GLP-1 & PBS News · July 2026Americans Pay $50 a Month for Wegovy Under Medicare. Australians Pay $400. Here's Why.
The US just made Wegovy available for as little as $50 a month under a new Medicare program. Meanwhile, Australians on Wegovy or Ozempic are still paying up to $500 out of pocket every month. Here's where Australia's PBS listing actually stands, and what you can do right now while you wait.
5 min read
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What the US just did, and why it matters
In December 2025, the US Centers for Medicare and Medicaid Services (CMS) announced the BALANCE model, Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth, a voluntary program that makes Wegovy and other GLP-1 weight loss drugs available to eligible Medicare enrollees for as little as US$50 per month (approximately A$78).
Under the program, Medicare covers approximately US$245 of the drug's cost, with patients paying just $50. Around 10% of Medicare enrollees are eligible under the initial rollout, with access expected to expand through 2026 and 2027 as more Part D plans and state Medicaid programs join.
This is a significant policy shift. Until this announcement, US federal law actually banned Medicare from covering medications prescribed purely for weight loss. The BALANCE model changes that, and it sends a clear signal to the rest of the world about where GLP-1 policy is heading.
Source: CMS press release: BALANCE model launch, December 2025
What Australians are paying right now
While Americans enrolled in the BALANCE model pay $50 a month, Australians on Wegovy are paying, depending on dose and pharmacy, between $350 and $500 AUD every month entirely out of pocket.
At the standard maintenance dose of 2.4mg per week, most patients report costs around $400/month. Starter doses (0.25mg–1.0mg) are cheaper at around $320–$380, but costs increase as patients titrate up to the therapeutic dose over four to five months.
Some private health insurers offer partial relief. Bupa, Medibank, and nib provide reimbursements of $80–$130 per month on certain policy tiers, but only on select premium plans. That still leaves most Australians paying $270–$320 per month after any rebate.
| Country / Program | Monthly patient cost | Coverage |
|---|---|---|
| USA: Medicare BALANCE model | ~A$78 (US$50) | Medicare covers ~US$245 |
| Australia: no PBS listing (yet) | $350–$500 AUD | Full out-of-pocket |
| Australia: estimated PBS price (once listed) | ~$31.60 (concessional: $7.70) | PBS co-payment, subject to negotiation |
Estimated PBS price based on standard PBS co-payment rates. Subject to price negotiation outcome between the Australian Government and Novo Nordisk.
Track your Wegovy or Ozempic while you wait for the PBS
MediRemind Scripts tracks your weekly injection schedule, stores your eScript, and reminds you before your repeat supply runs out. MediRemind offers a 30-day trial, then a subscription.
Where Australia's PBS listing actually stands
Australia is not standing still. In November 2025, the Pharmaceutical Benefits Advisory Committee (PBAC) gave a positive recommendation for Wegovy (semaglutide 2.4mg) to be listed on the PBS, but with specific eligibility criteria:
- BMI ≥35 kg/m² (or ≥32.5 kg/m² for people of Asian, Aboriginal, or Torres Strait Islander background)
- Established cardiovascular disease, such as a prior heart attack, stroke, or symptomatic peripheral arterial disease
The recommendation is consistent with Wegovy's cardiovascular risk-reduction indication, which the TGA approved based on the landmark SELECT trial showing a 20% reduction in major cardiovascular events in patients with obesity and pre-existing heart disease.
Importantly, a positive PBAC recommendation is not a PBS listing. What comes next is a price negotiation between the Australian Government and Novo Nordisk. Health Minister Mark Butler has publicly confirmed negotiations are underway but has not provided a timeline.
Based on past precedent, PBS listings typically take 6–18 months after a positive PBAC recommendation. That puts a potential listing date anywhere from mid-2026 to mid-2027.
Sources: RACGP newsGP · Diabetes Australia
The global momentum is undeniable
The US is not alone. GLP-1 drugs are being fast-tracked for subsidised access in multiple countries simultaneously:
- United States: Medicare BALANCE model: Wegovy from US$50/month (December 2025)
- United Kingdom: NHS England approved Wegovy for obesity management in specialist weight management services (2023), with broader rollout underway
- Denmark: Partial coverage through national health insurance schemes
- Australia: PBAC positive recommendation November 2025, PBS listing pending
The pattern is clear: governments that initially resisted subsidising GLP-1s on cost grounds are now moving, driven by compelling evidence that these drugs prevent cardiovascular events, reduce hospitalisations, and ultimately save the health system money. The US Medicare decision, from an institution that was literally banned from covering weight loss drugs, is the strongest signal yet.
Australia has historically followed the US and UK in drug subsidy decisions by 12–24 months. If that timeline holds, the PBS listing is closer than many patients realise.
What you can do right now if you're on Wegovy or Ozempic in Australia
Waiting for a PBS listing is frustrating when you're paying $400 a month. Here's what's worth doing in the meantime.
1. Track your repeat prescription carefully
The most common reason patients stop Wegovy or Ozempic mid-treatment is a repeat expiring before it is renewed. Weekly injectable medications like Wegovy run on a strict repeat schedule, and your repeat can lapse faster than you expect. MediRemind Scripts sends you a reminder before your repeat runs out so you can avoid a paperwork-related schedule gap.
Track your GLP-1 treatment in MediRemind
Weekly injection reminders · Repeat script alerts · eScript QR code storage
Download MediRemind: 30-day trial, then a subscription2. Check your private health cover
Bupa, Medibank, and nib offer partial reimbursement on select policy tiers. It's worth calling your insurer to ask whether your current cover includes weight management medications. Even $80–$130/month back makes a meaningful difference over a 12-month course.
3. Join the PBS waitlist
We'll email you the moment Wegovy gets a confirmed PBS listing date in Australia. Join the waitlist here, no spam, one email when the listing is confirmed.
4. Ask your GP about cardiovascular eligibility
The PBAC's recommendation specifically covers patients with established cardiovascular disease. If you've had a heart attack, stroke, or have peripheral arterial disease, you may qualify for PBS access when it's listed. Your GP can confirm whether you meet the criteria now so you're ready to apply the moment the listing goes live.
Wegovy isn't on the PBS yet: what's your situation?
PBS Waitlist
Not on Wegovy yet? Join the waitlist.
We'll email you the moment a PBS listing date is confirmed, no spam, one email only.
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Already on GLP-1
Already using Wegovy, Ozempic or Mounjaro?
Download MediRemind to track your weekly doses, repeat scripts and eScript QR codes while you wait for the PBS listing.
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Frequently asked questions
Is Wegovy covered by Medicare in Australia?
No. Medicare in Australia does not currently cover Wegovy for weight loss. The PBS received a positive PBAC recommendation for Wegovy in November 2025, but the drug is still in price negotiation with Novo Nordisk. A confirmed PBS listing date has not yet been announced.
How much does Wegovy cost in Australia in 2026?
Without PBS subsidy, Wegovy costs $350–$500 AUD per month depending on dose and pharmacy. At the maintenance dose of 2.4mg/week, most patients pay approximately $400/month. Some private health insurers offer partial reimbursement of $80–$130/month on select policy tiers.
When will Wegovy be listed on the PBS in Australia?
The PBAC gave a positive recommendation in November 2025. Price negotiations with Novo Nordisk are underway. Based on historical timelines, PBS listing typically takes 6–18 months after a positive PBAC recommendation, putting a potential listing date between mid-2026 and early 2027. No confirmed date has been announced.
Who qualifies for Wegovy on the PBS in Australia?
The PBAC's November 2025 recommendation covers adults with a BMI ≥35 kg/m² (or ≥32.5 for people of Asian, Aboriginal, or Torres Strait Islander background) who also have established cardiovascular disease, such as a previous heart attack, stroke, or symptomatic peripheral arterial disease.
How does the US Medicare Wegovy BALANCE model work?
Announced in December 2025 by CMS, the BALANCE model is a voluntary Medicare program in which eligible enrollees pay just US$50/month (approximately A$78) for Wegovy and other GLP-1 weight loss drugs. Medicare covers approximately US$245 of the drug cost. Around 10% of Medicare enrollees are eligible in the initial phase.
Can I track my Wegovy injections with MediRemind?
Yes. MediRemind tracks weekly GLP-1 injection schedules (Wegovy, Ozempic, Mounjaro), stores your eScript QR codes, and sends repeat prescription reminders before your supply runs out. Available on App Store and Google Play. MediRemind offers a 30-day trial, then a subscription.
Track your Wegovy or Ozempic while you wait for the PBS
MediRemind Scripts tracks your weekly injection schedule, stores your eScript, and reminds you before your repeat supply runs out. MediRemind offers a 30-day trial, then a subscription.
Sources
- Centers for Medicare and Medicaid Services. CMS Launches Voluntary Model to Expand Access to Life-Changing Medicines. December 2025. cms.gov
- CNN Politics. Medicare opens door to covering blockbuster drugs for weight loss. December 2025. cnn.com
- RACGP newsGP. Wegovy recommended for PBS listing. November 2025. racgp.org.au
- Diabetes Australia. Wegovy to be listed on PBS. 2026. diabetesaustralia.com.au
- Pharmaceutical Benefits Scheme. Medicine Status: semaglutide 2.4mg (Wegovy). pbs.gov.au
- Lincoff AM et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT trial). NEJM, 2023. nejm.org
- Pharmacy Daily. PBAC recommends Wegovy PBS listing for weight loss. pharmacydaily.com.au
This article is for general information only and does not constitute medical or pharmaceutical advice. Information about PBS listings, TGA approvals and medication pricing is accurate at the time of writing and subject to change, verify current status at PBS.gov.au or TGA.gov.au before relying on it. Speak to your doctor or pharmacist before making any decisions about your medication or treatment. MediRemind is not affiliated with Novo Nordisk or any other pharmaceutical manufacturer.
References to weight management medications on this page are for general information only. MediRemind does not prescribe, supply or endorse any specific medication. Individual circumstances vary, speak to your doctor about which treatment is appropriate for you.