It took Selina Patia 10 years to get her type 2 diabetes under control.
“When I was first diagnosed, I felt so lost. I didn’t know what to do or what my next steps were.”
Patia was diagnosed in 2016. Uncomfortable with the prospect of insulin injections, she took medication that caused ongoing stomach problems.
“I kept saying the meds were causing me issues, but nobody was listening. I was just told, ‘Keep taking your meds and watch what you’re eating.’”
She began researching diabetes herself, talking to people about their experiences and eventually changing doctors.
It was through that process that she found treatment options that worked for her.
Patia, who is Māori and Pasifika, says her experience reflects challenges faced by others in her communities, which experience some of the poorest outcomes for type 2 diabetes.
Those inequities are now under renewed scrutiny after Pharmac removed ethnicity-based eligibility criteria that previously gave Māori and Pasifika greater access to funded type 2 diabetes medicines.
The decision prompted strong criticism. Although Pharmac has since expanded access to the medicines, experts remain concerned Māori and Pasifika may still face barriers to receiving appropriate care.
A puzzling decision
Pharmac’s latest decision came after it proposed removing the ethnicity criteria and lowering the cardiovascular risk threshold for access to four medicines.
The original proposal, released in May, was expected to give an estimated 23,000 more people access to the medicines over five years.
Under the revised proposal, access will instead be widened to anyone with type 2 diabetes whose blood sugar remains high despite other treatment. Pharmac estimates this will give an additional 31,000 people access over five years.
Pharmac said it received nearly 1,900 submissions during consultation, with many concerned that removing the ethnicity criteria could mean Māori and Pacific people who qualified under the existing criteria, but were not yet accessing treatment, could lose access.
Submissions also highlighted the disproportionate impact of type 2 diabetes and its complications on Māori and Pacific communities.
“Following the substantial feedback received from our consultation, Pharmac worked on an updated proposal that would enable us to widen access to these medicines for even more people than we originally proposed,” Pharmac said.
Associate Health Minister David Seymour welcomed the decision.
“Pharmac has made the decision to fund these medicines for everybody who needs them, no matter their ethnicity,” he said.
The medicines will be available to a wider group from Sept. 1, including empagliflozin, empagliflozin with metformin, liraglutide and dulaglutide.
Concerns inequities could worsen
Mataroria Lyndon, from Te Tiratū Iwi Māori Partnership Board, says removing the ethnicity criteria assumes the health system is already delivering equal access.
He says that is not the case.
“Māori and Pasifika are more likely to live with diabetes in Aotearoa. Māori are twice as likely as non-Māori to have diabetes,” Lyndon says.
Diabetes can lead to serious complications, including heart and kidney disease, vision loss and amputations.
“Māori are three times more likely than non-Māori to lose their leg or foot,” he says.
“That’s why we need a targeted response to address it, not a one-size-fits-all approach.”
Lyndon says Pharmac needs to provide evidence that removing the ethnicity criteria will not worsen outcomes for Māori.
“The issue was that even proposing to remove an ethnicity criterion is a breach of Te Tiriti, but it also undermines the need.”
University of Waikato associate professor Rawiri Keenan is also concerned about the decision, although he welcomes the wider access to the medicines.
“On the one hand, making it available to any patient with diabetes who’s not meeting the targets for good control means those barriers shouldn’t be there,” he says.
“But historically, we know that they are there.”
Keenan says ethnicity-based criteria played an important role in improving access to care for Māori and Pacific people.
“There’s always a risk that when it isn’t named, it gets forgotten.”
For Patia, the debate reflects a problem she experienced first-hand: knowing there should be another option, but not knowing how to find it.
“I started researching on my own, started learning, started talking to people about their own journey and what that looks like.”
