14 September 2021: OIA response | Background papers for decision to fund and promote diabetes medicines specifically for Māori and Pacific peoples

14 September 2021 

Dear [name and contact details withheld] 

Request for information 

I am writing in response to your request dated 17 August 2021 under the Official Information Act 1982 (OIA) for background information about our decision to include ethnicity criterion for two new diabetes medicines. You requested: 

the background papers for the policy decision on the provision of this medicine and the public advertising campaign.

I note you are referring to Pharmac’s You are a priority campaign, which encourages Māori and Pacific peoples with type 2 diabetes to speak with their doctor about accessing newly funded medicines. This campaign relates to our recent decision to fund two new medicines for type 2 diabetes (empagliflozin and dulaglutide). 

To assist with responding to your request I have included some background information about our equity work within this letter. 

Overarching health priorities in Aotearoa New Zealand

Pharmac uses the Government's health priorities when considering funding a medicine or medical device. The overarching health priorities and health conditions we consider when making decisions are detailed on our website: www.pharmac.govt.nz > About > What we do > How the health priorities affect Pharmac's work 

We are committed to eliminating inequities in access to medicines. Our campaign was designed specifically with Māori and Pacific peoples in mind as they are two of our priority populations. Diabetes is also one of our priority health conditions as it disproportionately affects Māori and Pacific peoples. 

We also recognise the benefit special measures can have in achieving equality. The Human Rights Commission has shared information about positive actions to achieve equality(external link) on its website. 

Equitable access and use of medicines and related products

Research shows that Māori are continuing to receive medicines in the community at a lower rate than non-Māori. This means Māori are not able to benefit from the health system in the same way as non-Māori and this is a concern. We believe every person in New Zealand should be able to access the funded medicines they need. 

Our Strategic Direction, driven by our six strategic priorities, highlights our commitment to upholding the articles of te Tiriti o Waitangi and advancing Māori health and aspirations. We have also developed Te Whaioranga (our Māori Responsiveness Strategy) and the Pacific Responsiveness Strategy. These strategies drive and support our work to enable equitable access and use of medicines and related products for Māori and Pacific peoples. 

We are working with our partners in the health sector to identify barriers and underlying causes of these inequities so that we can improve use of medicines in this area. This includes investigating areas of our decision-making to ensure our own processes aren’t contributing to inequities. We have developed a discussion paper titled Achieving medicine access equity in Aotearoa New Zealand: towards a theory of change as part of this work.

More information about our organisational strategies and programmes can be found on our website: www.pharmac.govt.nz > About

Decision to name Māori and Pacific peoples in funding criteria and campaign

Mortality rates for Māori with type 2 diabetes is seven times higher than non-Māori, and it is predicted that one in four Pacific peoples will have the disease within 20 years. 

In January 2021, we announced the decision to fund two new medicines for New Zealanders who are at high risk of heart and kidney complications from type 2 diabetes. 

Due to the disproportionate affect that type 2 diabetes has on Māori and Pacific peoples, we also made the decision to specifically name these ethnicities within the funding criteria for these medicines. 

Information about these new medicines was shared using our normal communication methods. This includes publishing on our website, posting on social media, and sending information to health professionals to share with their patients. However, we are aware these methods don’t always reach Māori and Pacific communitunies. 

The aim of the ‘You are a Priority’ campaign is to raise awareness with Māori and Pacific communitunies and support our goal of reducing inequities. Our intention was not to make anyone feel excluded, it was about getting information to people we don’t usually reach. 

While the ethnicity based Special Authority criteria and awareness campaign is increasing the number of Māori and Pacific people taking the medicine, it is not disadvantaging other New Zealanders who also meet the criteria. 

As of 1 August 2021, there have been 231,278 approved Special Authority applications for empagliflozin with and without metformin. Of these applications, 47% had ticked the Māori or Pacific criteria. 

Documents for your request

In response to your request for documents, please find a copy of the business case for the advertising campaign attached with this response.

As noted in our email to you on 17 August 2021, we have already published all the information we hold about including ethnicity criterion within the Special Authority for empagliflozin. Therefore, we have not provided a copy of the background papers for the Special Authority criterion decision with this response on the basis that the information is already publicly available (section 18(d) of the OIA).

Please note you have the right, by way of complaint under section 28(3) of the OIA to an Ombudsman, to seek an investigation and review of our decision.

We trust that this information answers your queries. We are making our information more freely available, so we now publish selected OIA responses (excluding personal details) on our website. Please get in touch with us if you have any questions about this. 

Yours sincerely 

Rachel Read
Manager, Policy and Government Services