Te Pāti Māori says Pharmac’s proposed changes to Type 2 diabetes medicine access were put forward without modelling their impact on Māori health outcomes, despite advice that the changes could create new barriers for Māori and Pacific patients.
In responses to Written Parliamentary Questions from Te Pāti Māori co-leader, Debbie Ngarewa-Packer, revealing neither Associate Health Minister David Seymour nor Pharmac undertook modelling on the potential impact the changes could have on diabetes-related complications for Māori.
In written responses, Seymour confirmed, “no modelling on diabetes related complications for Māori was carried out.”
Pharmac is currently consulting on a proposal to remove the ethnicity-based pathway that currently allows Māori and Pacific peoples with Type 2 diabetes to access medicines including Jardiance, Jardiamet, Trulicity and Victoza without having to demonstrate specific cardiovascular or kidney disease risk factors.
The proposal would instead lower the cardiovascular disease risk threshold required for access from 15 per cent to 10 per cent over five years, a move Pharmac says would allow more people to benefit from treatment earlier.
Te Pāti Māori co-leader Debbie 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.
‘Could create new barriers’
A board paper prepared for Pharmac directors in March acknowledged that removing the ethnicity criterion could create new barriers for Māori and Pacific patients.
Advice from Pharmac’s Obesity Treatments Advisory Group noted removing the 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.
However, Pharmac 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.
Pharmac’s analysis also acknowledged uncertainty about the scale of the impact on Māori and Pacific communities.
“While removing the ethnicity criterion could have a negative impact for Māori and Pacific people, the scale of that impact is uncertain,” the paper states.
Despite that uncertainty, Pharmac concluded that lowering the cardiovascular risk threshold would enable access for a larger group of people at high risk of developing cardiovascular and kidney complications and ranked the proposal as a high-value investment.
In another Written Parliamentary Question, Seymour confirmed he had not specifically instructed Pharmac 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.
Ngarewa-Packer said the documents point to a politically driven process rather than one 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.”
“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.” Ngarewa-Packer said.
Pharmac estimates more than 23,000 additional people could become eligible for the medicines over five years under the revised cardiovascular risk threshold, with around 10,000 expected to access treatment in the first year.
The consultation closes on 11 June.
‘Clinical need instead of who their ancestors are’ - Seymour
In a statement, David Seymour said the proposal would significantly expand access to the medicines, with around 10,000 additional people expected to benefit in the first year and 23,000 over five years.
He said Pharmac 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’s funding model and noted decisions on medicine access are made independently of ministers.
A spokesperson for Seymour said 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 a statement, Pharmac 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 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.
