Pharmacists are likely aware that Wegovy® (semaglutide) is now available in Australia. The PDL Professional Officers have received several incident reports involving patients being supplied with the incorrect strength of the product.
Wegovy is available as a FlexTouch Pen containing four weekly doses within one pen in the following presentations:
Product selection
Prescriptions can vary in format depending on the software used by the prescriber. This can lead to confusion regarding the prescriber’s intentions and result in supplying the incorrect dose or strength.
PDL has received reports of Wegovy 0.25mg being prescribed by total strength/total volume, i.e. 1mg/1.5mL but the medicine has been incorrectly supplied as Wegovy 1mg. This results in the patient receiving four times the intended dose.
In other examples of confusing prescribing formats, some prescriptions have been expressed in the same manner as single use pens available in the USA, e.g. the weekly dose/total volume displayed is 0.25mg/0.5mL.
It is recommended that pharmacists familiarise themselves with the presentations of the Wegovy FlexTouch Pens, and note that unlike Ozempic®, when initiating Wegovy a different pen is required when transitioning from 0.25mg to 0.5mg weekly doses.
Examples of Wegovy prescriptions
Example 1: Prescription presented as total strength/total volume, strength/mL and weekly milligram dose.
Example 2: Prescription presented as total strength/total volume and weekly milligram/dose; however, directions do not align with item prescribed.
Example 3: Prescription expressed as total strength/total volume based on the USA product which contains four pens, each containing 0.25mg in 0.5mL. The Australian product contains 1mg in 1.5mL in one pen which contains four doses of 0.25mg.
The Professional Officers are aware of incidents where patients have been supplied Wegovy using original or repeat non-PBS prescriptions for Ozempic, which has led to complaints from patients regarding the price difference. PDL suggests pharmacists refer to the TGA reference for guidance and advice to patients. It is recommended to discuss pricing with patients before supply. The following are excerpts from the TGA advice on semaglutide supply:
- Pharmacists should continue to prioritise limited supplies of Ozempic for type 2 diabetes patients stabilised on treatment.
- Pharmacists may choose to advise patients who are prescribed semaglutide for chronic weight management that a new brand (Wegovy) is available and encourage them to talk to their prescriber.
The TGA also advises the following to patients:
- Wegovy and Ozempic contain the same active ingredient but are approved for different uses with differing strengths at higher doses.
- Wegovy cannot be dispensed using a prescription for Ozempic and you will need your doctor to write you a new prescription.
PDL tips to avoid dispensing incidents
The PDL Professional Officers recommend pharmacists exercise extra caution when dispensing Wegovy prescriptions, to ensure the supplied product aligns with the intention of the prescriber and is safe and appropriate for the patient.
- If there is uncertainty regarding the intention of the prescriber, delay supply until confirmation from the prescriber is received.
- Ensure all pharmacists and dispensary staff are aware of the risk of confusion. This can be achieved by displaying signage in front of the product to alert staff to the selection risk, implementing manual pop-ups in the dispensing software to remind pharmacists to be vigilant when dispensing
these prescriptions. - Counsel the patient to ensure they understand the dose they are using and know how to administer the product.
- Seek assistance from the manufacturer for patient counselling resources.
- The PDL Professional Officers are currently advocating for consistency across all prescribing and dispensing platforms to reduce the risk for error with semaglutide products.
The “click” method
Similar to prescriptions for the Ozempic brand of semaglutide, pharmacists may encounter prescriptions for Wegovy where the prescriber intends for the patient to count clicks to achieve a smaller dosage than what the product is designed to deliver.
The PDL Professional Officers have received incident reports where patients have self-administered a higher than intended dose using the click method with Ozempic. The clinical risk of administration errors may be more significant with the higher dose Wegovy pens. Pharmacists are encouraged to refresh their knowledge on the concerns with the “click” method. PDL does not encourage the click method. For further insights, please review our recent Practice Alert Caution with click method for semaglutide pen.
The manufacturer states there are four doses in each pen and four needles per pack. They advise that each pen is intended to be used for the specified dose on the pack.
For immediate advice and incident support, call PDL on 1300 854 838 to speak to one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.
