Pharmac's Diabetes Drug Access Overhaul Under Fire: No Māori Impact Modelling Conducted
核心洞察
Associate Health Minister David Seymour confirmed no modelling was undertaken on how proposed changes to Type 2 diabetes (搜索) medicine access would affect Māori health outcomes or complication rates.
Pharmac (搜索)'s proposal would remove ethnicity-based priority access for Māori and Pacific patients to drugs including Jardiance, Trulicity, and Victoza, replacing it with a lowered cardiovascular risk threshold.
Pharmac (搜索)'s own board papers estimate up to 7,000 fewer Māori and Pacific people could become newly eligible for these medicines over five years under the revised criteria.
Associate Health Minister David Seymour has confirmed that neither he nor Pharmac (搜索) conducted any modelling on how proposed changes to Type 2 diabetes (搜索) medicine access would affect diabetes-related complications among Māori, sparking sharp criticism from Te Pāti Māori and raising concerns about health equity in Aotearoa New Zealand.
The admissions came through responses to Written Parliamentary Questions from Te Pāti Māori co-leader Debbie Ngarewa-Packer. Seymour confirmed in writing that "no modelling on diabetes related complications for Māori was carried out."
Pharmac (搜索) is currently consulting on a proposal to remove the ethnicity-based pathway that allows Māori and Pacific peoples with Type 2 diabetes (搜索) to access medicines including Jardiance (empagliflozin), Jardiamet (搜索), Trulicity (dulaglutide), and Victoza (liraglutide) without having to demonstrate specific cardiovascular or kidney disease risk factors.
What the Proposal Would Change
Under the proposed changes, the ethnicity criterion would be eliminated, and the cardiovascular disease risk threshold required for access would be lowered from 15 per cent to 10 per cent over five years. Pharmac (搜索) argues this would allow more people to benefit from treatment earlier, estimating that more than 23,000 additional people could become eligible for the medicines over five years, with around 10,000 expected to access treatment in the first year.
However, a board paper prepared for Pharmac (搜索) directors in March acknowledged that removing the ethnicity criterion "may introduce barriers to access for some Māori and Pacific people" because it would require additional testing and healthcare visits. The same paper estimated the proposed changes could result in "up to 7,000 fewer Māori and Pacific people becoming newly eligible" for the medicines over five years.
Pharmac (搜索) noted the estimate was theoretical because some patients qualify under multiple eligibility pathways, making it difficult to determine how many people rely solely on the ethnicity criterion. The agency's analysis also acknowledged uncertainty about the scale of the impact, stating: "While removing the ethnicity criterion could have a negative impact for Māori and Pacific people, the scale of that impact is uncertain."
Political and Equity Concerns
Ngarewa-Packer said the Government was making significant changes to Māori access without understanding the consequences. "They don't know who they're harming. They don't know how many Māori with diabetes rely on this. They haven't modelled the complications, the amputations, the renal failure, the early deaths. And they're proceeding anyway," she said.
The Te Pāti Māori co-leader characterised the process as politically driven rather than grounded in Māori health equity. "This is what race-blind policy looks like. Treating everyone the same in a system built on inequality doesn't create fairness. It locks it in," Ngarewa-Packer said.
"Māori face the highest rates of diabetes-related complications in Aotearoa. These criteria exist because of that gap. Removing them without evidence is a Tiriti breach, full stop."
Seymour's Response
In a statement, Seymour defended the proposal, saying it would significantly expand access to the medicines. He noted that Pharmac (搜索) expected around a third of those gaining access would be Māori or Pacific peoples. "That is the benefit of providing access to Kiwis based on their clinical need instead of who their ancestors are," Seymour said.
The Minister said he had confidence in Pharmac (搜索)'s funding model and noted that decisions on medicine access are made independently of ministers. A spokesperson for Seymour added that Pharmac's decision-making process is independent from the Government and that ministers do not receive the analysis, modelling, or data underpinning its decisions.
In another Written Parliamentary Question, Seymour confirmed he had not specifically instructed Pharmac (搜索) to remove ethnicity-based criteria but said his 2025 Letter of Expectations directed the agency to give effect to Cabinet Circular CO(24), which outlines the Government's preference for needs-based service provision. The March board paper similarly states the review was undertaken in line with Cabinet Circular CO(24), the Government's Letter of Expectations, and Pharmac's interpretation of the Pae Ora Act.
Pharmac (搜索)'s Clinical Position
Pharmac (搜索) Chief Medical Officer Dr David Hughes said the agency's clinical advisors had advised that lowering the cardiovascular disease risk threshold would mean many Māori and Pacific people with Type 2 diabetes (搜索) would still meet the proposed access criteria. Hughes said Pharmac was consulting on the proposal to ensure the criteria work in practice and do not create unintended barriers before any final decision is made.
The consultation closes on 11 June, with members of the public able to make submissions through the Pharmac (搜索) consultation website.