus/Juniper, Jan–Jun 2022, n=5,604)

Reasons for Discontinuation (Global Evidence)

Weight Rebound After Discontinuation

• Obesity group: 55% gained weight in the year after stopping GLP-1; 45% continued to lose weight or maintained.^[7]
• Diabetes group: 44% gained weight post-cessation.^[7]
• Meta-analysis: semaglutide/tirzepatide patients regained 9.69 kg over 48–52 weeks after stopping.^[7]
• BMJ data (January 2026): patients stopping Mounjaro or Wegovy regain weight 4× faster than those stopping conventional diet/exercise programs.^[9][11]

Pharmac NZ explicitly cited high discontinuation rates as a concern in its funding deliberations, and the prospect of lifelong treatment (needed for sustained effect) presents a long-term cost commitment for any public payer.^[1][7][11] AU private market discontinuation rates may be higher than US figures due to the absence of insurance coverage for obesity indications and a purely out-of-pocket cost burden.^[7]

Key finding: Cost is the dominant patient-reported reason for GLP-1 discontinuation, and weight rebounds rapidly (9.69 kg over ~50 weeks) after stopping — meaning unaffordable access doesn't just delay treatment, it creates a medically harmful start-stop cycle for price-sensitive users.^[7][36]

Section 9: Telehealth and Private Market Channels

Australian Telehealth GLP-1 Market — Key Providers

Eucalyptus Financial Metrics

Business Model and Patient Flow

The standard telehealth GLP-1 pathway: online ad → quiz → telehealth consultation → script → medication delivered.^[5] Australian law prohibits directly naming specific prescription drugs in consumer advertising; providers use "medical weight-loss programs" framing.^[5] Juniper claims to be the only telehealth company with ACHS certification in Australia.^[5][26]

Clinical Outcomes (Eucalyptus/Juniper Real-World, Jan–Jun 2022, n=5,604)

Regulatory Actions Against Telehealth GLP-1 Channels (Australia)

Telehealth Share of New Starts (New Zealand)

Wegovy is available in NZ via both GP and telehealth services.^[29] Well Revolution, a NZ telehealth provider, offers same-day online prescriptions with licensed NZ doctors.^[34] No NZ-specific data on telehealth's share of total new GLP-1 starts is available in the current corpus — this is a data gap.

Key finding: Australia's telehealth GLP-1 sector generated ~A$200M in weight-loss revenue in 18 months, then attracted a US$1.15B acquisition — but simultaneously drew 3,000+ ad takedowns, 10 infringement notices, a compounding ban, and prescribing restrictions, signalling a sector-level regulatory inflection point that will reshape how private GLP-1 access is delivered.^[5][26]

Section 10: Equity and Access Disparities

New Zealand: Māori Access Gap

Māori carry higher rates of obesity, diabetes, and chronic disease, yet are disproportionately excluded from private-pay GLP-1 access.^[11][29] Associate Professor Lesley Grey: "the very people who may be able to benefit most are going to be the least likely to be able to take it now" — linking higher obesity prevalence to lower average incomes.^[28] The unfunded model is directly described as deepening health inequities.^[32]

Australia: First Nations Access Gap

Off-label GLP-1 use for weight loss is disproportionately concentrated in socioeconomically advantaged areas, while PBS-covered T2D prescribing reaches more disadvantaged populations.^[27][35] Affluent Australians are twice as likely to use GLP-1 drugs, especially off-label.^[6]

Cost as Primary Equity Barrier

Key finding: In both countries, the populations with the highest obesity burden — Māori in NZ (50% obese; 12% of Wegovy users), First Nations in Australia (74% overweight/obese; limited PBS access) — are most excluded from a self-pay GLP-1 market structured around the ability to spend $5,000–$6,000/year. Public funding is the only mechanism that closes this gap.^[29][19]

Section 11: Adoption Forecasts 2026–2028

New Zealand — Near-Term Trajectory

Australia — Market Penetration Forecasts

Global Market Forecasts (Context for AU/NZ)

Asia-Pacific is expected to grow at the fastest CAGR among all regions through 2035. IQVIA phases the market as: 2025–2026 Inflection Point (acceleration, new launches, oral entry) → 2027–2028 Innovation Phase (competition intensifies, comorbidity focus, muscle preservation) → 2029–2030 Long-term Transformation.^[9]

Key Demand Drivers and Uncertainties (AU/NZ-Specific)

• PBS Wegovy listing (AU, est. late 2026): Would dramatically expand eligible patient pool beyond the 400,000+ current private users.^[19]
• Pharmac funding (NZ, est. late 2026): Would shift access from ~62,000 affluent users to the broader eligible population.^[18][32]
• Oral GLP-1s: FDA approved oral Wegovy December 2025; Eli Lilly's Orflorglipron (Foundayo) launched US April 2026 — eliminates injection barrier; early data shows ~2/3 of oral Wegovy volume is new to any GLP-1 (market expansion, not switching).^[9]
• Semaglutide patent expiry: The compound patent expires in March 2026 in India, China, Brazil, Canada, and Turkey, but US protection extends to December 2031 ('343 compound patent), so US generic/biosimilar competition is not expected before 2032. AU and NZ pricing is most likely to be affected via parallel-trade dynamics and supply from off-patent jurisdictions rather than direct US biosimilar launch in 2026.^[9][11][31]
• Duration uncertainty: Major international insurers limit subsidization to 2 years — optimal subsidization duration remains unresolved.^[31]
• Wegovy AU launch (August 2024): Did not reduce overall GLP-1 use — demand was purely additive.^[9]

Key finding: Morgan Stanley forecasts GLP-1 penetration reaching 40% of Australia by 2030 — a trajectory that, if realized, would cost ~A$8.5 billion in PBS subsidies and would represent 25× the current PBS-subsidized Ozempic penetration rate of ~0.7% — the largest pharmaceutical expenditure shift in Australian PBS history.^[31]

Section 12: Innovation Pipeline Affecting AU/NZ Adoption

Near-Term Pipeline (2025–2026)

Market Segmentation Shift (2027–2028 Innovation Phase)

• Beyond weight loss: comorbidity benefit focus (cardiovascular, renal, sleep apnea)^[9]
• Long-term maintenance protocols replacing episodic use^[9]
• Muscle preservation / anti-sarcopenic formulations entering development^[9]

Industry Scale and Competitive Dynamics

• Novo Nordisk + Eli Lilly expected to spend >$50 billion (2022–2028) building GLP-1 supply chains.^[31]
• Novo Nordisk share price: down ~40% year-to-date as of March 2026, as GLP-1 competition intensifies.^[33]
• Semaglutide holds ~52.83–58% market share of obesity GLP-1 market in 2025.^[9][8]

Key finding: Oral GLP-1s and generic/biosimilar entry are converging to structurally lower the cost floor of GLP-1 therapy — a dynamic that makes the current NZ/AU funding debates over injectables potentially moot by 2028 if oral semaglutide becomes the default first-line option at biosimilar pricing.^[9][31]

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