Medications and Technology for Diabetes in Aotearoa New Zealand
How New Zealand Compares with the US, UK and Australia
The last decade has seen rapid advances in diabetes pharmacotherapy and digital/medical-device technology. New classes of glucose-lowering drugs (SGLT2 inhibitors, GLP-1 receptor agonists) and a widening array of continuous glucose monitors (CGMs), insulin pumps and hybrid closed-loop systems are transforming care. How these advances translate into real-world benefit, however, depends heavily on national funding decisions, eligibility criteria, reimbursement rules and service capacity. Below I compare the four countries on three core domains: (1) publicly funded access and eligibility; (2) direct cost and out-of-pocket exposure; and (3) service capacity, training and equity implications.
Publicly funded access and eligibility
Aotearoa New Zealand
Since October 2024 New Zealand’s national pharmaceutical purchaser, PHARMAC, has funded access to a range of CGMs and two insulin pumps for people meeting eligibility criteria; the roll-out expanded further in 2025 to broaden the list of funded standalone CGMs for people with type 1 and type 3c diabetes. In medicines, selected SGLT2 inhibitors (notably empagliflozin) and some GLP-1 agents have been added to the funded schedule for defined indications, but many newer GLP-1s and combination therapies remain subject to PHARMAC decisions and negotiated pricing. Pharmac
United Kingdom
The NHS provides broad coverage for licensed diabetes medicines and devices, guided by NICE technology appraisals. England has embarked on phased access to hybrid closed-loop systems pending cost agreements with manufacturers; CGM access has expanded for many people with type 1 diabetes via NHS routes, but local eligibility and rollout timing vary between regions. NICE has issued guidance on hybrid closed-loop systems with requirements for cost-effectiveness and multidisciplinary support. NICE
United States
Medication access in the US is comprehensive in formulation — almost all modern insulins, SGLT2s and GLP-1s are available — but access depends on insurance coverage (private plans, Medicare, Medicaid). Medicare covers certain supplies and insulin in differing ways (Part B vs Part D rules apply for pump-related insulin), and CGM/insulin pump coverage is subject to payer policy and clinical criteria. As a result, device access is often uneven and can involve substantial prior authorisations or patient co-payments. Medicare
Australia
Australia offers subsidised access to many diabetes medicines through PBS and to CGM consumables and pump consumables for eligible people via the NDSS. All people with type 1 diabetes may apply for subsidised CGM products; full subsidy rules and concession eligibility vary by age and clinical circumstance, and there remain campaigning efforts to extend broader subsidised access, particularly for high-need groups. NDSS
Cost and out-of-pocket burden
Across these jurisdictions a consistent theme is that universal or near-universal availability of a medicine or device does not guarantee affordability for every patient. The US typically exposes patients to the highest out-of-pocket risk when insurance is limited or when high-cost branded therapies are used; even insured Americans can face substantial co-payments for GLP-1s or CGM supplies. The UK and Australia tend to minimise day-to-day medicine costs through national subsidy schemes, but device rollout is often staged and may require local service capacity to be in place. New Zealand’s PHARMAC decisions reduce direct costs for those covered by funded programmes, but eligibility rules and staged implementations mean many people still face access delays or must self-fund outside criteria.
Technology types and implementation capacity
The practical benefit of CGMs, pumps and hybrid systems rests on more than procurement: successful implementation needs trained clinical teams, structured training programmes, after-sales support, and pathways for data review. The NHS has established national audit and care pathways that support structured implementation where cost agreements exist; Australia’s NDSS provides central distribution and support mechanisms for subsidy recipients; New Zealand’s roll-out includes diabetes specialist team training and pump/CGM support but must rapidly expand workforce capacity to meet projected demand; the US market offers rapid device availability but variable post-market training depending on provider networks and vendor support.
Equity, Indigenous and rural considerations
Funding decisions that improve overall access can nevertheless widen inequities if rollout and training resources are concentrated in urban or better-resourced centres. In New Zealand, for example, the Māori and Pacific communities, and people in rural areas, have historically experienced both higher diabetes prevalence and more constrained access to specialist services; device funding therefore needs to be paired with workforce and outreach strategies to avoid increasing disparities. Similar Indigenous and remote-population equity concerns exist in Australia (Aboriginal and Torres Strait Islander communities) and in parts of the US. The UK’s centralised NHS structure and audit capability can support equitable rollouts if cost agreements and regional implementation plans prioritise underserved groups.
Workforce, training and health-system readiness
Adopting CGMs and automated insulin delivery at scale requires investment in diabetes education, upskilling of nurses and primary care clinicians, telehealth capacity for remote review of sensor data, and clear referral pathways. Countries with strong primary care integration (UK, parts of Australia) can leverage existing recall and chronic disease management structures to embed device-supported care; New Zealand faces the practical task of expanding specialist and educator capacity concurrently with device access to ensure devices translate into improved outcomes rather than additional complexity.
Where the comparative strengths and weaknesses lie
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United States: fastest access to the full range of products, but access inequities driven by insurance fragmentation and cost-sharing.
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United Kingdom: strong evidence appraisal and national frameworks (NICE) that can yield equitable access when price agreements are reached, supported by robust audit infrastructure.
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Australia: broad subsidisation of medicines and targeted CGM consumable subsidies, with NDSS infrastructure supporting distribution; ongoing policy debate about widening device subsidies.
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New Zealand: decisive national purchasing via PHARMAC can secure lower prices and programme design, and recent moves to fund CGMs and pumps mark a major advance — but success depends on rapid investment in training, distribution and equity-targeted outreach.
Technological and pharmacological advances create genuine opportunities to improve diabetes outcomes. However, countries differ sharply in how those opportunities are turned into equitable, effective care. New Zealand’s recent funding decisions represent important progress in narrowing gaps in device access, but to fully realise benefits the health system must scale workforce training, create culturally safe outreach for Māori and Pacific communities, and monitor outcomes to ensure health gains are equitably distributed. International models show that pairing negotiated procurement with clear implementation plans and audit frameworks offers the best chance that innovations will reduce—not widen—existing disparities.
Karen Reed, October 2025
