Concerns are mounting over proposed changes to access criteria for funded diabetes medicines, with senior clinicians claiming restrictions on public comment are preventing an open debate about the potential impact on Māori and Pacific patients.
The controversy centres on Pharmac’s proposal to remove ethnicity-based eligibility criteria for three funded Type 2 diabetes medicines — empagliflozin, dulaglutide and liraglutide — while expanding access through revised clinical risk thresholds. Pharmac says the changes would allow around 10,000 additional people to access the medicines in the first year, rising to approximately 23,000 within five years.
However, some clinicians and health advocates argue the proposed changes could create new barriers for Māori and Pacific communities, who experience disproportionately high rates of diabetes and diabetes-related complications. They contend that removing targeted access pathways risks widening existing health inequities.
The debate has intensified following claims that Health New Zealand staff have been instructed not to publicly oppose the proposals during the consultation process. Critics say this has limited the ability of frontline specialists to share their professional views on the potential consequences for patients.
The issue has also entered the political arena. Te Pāti Māori has criticised the proposed changes, citing concerns that thousands of Māori and Pacific patients could face additional hurdles in accessing medicines designed to reduce the risk of serious complications such as heart disease and kidney failure.
Pharmac maintains the proposal is part of a wider review of medicine access criteria and follows advice that earlier treatment based on cardiovascular and kidney risk could improve health outcomes for a broader group of patients. The agency says people already receiving the medicines would continue to have access if the changes proceed.
The medicines at the centre of the debate are widely used to help manage Type 2 diabetes and reduce the risk of long-term complications. International clinical guidance increasingly supports earlier use of these therapies for patients at elevated cardiovascular and renal risk.
The consultation has reignited broader discussions about equity in healthcare and whether targeted measures are necessary to address longstanding disparities experienced by Māori and Pacific communities.
Submissions on the proposal have now closed, with health organisations, clinicians and community advocates awaiting Pharmac’s final decision on whether the changes will proceed.
