Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being prescribed in Australia and internationally, primarily for the management of type 2 diabetes mellitus (T2DM) and excess weight. The cost to the Australian taxpayer of subsidising GLP-1RAs on the Pharmaceutical Benefits Scheme (PBS) has increased exponentially, accounting for 26% (AU$194 million) of PBS T2DM therapy expenditure in the 2021-2022 financial year. 1 Semaglutide's initial public summary estimated 50 000-100 000 first-year prescriptions, increasing to 200 000 by Year 6. 2 However, in the 2022-2023 financial year, 1 255 370 PBS prescriptions cost the taxpayer over AU$146 million with a 695% increase in PBS-subsidised prescriptions over 2 years. 3 From 1 June 2024, major PBS changes mean GLP-1RAs can only be initiated if there is a contraindication to, intolerance of or lack of meaningful glycaemic response to a sodium-glucose cotransporter 2 inhibitor. Additionally, a telephone/electronic authority is required for initiation, while continuing prescriptions remain streamlined authorities. 1 The rationale for these changes appears to be reducing the subsidised prescription of GLP-1RAs. From previous experience, restricted medications undergo an immediate and sustained reduction in PBS prescriptions; however, this does not affect total prescriptions (including private prescriptions). 4 The mechanism of this reduction is in enforcing adherence to prescribing rules but also increasing prescribing time cost. This increased time cost is likely to affect patients requiring longer consultation times, including those with complex comorbidities, those who need an interpreter or those with any impairment impeding communication. It is likely that these patients are precisely those who would either benefit most from GLP-1RA therapy or already experience significant health inequity.GLP-1RAs have had limited Australian availability since November 2022, 5 with demand surpassing expectations and increasing rapidly. By restricting PBS access to GLP-1RAs, paradoxically a greater proportion of the Australian GLP-1RA supply will be available for private prescription, increasing access for those who can afford it. The net result will be an exacerbation of existing disparities in GLP-1RA access. It is imperative that reductions in healthcare expenditure do not perversely exacerbate existing health disparities. The potential adverse effects of these PBS changes on access must be monitored, through prospective study of clinical and socio-economic characteristics of those prescribed GLP-1RA therapies.