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Pharmac’s Decision re Changes to Type 2 Diabetes Medication Funding

Back in May, Diabetes Info NZ looked at Pharmac’s proposal to change the funded access criteria for several medicines used to treat Type 2 diabetes.

The proposal generated a lot of discussion.

There was broad support for making these medicines available to more people — particularly earlier in the course of Type 2 diabetes — but there were also significant concerns about the proposed removal of ethnicity-based access criteria for Māori and Pacific peoples.

That consultation has now closed, Pharmac has considered the feedback, and the decision has been made.

The changes will come into effect on 1 September 2026.

And there is an important difference between what was originally proposed and what Pharmac has ultimately decided.

So, what has Pharmac decided?

From 1 September, funded access to four diabetes medicines will be widened:

empagliflozin (Jardiance)
empagliflozin + metformin (Jardiamet)
dulaglutide (Trulicity)
liraglutide (Victoza)

The new criteria are designed to make these medicines available to people with Type 2 diabetes whose HbA1c remains above target despite treatment with other funded diabetes medicines.

The key HbA1c threshold is 53 mmol/mol.

This sits nicely with current Type 2 Diabetes Management guidance, however ……. This is a significant change.

Rather than requiring someone to have a particular level of cardiovascular risk, existing cardiovascular disease, diabetic kidney disease, or a particular ethnicity, the new criteria focus primarily on whether their blood glucose levels remain above target despite appropriate treatment.

Pharmac estimates that around 14,000 additional people could benefit during the first year, increasing to around 31,000 people after five years.

Around 145,000 people are already using these medicines.

This isn’t quite the decision that was originally proposed

This is an important distinction.

The consultation proposal suggested:

lowering the cardiovascular-risk threshold from 15% to 10%; and
removing the ethnicity-based criteria that currently provide earlier access for Māori and Pacific peoples.

The final decision goes further in widening access.

The cardiovascular-risk threshold has been removed altogether.

The criteria relating specifically to existing cardiovascular disease and diabetic kidney disease have also been removed from the Special Authority criteria.

Instead, the emphasis is on whether a person’s HbA1c remains above 53 mmol/mol despite treatment with other funded medicines.

Pharmac says the revised criteria were developed in response to the feedback it received during consultation.

Almost 1,900 submissions were received.

What does this mean for someone with Type 2 diabetes?

In simple terms, from 1 September, more people with Type 2 diabetes should be able to access these medicines without having to demonstrate a particular level of cardiovascular risk.

For empagliflozin (Jardiance) or empagliflozin + metformin (Jardiamet), the new criteria require:

Type 2 diabetes; and
an HbA1c of 53 mmol/mol or less has not been achieved despite regular use of at least one blood-glucose-lowering medicine for at least three months.

This could include medicines such as metformin, vildagliptin or insulin.

For dulaglutide (Trulicity) and liraglutide (Victoza), the requirements remain more restrictive.

These medicines require Type 2 diabetes and an HbA1c above 53 mmol/mol despite regular use of empagliflozin, metformin and vildagliptin for at least six months, where clinically appropriate.

There are also restrictions around combining these medicines.

So although access is being widened considerably, it does not mean that everyone with Type 2 diabetes will automatically be offered any of these medicines.

The clinical decision about what treatment is appropriate still sits between the person with diabetes and their healthcare professional.

What about Māori and Pacific peoples?

This is probably the most sensitive part of the decision.

The ethnicity-based access criteria introduced in 2021 have been removed.

During consultation, many people expressed strong concerns about this.

Māori and Pacific peoples experience a disproportionately high burden of Type 2 diabetes and diabetes-related complications. There were also concerns that cardiovascular risk assessment tools may underestimate risk in some populations, and that Māori and Pacific peoples may be less likely to receive a formal cardiovascular risk assessment in the first place.

Pharmac acknowledges these concerns.

It says that Māori and Pacific peoples have been starting these medicines at proportionally higher rates since the ethnicity-based criteria were introduced, and that this may have contributed to reducing an existing health equity gap.

However, Pharmac believes the revised criteria will continue to provide access to those who would have benefited under the previous criteria, while allowing clinicians greater flexibility to identify individual patients who may benefit from treatment.

This will be something worth watching closely.

Removing an ethnicity-based criterion does not, by itself, remove the inequities that led to that criterion being introduced in the first place.

The real test will be what happens in practice.

Will Māori and Pacific peoples continue to access these medicines at appropriate rates?

Will the gap in diabetes outcomes continue to narrow?

Will people who might benefit from these medicines actually be identified and offered them?

Those are questions that can only really be answered with time and good-quality data.

There is some good news for people already taking empagliflozin

One concern raised during the consultation was that people who had gained access to empagliflozin through the existing ethnicity-based criteria might subsequently find themselves unable to progress to a GLP-1 medicine such as dulaglutide or liraglutide.

Pharmac has specifically changed the wording to address this concern.

The revised criteria make it clear that existing users of empagliflozin can progress to a funded GLP-1 medicine where clinically indicated.

That’s an important clarification.

What hasn’t changed?

It is also important not to interpret the announcement as meaning that all the barriers to accessing newer diabetes medicines have disappeared.

The HbA1c threshold remains aligned with previous guidance on treatment targets.

For empagliflozin and Jardiamet, HbA1c must remain above 53 mmol/mol despite at least three months of appropriate treatment.

For dulaglutide and liraglutide, the person must have remained above the target despite at least six months of treatment with the specified medicines, where clinically appropriate.

And there remains a treatment sequence.

In general, empagliflozin or empagliflozin + metformin comes before funded liraglutide or dulaglutide, where clinically appropriate.

There is also currently a restriction on using funded empagliflozin/empagliflozin + metformin together with a funded GLP-1 medicine, except where empagliflozin is being used for heart failure.

Pharmac notes that it has received an application seeking funding for concurrent use of an SGLT2 inhibitor and GLP-1 receptor agonist, but this will go through the usual assessment process.

What about the HbA1c threshold?

This is another issue that came through strongly in the consultation.

Some respondents questioned whether an HbA1c threshold of 53 mmol/mol remains appropriate, particularly given that the diagnostic threshold for Type 2 diabetes is now 48 mmol/mol.

Others pointed out that someone can have significant cardiovascular or kidney risk even when their HbA1c is below the funding threshold.

Pharmac says changing the HbA1c threshold was outside the scope of this particular proposal.

It has, however, noted the feedback for future consideration by its Diabetes Specialist Advisory Committee.

So this part of the conversation isn’t necessarily over.

A bigger question: does wider funding mean better access?

This is perhaps the most important question of all.

Changing the funding criteria is an important step.

But funded access and actual access are not necessarily the same thing.

Someone still needs to:

know that the medicine exists;
understand whether it might be appropriate for them;
be able to get an appointment with an appropriate healthcare professional;
have their HbA1c and other relevant information assessed;
navigate the Special Authority process;
and be able to start and continue treatment.

These practical barriers matter.

They matter particularly when we are talking about health inequities.

Pharmac itself acknowledges that concerns were raised about access to healthcare, cardiovascular risk assessments and the wider barriers experienced by Māori and Pacific communities.

It says feedback about the need for Māori-led initiatives around screening, primary care, early intervention and adherence support will be passed to Health New Zealand and the Ministry of Health.

So, is this good news?

Overall, wider access to effective diabetes medicines is good news.

For many people with Type 2 diabetes, the previous criteria meant that access could depend on reaching a particular level of cardiovascular risk or having already developed complications.

The new criteria remove those requirements.

That potentially means treatment can be offered to people before they develop cardiovascular or kidney complications — rather than waiting until their risk becomes high enough to meet a particular threshold.

That is a positive step.

At the same time, removing the ethnicity-based criteria raises legitimate questions about health equity, particularly given the disproportionate impact of Type 2 diabetes on Māori and Pacific peoples.

It is possible to hold both of these thoughts at the same time.

We can welcome wider access while continuing to ask whether that access is equitable in practice.

What should you do if you think you might now qualify?

If you have Type 2 diabetes and your HbA1c remains above target despite using funded diabetes medicines, it may be worth talking to your GP, nurse practitioner, diabetes specialist or other appropriate healthcare professional about the new criteria.

But don’t assume that a medicine is automatically right for you simply because you meet the funding criteria.

Funding eligibility and clinical suitability are not the same thing.

Your healthcare professional can help you consider the potential benefits, risks, side effects, interactions and practicalities of different treatment options — and how they fit with your individual circumstances and preferences.

And remember: you don’t need to wait until 1 September to start the conversation.

The new criteria come into effect on 1 September, so if you think they may change your treatment options, it may be useful to discuss them with your healthcare team in advance.

And finally…

The consultation process demonstrated just how much people care about access to diabetes medicines — and how complex the issue of equity can be.

Pharmac says the feedback it received helped shape the final decision.

Almost 1,900 people and organisations took the time to respond, raising questions about clinical effectiveness, affordability, health equity, Māori and Pacific health outcomes, the HbA1c threshold, cardiovascular risk assessment, and the practical realities of accessing healthcare.

The final decision doesn’t resolve all of those questions.

But it does represent a significant change in funded access to some important medicines for people living with Type 2 diabetes in Aotearoa New Zealand.

The next step is to see what happens in the real world.

Will more people gain access?

Will treatment begin earlier?

Will health outcomes improve?

And — critically — will wider access translate into more equitable access?

Those are questions worth continuing to ask.

Find out more

For the full details, including the new Special Authority criteria, see Pharmac’s:

Decision to widen access for Type 2 diabetes medicines

For background on the consultation and how the original proposal was received, you can also read the earlier Diabetes Info NZ article:

Understanding Pharmac’s Proposed Changes to Type 2 Diabetes Medication Funding

Published: August 2026