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

There has been a lot of discussion recently about Pharmac’s proposed changes to funded access for some Type 2 diabetes medicines — particularly on social media and within the diabetes and healthcare communities.

For many people living with diabetes and their whānau, it can feel confusing trying to understand:

• what is actually being proposed,
• why some people are welcoming the changes,
• why others are deeply concerned,
• and what it might mean personally.

This post aims to explain the consultation in simple terms and help people make sense of the wider conversation.

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Which medications are we talking about?

The consultation relates to funded access for:

• Empagliflozin (Jardiance/Jardiamet)
• Dulaglutide (Trulicity)
• Liraglutide (Victoza)

These medications are increasingly recognised internationally not only for lowering blood glucose levels, but also for helping reduce:

• heart disease,
• kidney disease,
• hospitalisations,
• and long-term diabetes complications in general.

What is Pharmac proposing?

1. Lowering the cardiovascular risk threshold

Currently, one criterion for accessing these funded medicines requires people to have a:

• 15% or higher risk of a serious cardiovascular event within the next 5 years.

Pharmac is proposing to lower this threshold to:

• 10% or higher risk over 5 years.

In simple terms, this could allow more people to access these medicines earlier — before becoming more unwell or developing serious complications.

Many people living with diabetes have shared frustration about needing to “wait until things get worse” before becoming eligible for these newer medicines.

2. Removing Māori and Pacific ethnicity-based access criteria

This is the most debated part of the consultation.

Since 2021, Māori and Pacific peoples have been able to access these medicines earlier through specific equity-based criteria.

These criteria were originally introduced because Māori and Pacific communities experience:

• higher rates of Type 2 diabetes,
• earlier and more severe complications, including higher rates of kidney and heart disease,
• and inequitable access to healthcare services and medications.

Pharmac is now proposing to remove these ethnicity-based criteria while in theory ‘broadening eligibility overall’.

Why are healthcare providers and advocates concerned?

Several diabetes organisations, Māori health leaders, clinicians, and healthcare providers have raised concerns about the proposal.

The consensus is that the ‘diabetes community’ largely supports lowering the cardiovascular risk threshold to 10%, but strongly does not support removal of the ethnicity-based criteria.

Areas of concern include:

• evidence suggesting the currently funded ethnicity pathway improved access,
• the real potential that inequities could worsen again,
• and that the “same rules for everyone” does not necessarily lead to equal outcomes in real life.

In addition, it has been pointed out that:

• not everyone has equal access to cardiovascular risk assessments,
• primary care access remains difficult for many people,
• and barriers such as cost, transport, workforce shortages, and continuity of care still affect many communities.

Others have questioned whether a two-week consultation period allows enough time for meaningful engagement and feedback.

Why might some people support the proposal?

Others support the proposed changes because lowering the cardiovascular risk threshold may allow many more people to access treatment earlier.

Some people also believe medicine access should be based on broader clinical criteria rather than ethnicity-specific pathways.

Pharmac estimates that thousands more people may become eligible for funded treatment if the proposal goes ahead.

Supporters argue that earlier treatment may help reduce:

• heart attacks,
• strokes,
• kidney failure,
• and other serious diabetes complications over time.

The wider context: Pharmac’s 2025 Access Criteria Policy

Pharmac says the proposal aligns with its newer Access Criteria Policy introduced in 2025.

The policy aims to make medicine access criteria:

• simpler,
• more consistent,
• easier to navigate,
• and less administratively complex.

However, some clinicians and health advocates are questioning whether more “universal” or simplified criteria always lead to equitable outcomes in practice — particularly when healthcare access itself is already unequal.

One of the key questions emerging from this consultation is:

If barriers to healthcare still exist, will broader eligibility alone be enough to improve equitable outcomes?

A lived experience perspective

From a lived experience perspective, it is understandable why this consultation is generating strong feelings.

Many people living with diabetes have experienced frustration at needing to become “sicker” before accessing newer medicines. Earlier access and prevention matter.

At the same time, many Māori and Pacific whānau are understandably worried about losing an equity pathway that was specifically introduced to address longstanding inequities in diabetes outcomes and healthcare access.

This is not a simple “for or against” conversation.

The real question may be:

How do we ensure that changes to medicine access genuinely improve equitable outcomes in real life — not just on paper?

Eligibility criteria alone do not automatically create equitable access if people still face barriers such as:

• difficulty getting appointments,
• cost pressures,
• transport challenges,
• workforce shortages,
• lack of continuity of care,
• or difficulty navigating the health system.

These broader social and healthcare factors still matter enormously.

That is why lived experience voices are important in this consultation.

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Have your say!

Pharmac is inviting feedback from people living with diabetes and their whānau, healthcare professionals, and community organisations.

You do not need to write a long or technical submission. Simply fill in the online form or send your submission by email to consult@pharmac.govt.nz

Share your thoughts and/or experiences around:

• accessing care,
• medicine eligibility,
• diabetes complications,
• cost barriers,
• healthcare access,
• or what equitable care means to you

>> Pharmac consultation document

>> Pharmac online feedback form

Submissions (extended period) now close Thursday 11th June 2026 at 5pm

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Published 25th May 2026; Updated 26th May 2026

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