There's no logic to it, really.
In New Zealand, a proposed change to how four targeted diabetes medications are allocated raises a quiet but consequential question: when a policy expands access for many, who bears the cost of that expansion? Pharmac's plan to remove ethnicity-based criteria for drugs proven to protect against diabetic kidney disease would broaden eligibility on paper, yet may withdraw a lifeline from Māori and Pasifika communities who carry a disproportionate and documented biological burden of the disease. The debate sits at the intersection of equity and universalism — a tension as old as public medicine itself.
- Māori and Pasifika New Zealanders face diabetes rates two to three times higher than Pākehā, and are specifically vulnerable to diabetic kidney disease — the very condition these four drugs were designed to slow.
- A 2021 Pharmac pathway gave these communities early access without requiring proof of existing organ damage, recognising that population-level risk was evidence enough — and that pathway is now on the chopping block.
- The proposed policy lowers the cardiovascular risk threshold for all patients but eliminates ethnicity criteria entirely, meaning drugs could flow toward people selected by a risk calculator rather than those with the highest proven vulnerability.
- Endocrinologists warn the reshuffling is medically illogical: other medications already address cardiovascular risk, but these four are the only ones shown to protect kidneys — making their redirection a clinical as well as an equity failure.
- With the consultation period closed and roughly 23,000 additional people projected to gain access, the unresolved question is whether two-thirds of that expansion coming from lower-risk populations constitutes fairness — or its opposite.
Pharmac, New Zealand's medicines funding agency, is proposing to change how four diabetes drugs — empagliflozin, its combination with metformin, dulaglutide, and liraglutide — are allocated. These are not routine treatments. They are the first medications proven to specifically protect against diabetic kidney disease, a complication that strikes Māori and Pasifika people at dramatically higher rates than other New Zealanders. One in twelve Māori have type 2 diabetes; for Pacific people, it is one in seven; for Pākehā, one in twenty.
In 2021, Pharmac acknowledged this disparity by creating a pathway allowing Māori and Pasifika patients to access these drugs without first demonstrating existing cardiovascular or kidney damage — a recognition that their population-level risk was itself sufficient evidence. The new proposal would dismantle that pathway. While it lowers the cardiovascular risk threshold from fifteen percent to ten percent for all patients, it removes ethnicity-based criteria entirely.
John Baker, chair of the Diabetes Foundation Aotearoa and an endocrinologist at Middlemore Hospital, has been direct in his criticism. Other medications already exist to manage cardiovascular risk, he notes — these four drugs are unique in their ability to slow the specific kidney damage that disproportionately affects Māori and Pasifika bodies. Allocating them based on a cardiovascular risk calculation means directing them away from the people they were designed to protect.
Pharmac projects that around 23,000 more people would access these medicines over five years. The government estimates roughly a third would be Māori or Pasifika — leaving two-thirds going to populations without the same kidney disease vulnerability. Associate Health Minister David Seymour has framed the removal of ethnicity criteria as a fairness measure, but critics argue the original criteria were never about identity — they were about biology, and about a measurable, population-specific risk of severe harm. The consultation period closed in late May 2026, and the outcome will determine whether the country's most at-risk diabetes patients retain access to the only medicines proven to protect their kidneys.
Pharmac, New Zealand's medicines funding agency, is proposing a change to how four diabetes drugs are allocated—and doctors are warning it could pull lifesaving medications away from the people who need them most.
The drugs in question are empagliflozin, empagliflozin combined with metformin, dulaglutide, and liraglutide. They are not ordinary diabetes treatments. They are the first medications shown to specifically protect against diabetic kidney disease, a devastating complication that strikes Māori and Pasifika people at rates far higher than other New Zealanders. One in twelve Māori have type 2 diabetes. For Pacific people, it is one in seven. Among Pākehā, the rate is one in twenty. In 2021, recognizing this disparity, Pharmac created a pathway that allowed Māori and Pasifika patients to access these four drugs without having to first demonstrate they had cardiovascular or kidney damage—a recognition that their risk was already proven by epidemiology.
Now Pharmac wants to change that. The proposal would lower the cardiovascular risk threshold for all patients from fifteen percent to ten percent, but it would also strip away the ethnicity-based criteria entirely. What sounds like expansion—more people getting medicine—is actually a reshuffling. The drugs would go instead to people whose risk is calculated on paper, not to people whose bodies carry a documented, population-level vulnerability to kidney failure.
John Baker, chair of the Diabetes Foundation Aotearoa and an endocrinologist at Middlemore Hospital, told RNZ the logic simply does not hold. "I don't know why the ministers have decided to go down this path," he said. "There's no logic to it, really." The problem, he explained, is that other drugs already exist to manage cardiovascular risk. These four medications are different. They are the only ones proven to slow the specific kidney damage that ravages Māori and Pasifika bodies. Giving them to people selected by a cardiovascular risk calculation means giving them to people who do not have the condition these drugs were designed to prevent.
Pharmac's own projections show the scale of the shift. The agency estimates that around 23,000 more people would access these medicines over five years. The government has said roughly a third of those would be Māori or Pasifika—meaning two-thirds would not be. Associate Health Minister David Seymour framed the change as a matter of fairness: Kiwis "shouldn't miss out on medicines because of where their ancestors came from." But that argument misses the point. The ethnicity criterion was never about ancestry as identity. It was about biology—about the fact that Māori and Pasifika people, as groups, face a measurably higher risk of a specific, severe complication. Removing that criterion does not level the playing field. It tilts it away from the people most likely to suffer.
Dr Ryan Paul, co-chair of Mahitahi Matehuka, the National Diabetes Network, has already raised the alarm. Baker's position is clear: the proposal will take drugs from Māori and Pasifika patients and give them to people who do not have a risk of diabetic kidney disease. The consultation period closed in late May 2026. What happens next will determine whether New Zealand's most vulnerable diabetes patients keep access to the only medications proven to protect their kidneys.
Citas Notables
The effect of the change they're proposing is that the drugs will be given to people who don't have a risk of diabetic kidney disease. And that doesn't make sense.— John Baker, chair of the Diabetes Foundation Aotearoa
Kiwis shouldn't miss out on medicines because of where their ancestors came from.— Associate Health Minister David Seymour
La Conversación del Hearth Otra perspectiva de la historia
Why does removing ethnicity as a criterion sound fair but actually isn't?
Because ethnicity here isn't about identity—it's a marker for a real biological difference in risk. Māori and Pasifika people develop diabetic kidney disease at much higher rates. These four drugs are the only ones that prevent that specific damage. If you remove the ethnicity criterion and rely on cardiovascular risk instead, you're measuring the wrong thing for the people who need the drug most.
So the government is saying everyone should be treated the same way. What's wrong with that?
Treating everyone the same only works if everyone faces the same risk. But they don't. A Pākehā person with a ten percent cardiovascular risk might never develop kidney disease. A Pasifika person with the same ten percent cardiovascular risk is statistically much more likely to. The drug targets kidney disease, not cardiovascular risk. So you'd be giving it to people who don't need it and taking it from people who do.
Pharmac says 23,000 more people will get access. Isn't that good?
More access sounds good in isolation. But it matters who those 23,000 are. If two-thirds of them are people without diabetic kidney disease risk, and you're pulling the drug from people who have that risk, you've actually made the system worse for the people most likely to suffer the worst outcomes.
What would happen to a Māori patient under the new rules?
They'd have to prove they already have cardiovascular or kidney damage before they could get the drug. But the whole point of these medications is to prevent that damage before it happens. The old rule recognized that Māori patients didn't need to prove damage first—their population-level risk was evidence enough. The new rule makes them prove it.
Is there any way this makes sense?
Only if you believe that fairness means ignoring real differences in risk. But medicine doesn't work that way. You treat based on who's most likely to be harmed.