Pharmac Widens Diabetes Access to 31,000 More People, and the Non-Pharmac Gap Does Not Move

Source: Pharmac, decision to widen access for type 2 diabetes medicines

From 1 September 2026 four type 2 diabetes medicines lose their ethnicity and cardiovascular criteria. Nobody keeps a running tally of what Pharmac's decisions do to the gap health insurance exists to fill, so we started one.

By Henry Smith · Health system · 2026-08-12

From 1 September 2026, about 14,000 more New Zealanders can get funded empagliflozin, dulaglutide or liraglutide in the first year, rising to about 31,000 after five years. Every one of those medicines was already funded before the decision. That distinction is the whole story for anyone holding a non-Pharmac drug benefit.

What Pharmac decided

Pharmac announced on 5 August 2026 that from 1 September 2026 the Special Authority criteria for empagliflozin (Jardiance), empagliflozin with metformin (Jardiamet), dulaglutide (Trulicity) and liraglutide (Victoza) will be amended to make them available to all people with type 2 diabetes who cannot get their HbA1c below 53 mmol/mol using other funded diabetes medicines. The decision removes the ethnicity-based criteria, the cardiovascular risk threshold and the diabetic kidney disease indication (Pharmac, 5 August 2026, retrieved 20 August 2026).

Pharmac states that 145,000 people currently use these medicines, that around 14,000 more will benefit in the first year, and that the figure rises to around 31,000 after five years. Patients still need to start on empagliflozin or empagliflozin with metformin before accessing funded liraglutide or dulaglutide where clinically appropriate.

The decision is wider than what Pharmac consulted on. The May 2026 proposal was to remove the ethnicity criteria and lower the cardiovascular risk threshold. Pharmac says it received nearly 1,900 submissions, many concerned that removing the ethnicity criteria would cost eligible Māori and Pacific people access, and it responded by widening the proposal further so that "everyone, including Māori and Pacific people, who would currently be able to access these medicines would be covered under these revised criteria".

The 2026 ledger nobody maintains

Pharmac publishes each decision on its own page and never adds them up. Here is the running total, taken from Pharmac's own consultations and decisions feed, which carried twenty items covering 2 June to 12 August 2026 when we retrieved it on 20 August 2026.

Published	Decision	Effective	What actually changed	Pharmac's own people estimate
2 Jun 2026	Extend pharmacy services	2 Jun 2026	Already-funded medicines supplied without a prescription	not published
9 Jun 2026	Ambulance medicines and tenecteplase	1 Jul 2026	New funding for tenecteplase and glucose oral solution, plus transfer of ambulance medicines to Pharmac	not published
24 Jun 2026	Another brand of methylphenidate	1 Oct 2026	New brand of an already-funded medicine, for supply resilience	not published
30 Jun 2026	Rosuvastatin open listing	1 Oct 2026	Special Authority and hospital restrictions removed	76,000 now, plus 65,000 in year one, plus 108,000 over five years
5 Aug 2026	Type 2 diabetes medicines	1 Sep 2026	Special Authority criteria widened	145,000 now, plus 14,000 in year one, plus 31,000 over five years
12 Aug 2026	Estradiol TDP Mylan patches	1 Sep 2026	Three months' supply allowed, patch limit removed	not published

Compiled from Pharmac's consultations and decisions feed, retrieved 20 August 2026, and the individual decision pages linked in the references. The feed carries only the twenty most recent items, so decisions before 2 June 2026 are not in this table.

Two of the six carry patient counts, and adding them is the arithmetic Pharmac did not do. Together the rosuvastatin and diabetes decisions cover 221,000 current users and are estimated to add 79,000 people in year one and 139,000 over five years. That is a 35.7% increase in year one and a 62.9% increase over five years in the number of people accessing those two medicine groups, from two decisions taken five weeks apart.

Does any of this shrink the non-Pharmac gap?

No, and the reason is a definition rather than an opinion.

A non-Pharmac drug benefit exists to pay for medicines that Medsafe has approved but Pharmac does not fund. nib describes its non-PHARMAC Plus option as cover for "Medsafe-approved, non-PHARMAC funded drugs prescribed in line with Medsafe's guidelines" (nib NZ, retrieved 20 August 2026). Southern Cross's chemotherapy sub-limit applies to drugs that are Medsafe-indicated but not funded by Pharmac (Southern Cross, retrieved 20 August 2026).

Empagliflozin, dulaglutide, liraglutide and rosuvastatin were all on the Pharmaceutical Schedule before these decisions and are all on it after. They are Pharmac-funded medicines. What changed is not whether the state pays for them, but who qualifies.

That leaves a third category that neither system names clearly: a medicine that is funded, but not for you. Before 1 September 2026, a person with type 2 diabetes and an HbA1c above 53 mmol/mol who was not Māori or Pacific, had no established cardiovascular disease, no 15% five-year risk and no diabetic kidney disease was in exactly that position. Pharmac funded the medicine. It did not fund it for them. On the plain wording above, a non-Pharmac benefit was not designed to catch them either, because the medicine is Pharmac-funded.

So the honest answer to whether the non-Pharmac benefit got more or less valuable this year is: on the evidence of June to August 2026, neither. Not one decision in the ledger moved a medicine from unfunded to funded for community use. The single instance of genuinely new funding, tenecteplase, is a pre-hospital emergency medicine administered by ambulance services, not something a private drug benefit would ever have been asked to pay for.

What did shrink is the Special Authority gap, and it shrank by roughly 79,000 people in year one. That is a real improvement in access, and it is a different gap from the one health insurance sells cover for.

What it means for your cover

Three practical consequences.

If you have type 2 diabetes and your HbA1c has stayed above 53 mmol/mol on other funded medicines, the decision applies to you from 1 September 2026 regardless of your ethnicity or cardiovascular risk. That is a prescriber conversation, not an insurance one.

If you hold a non-Pharmac drug benefit, nothing in this year's decisions reduces what that benefit is for. The gap it covers is unfunded oncology and biologic medicines, where the published treatment costs run into six figures and the standard sub-limits do not. We chart every published non-Pharmac limit against the published cost of the treatment in non-Pharmac drug cover in NZ.

If you were relying on a non-Pharmac benefit to fund a scheduled medicine you cannot get Special Authority for, check the wording rather than assuming. The two wordings we quote above turn on whether Pharmac funds the medicine, not on whether Pharmac funds it for you, and that is a claims question no published page answers.

The honest limits

The ledger is incomplete by construction. Pharmac's decisions feed carries only the twenty most recent items, so this table starts on 2 June 2026. Decisions taken between January and May 2026 are not covered and we make no claim about them. We will extend the table forward from here rather than backfilling from secondary sources.

The patient numbers are Pharmac's estimates, not outturns. The 14,000, 31,000, 65,000 and 108,000 figures are forecasts published at the time of the decision. Nothing has been measured yet.

The two people counts may overlap. A person could be counted in both the diabetes and the rosuvastatin estimates, since type 2 diabetes and statin therapy commonly coincide. Pharmac does not publish an overlap adjustment, so 79,000 and 139,000 are upper bounds on the number of distinct people, not confirmed distinct counts.

Only two insurer wordings were checked. There are more non-Pharmac benefit designs on the New Zealand market than the two quoted, the wordings differ, and a policy document will say more than a product page. Nothing here is a statement about what any insurer would pay on a specific claim.

Sources

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