Decision

One Blood Test Now Decides Who Gets Four Diabetes Medicines Funded

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

From 1 September 2026 the ethnicity and heart-risk rules come off four type 2 diabetes medicines, and one blood test decides instead. All four were already state-funded, so non-Pharmac drug cover does not move. The hole it leaves is the part worth reading.

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

What this means for you If you hold health cover with a non-Pharmac drug benefit, this decision changes nothing about what that benefit pays for: all four diabetes medicines were already funded by the state before it and still are, so the gap the benefit was built to fill has not moved. What did change is who can get a Special Authority, the form a doctor fills in to unlock funding, and from 1 September 2026 that turns only on whether your HbA1c blood sugar test stayed above 53 mmol/mol on other funded medicines, not on your ethnicity or heart risk. The grey area left over is a medicine Pharmac funds but not for you, because the two insurer wordings quoted here turn on whether Pharmac funds the medicine at all rather than whether it funds it in your case.

Written by Henry Smith · Reviewed by Smiths Insurance & KiwiSaver, licensed Financial Advice Provider (FSP712931)

From 1 September 2026, four type 2 diabetes medicines stop asking about your ethnicity and your heart risk. One blood test decides instead: HbA1c, the reading that shows your average blood sugar over the past three months. If other funded diabetes medicines have not brought yours below 53 mmol/mol, you qualify. That is now the whole test.

About 145,000 people already take these medicines. Pharmac expects around 14,000 more in the first year and around 31,000 more within five years (Pharmac, 5 August 2026). If that describes you, the conversation is with your doctor, not your insurer.

Every one of the four was already funded before this decision, which is why it does not touch your health insurance, and why the sharper story is who it still leaves out.

I pay for non-Pharmac drug cover. Does this change it?

No. It does leave one hole in that cover, and the hole is the part worth knowing.

Two agencies stand between a medicine and you. Medsafe decides whether a medicine is safe to sell here. Pharmac decides which of those the state pays for. A non-Pharmac drug benefit, the add-on some health policies sell, exists to buy the ones that clear the first gate and not the second.

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). Southern Cross caps what it will pay for cancer drugs, and that sub-limit applies to drugs Medsafe has approved but Pharmac does not fund (Southern Cross).

Read those two wordings and a third category falls out that neither system names: a medicine Pharmac funds, but not for you.

Until 1 September that described a lot of New Zealanders with type 2 diabetes. Blood sugar still too high on the medicines they could get, but the wrong ethnicity, the wrong heart risk or the wrong kidney results to unlock the newer ones. Pharmac funded the medicine. It just did not fund it for them.

A non-Pharmac benefit was not built to catch that person either, because on both wordings the medicine counts as Pharmac-funded. So somebody in that middle ground can be paying for an add-on that does not reach them, and no published page says how it would land on a real claim.

What Pharmac actually changed

On 5 August 2026 Pharmac named four medicines: empagliflozin (Jardiance), empagliflozin with metformin (Jardiamet), dulaglutide (Trulicity) and liraglutide (Victoza).

All four sit behind a Special Authority, the form your doctor fills in that decides who gets funding. The old form asked about your ethnicity, about whether you had diagnosed heart disease or a five-year heart risk of 15% or more, and about diabetic kidney disease. All of that goes, replaced by the single HbA1c test. There is still an order to it. Empagliflozin comes first, alone or with metformin, then the other two if your doctor agrees.

The final decision went further than the one Pharmac consulted on. Its May 2026 proposal was narrower: drop the ethnicity rules, lower the heart risk threshold. Nearly 1,900 submissions came back, many of them warning that dropping the ethnicity rules would cost eligible Māori and Pacific people their access. So Pharmac widened the plan instead, so that "everyone, including Māori and Pacific people, who would currently be able to access these medicines would be covered under these revised criteria" (Pharmac).

What else has Pharmac changed this year?

Pharmac publishes each decision on its own page and never adds them up. So we did. Below is every decision on its public feed, which carried twenty items covering 2 June to 12 August 2026 when we retrieved it.

Published	Decision	Effective	What actually changed	People Pharmac expects to reach
2 Jun 2026	Extend pharmacy services	2 Jun 2026	Some already-funded medicines can be supplied without a prescription	not published
9 Jun 2026	Ambulance medicines and tenecteplase	1 Jul 2026	New funding for tenecteplase, an emergency clot-busting drug, and for glucose oral solution, plus ambulance medicines moved under Pharmac	not published
24 Jun 2026	Another brand of methylphenidate	1 Oct 2026	A second brand of a medicine already funded, so supply is harder to break	not published
30 Jun 2026	Rosuvastatin, a cholesterol pill, opened up	1 Oct 2026	Special Authority form and hospital restrictions dropped	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 rules 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, 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.

Only two of the six come with people counts, and between them the cholesterol and diabetes changes already reach 221,000 people. Pharmac expects those two to add 79,000 more in year one and 139,000 over five years, a 35.7% rise and then a 62.9% one, from decisions taken five weeks apart. Nobody at Pharmac published that sum.

Now read the table for what is not in it. Not one of the six moved a medicine from unfunded to funded for everyday use. The only genuinely new funding, tenecteplase, is given by ambulance crews at an emergency, and no private drug benefit was ever going to be billed for that. What shrank this year is the Special Authority gap, by roughly 79,000 people in year one: a real gain in access, and a different gap from the one health insurance sells cover for.

What this leaves you with

If you have type 2 diabetes and other funded medicines have not brought your HbA1c below 53 mmol/mol, the change applies to you from 1 September 2026, whatever your ethnicity or heart risk (Pharmac, 5 August 2026). Nothing about your insurance decides that.

If you pay for a non-Pharmac drug benefit, none of this year's decisions makes it less useful. The gap it covers is unfunded cancer and biologic medicines, the lab-made drugs used for conditions like severe arthritis, where published treatment costs run into six figures and the cover limits do not. We chart every published non-Pharmac limit against the published cost of the treatment in non-Pharmac drug cover in NZ.

And if that benefit was the fallback in your mind for a funded medicine you cannot get a Special Authority for, the wording is the thing to read. Both quoted here turn on whether Pharmac funds the medicine at all, not on whether it funds it for you.

Where could this be wrong?

The table is incomplete, and not by accident. Pharmac's feed carries only the twenty most recent items, so ours starts on 2 June 2026. We make no claim about decisions taken between January and May 2026, and we will add new ones as they come rather than backfill from other sources.

The people numbers are forecasts, not head counts. The 14,000, 31,000, 65,000 and 108,000 figures were Pharmac's estimates on the day of each decision. Nothing has been measured yet.

The two counts may double up. The same person can appear in both the diabetes estimate and the cholesterol one, because type 2 diabetes and cholesterol pills often go together, and Pharmac publishes no adjustment for that. Treat 79,000 and 139,000 as ceilings.

We read two insurer wordings, not the market. Other insurers write non-Pharmac cover differently, and a full policy document says more than a product page. Nothing here tells you what any insurer would pay on a particular claim.

What this means for your cover

Public waiting lists and what private treatment costs are the two numbers health cover is bought against. Health insurance in New Zealand

Sources

Every source below was read and checked on 21 August 2026.

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