Decision to enable new people to start treatment with dulaglutide for type 2 diabetes

What we’re doing

From 1 July 2025, we are removing the restriction that limits new people from starting treatment with dulaglutide (branded as Trulicity). This means people with type 2 diabetes who meet eligibility criteria will be able to start treatment.

Since 1 May 2024, access to both dulaglutide and liraglutide (branded as Victoza) has been limited to people already taking these medicines. This decision was made due to a worldwide shortage to ensure sufficient supply was available for those who had already started treatment.

We have received feedback from the diabetes clinical community that these medicines (GLP-1 agonists) are an important medicine for people with type 2 diabetes and it is a priority that access is restored as soon as possible.

From 1 March 2025 we removed the restriction on liraglutide as the supplier told us there was more stock available. Now the supplier of dulaglutide has assured us that there is enough stock to allow new patients to start on this treatment too.

More information about the ongoing supply issue on Pharmac’s website: Dulaglutide (Trulicity) and Liraglutide (Victoza): Supply issue

What does this mean for people?

Dulaglutide is a GLP-1 agonist that is used to treat type 2 diabetes. People with type 2 diabetes who have tried other appropriate treatment options and are at high-risk of diabetes related complications will be able to access funded dulaglutide from 1 July 2025.

As the supply of GLP-1 agonists remains constrained, we are reinstating the same criteria for dulaglutide that were in place prior to access being restricted in May 2024. These criteria are included in the details about this decision.

Who we think will be interested

  • People with type 2 diabetes and their whānau, families, caregivers and partners
  • Organisations with an interest in diabetes treatment(s)
  • Healthcare professionals in primary and secondary care who are involved in supporting people with type 2 diabetes
  • Health New Zealand | Te Whatu Ora
  • Pharmaceutical suppliers and wholesalers

Background about this decision

In September 2022, Pharmac was informed by the supplier of dulaglutide (Eli Lilly) of a supply issue affecting dulaglutide. This was due to unanticipated increases in global demand for dulaglutide and other GLP-1 agonists.

Our clinical advisors told us it was important to prioritise available stock for those already taking dulaglutide. They advised that an alternative treatment option should be made available to relieve some pressure on the demand for dulaglutide. Following this, Pharmac funded liraglutide from March 2023.

The global demand for GLP-1 agonists continued to grow rapidly, leading to a global supply shortage of both dulaglutide and liraglutide. In December 2023, access was restricted to those who had tried other treatment options. Unfortunately, this did not alleviate the supply issue and from 1 May 2024, a restriction was implemented meaning no new people were able to start treatment with GLP-1 agonists.

Now the restrictions on liraglutide and dulaglutide will be lifted. We will continue to work with the suppliers on the supply of GLP-1 agonists to ensure that people can access their medicines

Details about this decision

From 1 July 2025, the eligibility criteria for liraglutide will be amended as follows (additions in bold, deletions as strikethrough):

Special Authority for Subsidy

Note: Subsidy for patients with existing approvals prior to 1 May 2024. Approvals valid without further renewal unless notified. No new patients will be granted from 1 May 2024 until further notice.

Initial application from any relevant practitioner. Approvals valid without further renewal unless notified for applications meeting the following criteria:

All of the following:

  1. Patient has type 2 diabetes; and
  2. Target HbA1c (of 53 mmol/mol or less) has not been achieved despite the regular use of ALL of the following funded blood glucose lowering agents for a period of least 6 months, where clinically appropriate: empagliflozin, metformin, and vildagliptin; and
  3. Any of the following:
    1. Patient is Māori or any Pacific ethnicity*; or
    2. Patient has pre-existing cardiovascular disease or risk equivalent (see note a)*; or
    3. Patient has an absolute 5-year cardiovascular disease risk of 15% or greater according to a validated cardiovascular risk assessment calculator*; or
    4. Patient has a high lifetime cardiovascular risk due to being diagnosed with type 2 diabetes during childhood or as a young adult*; or
    5. Patient has diabetic kidney disease (see note b)*.

Notes: * Criteria intended to describe patients at high risk of cardiovascular or renal complications of diabetes.

a) Pre-existing cardiovascular disease or risk equivalent defined as: prior cardiovascular disease event (i.e. angina, myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, transient ischaemic attack, ischaemic stroke, peripheral vascular disease), congestive heart failure or familial hypercholesterolaemia.

b) Diabetic kidney disease defined as: persistent albuminuria (albumin:creatinine ratio greater than or equal to 3 mg/mmol, in at least two out of three samples over a 3-6 month period) and/or eGFR less than 60 mL/min/1.73m2 in the presence of diabetes, without alternative cause identified.

c) Funded GLP-1a treatment is not to be given in combination with [empagliflozin / empagliflozin with metformin hydrochloride] unless receiving (empagliflozin or empagliflozin in combination with metformin hydrochloride] for the treatment of heart failure.

Similar changes will be made to Part II of Section H of the Pharmaceutical Schedule.

Following the decision to fund empagliflozin for the treatment of heart failure with reduced ejection fraction, a note has been added to the eligibility criteria for dulaglutide to indicate that access to both treatments can only occur if empagliflozin is being used specifically for the treatment of heart failure.

We will continue to monitor the usage of both medicines (dulaglutide and liraglutide) and work with the respective suppliers to further secure stock availability and review the eligibility criteria accordingly.

If you have any questions about this decision, you can email us at enquiry@pharmac.govt.nz; or call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 660 050.