From September, Pharmac will widen access to four treatments for people living with type 2 diabetes.
Under the new criteria, access will no longer depend on whether a person has cardiovascular or kidney disease, is considered at high risk of a cardiovascular event, or meets ethnicity-based criteria.
Instead, the medicines will be funded for patients whose blood sugar levels remain high despite other treatment.
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Andrew Reynolds, Associate Professor within the Department of Medicine at the University of Otago, comments:
“This is good news for Aotearoa New Zealand. These drugs became available as funded medications for type 2 diabetes management in 2021, with funded access restricted to those who would benefit most. The initial proposal by the government in May this year to change access criteria by removing access by Ethnicity for Māori and Pacific was highly flawed.
“Edgar Diabetes and Obesity Research (EDOR) Center staff at the Universities of Waikato and Otago used a dataset of over 60,000 adults with type 2 diabetes followed since 2021 to show that the greatest reductions in cardiovascular disease and premature mortality were for those accessing these drugs through the Ethnicity pathway. Our submission to Pharmac sharing these data was one of nearly 1,900 they received on their proposed changes.
“As a result of the collective concern expressed in these submissions, the decision to widen, rather than restrict, access is a welcome evidence-based approach to health care. Pharmac’s strong bargaining position as the nation’s single buyer for funded medications has again paid dividends, with a new deal for enough of these medications to cover the wider access reported to come at minimal increased cost.
“The next patient groups to be considered for access to these drug classes beyond type 2 diabetes are likely to be those with obesity, sleep apnea, or requiring weight loss before major surgery.”
Conflict of interest statement: “No conflict of interested.”
Ryan Paul, Associate Professor at University of Waikato and Co-Lead of Mahitahi Matehuka (National Diabetes Network), comments:
“The recent announcement by Pharmac to expand access to empagliflozin (Jardiance), dulaglutide (Trulicity) and liraglutide (Victoza) for people with type 2 diabetes is a welcome and positive response to the record number of submissions received on its previous proposal in May, which would likely have reduced access to these important medicines.
“The decision is significant because beyond lowering blood glucose, these cost-effective therapies substantially reduce heart attacks, strokes, chronic kidney disease, heart failure, amputation and premature death, particularly among populations at highest risk, including Māori and Pacific peoples. The revised funding criteria also remove the requirement for additional testing and repeat clinic appointments, reducing unnecessary barriers that have disproportionately affected those with the greatest clinical need.
“However, funding will still require blood glucose levels to remain above target, meaning the funding criteria continue to fall short of current evidence-based clinical practice. Ideally, all New Zealanders with type 2 diabetes, chronic kidney disease and/or heart failure should have access to these life-saving therapies regardless of their glucose levels, consistent with international standards of care.
“Nevertheless, Pharmac’s decision represents an important step forward for the more than 330,000 New Zealanders living with type 2 diabetes. Improving access to these medicines has the potential to improve health outcomes, reduce health inequities and lessen demand on an already stretched health system. Continued investment in evidence-based diabetes care is essential, given diabetes costs Health New Zealand more than $2 billion annually, accounts for more than one in four occupied hospital beds, and remains one of the country’s leading causes of preventable illness, disability, loss of health and premature death.”
Conflict of interest statement: “My opinion does not represent Health New Zealand.”
Rawiri Keenan, Associate Professor, Primary Care Medicine, University of Waikato, comments:
“Short of maintaining the status quo of prioritised access for Māori and Pacific patients with diabetes, widening access to all people with diabetes requiring better control is the most logical step.
“The proposed removal of ethnicity clearly fell flat with those at the front line who see the inequities in diabetes care as well as the benefits from these medications.
“Keeping these life saving medications within easy reach means efforts can remain on eliminating other barriers to accessing care not creating new ones.
“Despite the political narrative, access to care and treatment aimed at particular patient groups (including by ethnicity) remains a strongly evidenced way to reduce morbidity and mortality.”
Conflict of interest statement: No conflict of interested declared.