Achieving medicine access equity in Aotearoa New Zealand: towards a theory of change

Not all New Zealanders are achieving best health outcomes from medicines funded by PHARMAC.

  • Due to a range of systemic barriers, Māori are not able to benefit from medicines in the community in the same way as non-Māori.
  • Although not so extensively studied, Pacific peoples and other groups are likely to face similar barriers.

Understanding why, and what we can do

To achieve our goal of equitable access to medicines, we need to understand the problem and how to address it.

We’ve developed a discussion piece which:

  • defines 'medicine access equity' - what fairer access to medicines would look like
  • examines the things that lead to inequitable access
  • builds a theory of change which reaches across the whole health sector, and beyond.


What is our aim? To eliminate inequities in access to medicines by 2025

What do we mean by medicine access equity?

PHARMAC defines medicine access equity to mean that that:

  • everyone should have a fair opportunity to access funded medicines to attain their full health potential
  • no one should be disadvantaged from achieving this potential.

In this context, different levels of support are needed for some community groups to get fair access to funded medicines.

This builds on the World Health Organization (WHO) definition of equity and health equity:

The absence of avoidable, unfair or remediable differences in funded medicine access among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification.

What do we mean by ‘access’?

For the best and most equiteable health outcomes, it's not enough to define access solely based on whether a medicine can be prescribed to someone. It also matters that they can get it and use it. We're using a wider definition that takes into account:

  • Availability - whether the medicine has been deemed safe by a regulatory body, is publicly funded and there is adequate supply.
  • Utilisation - the extent to which a population gains access to and uses available medicines optimally.
  • Outcomes - the quality, relevance and effectiveness of prescribing and dispensing.

Access, in this context, can refer to the first time someone is prescribed a medicine as well as ongoing access for long-term conditions.

What is our focus?

This work focuses on medicines that are publicly funded. Unfunded medicines are out of scope. However, PHARMAC will examine our decision-making processes and systems for investing in medicines to make sure our funding decisions don't contribute to inequities for priority populations.

We'll focus on conditions that respond well to medicines. This includes medicines for the prevention, treatment and/or management of:

  • asthma
  • diabetes
  • gout
  • hypertension (high blood pressure)
  • primary and secondary prevention of a cardiovascular event.

In line with the Government’s priorities, we'll focus on the primary care setting. Over time, we'll look to improve equity of access to medicines in secondary care and for funded vaccines.

Which populations?

First, we'll give priority to our Treaty partner: Māori. There's strong evidence that Māori experience health inequities.

Other priority populations will include:

  • Pacific peoples
  • people living in high socioeconomic deprivation
  • people living in rural and isolated areas
  • people who've been refugees.

What are the key enablers of medicine access equity?

The primary drivers for change to eliminate inequities in access to medicines we have identified are:

  1. Availability – how PHARMAC makes and implements funding decisions so that everyone who is eligible can access funded medicines 
  2. Affordability – reducing cost barriers so that people can afford funded medicines
  3. Accessibility – ensuring people don’t face challenges getting to see a prescriber or to the pharmacy
  4. Acceptability – the ability of health services to create trust, so patients are informed and engaged enough to accept the medicines they’ve been prescribed
  5. Appropriateness – the adequacy and quality of prescribing to ensure equitable health outcomes.

Each of these have several secondary drivers that contribute to them.

As far as we know, this is the first New Zealand publication that discusses medicine access equity and brings together expert opinion and evidence to build a theory about how to improve it.

While a lot of discussion in the media is about equity of access to new medicines, we believe there are greater gains overall for all New Zealanders by improving access to medicines we already fund. These funded medicines can help people live better and healthier lives. Right now, our work focuses on conditions that represent a high burden of disease, such as heart disease, asthma, COPD, diabetes, and gout.

We encourage you to read this alongside Te Whaioranga, our Māori Responsiveness Strategy.

This paper is intended to prompt discussion and action across the health system, and we encourage feedback.

Get in touch with our Access Equity team at