Widened access to diabetes medicines to benefit over 30,000 New Zealanders

Following substantial feedback on an earlier proposal, Pharmac is providing much wider access to four funded medicines for type 2 diabetes than originally proposed, by removing the existing requirements for people to have a history of cardiovascular or renal disease, elevated risk of cardiovascular disease, and the existing ethnicity criteria. Existing criteria requiring elevated blood sugar levels will remain.

Under the new eligibility criteria, around 14,000 more people with type 2 diabetes will be able to access funded empagliflozin, empagliflozin with metformin, liraglutide and dulaglutide over the next 12 months, with that number increasing to around 31,000 people after five years.

These medicines will be funded for New Zealanders with type 2 diabetes whose blood sugar levels remain high despite treatment with other funded diabetes medicines.

“Type 2 diabetes affects hundreds of thousands of New Zealanders and can lead to serious complications including heart and kidney disease,” says Pharmac’s Chief Medical Officer, Dr David Hughes.

“This decision means more people with type 2 diabetes will be able to access medicines that help lower blood sugar levels and reduce the risk of future complications which hugely impact their quality of life and, ultimately, put extra burden on the health system,” says Dr Hughes.

Empagliflozin, empagliflozin with metformin, liraglutide and dulaglutide are already funded treatments for type 2 diabetes to help lower blood sugar and reduce the risk of heart and kidney complications for some people.

Around 145,000 people already use these medicines.

“For people living with type 2 diabetes, earlier access to effective treatment can help improve blood sugar control and support better long-term health outcomes for them,” says Dr Hughes.

The decision follows major consultation with people living with type 2 diabetes, their families and whānau, health professionals, community organisations and advocacy groups in May this year.

Pharmac received nearly 1,900 submissions, and following feedback, extended the original consultation period by two weeks and provided additional information to inform submissions.

“We heard many personal stories about the impact of type 2 diabetes on people’s health, wellbeing and day-to-day lives,” says Dr Hughes.

Pharmac originally proposed widening access to these medicines by lowering the clinical cardiovascular risk threshold for heart disease (how likely someone is to have a heart attack in the next five years) and removing ethnicity-based eligibility criteria.

“While people supported widening access to these medicines, many were concerned that removing the ethnicity criteria would mean Māori and Pacific peoples, who are eligible for these medicines under the current criteria but not currently accessing treatment, would miss out,” says Dr Hughes.

“We carefully considered that feedback and have changed our original proposal in line with that feedback. Working with suppliers, we were able to support wider access than originally proposed.

“The final decision removes the cardiovascular risk threshold and ethnicity criteria and introduces broader access criteria based on poor blood sugar control.

Access to these medicines will now be based on a single set of funding criteria, making more people with type 2 diabetes eligible for funded treatment. Everyone, including Māori and Pacific people, who would currently be able to access these medicines would meet these revised criteria.

“People told us that earlier access to effective treatment could improve quality of life, make diabetes easier to manage, and help prevent serious complications. We took that feedback into account when making this decision, and we’re pleased to be able to make these medicines available to more New Zealanders.”