Proposal to amend the Special Authority access criteria for type 2 diabetes medicines

Medicines Consultation

What we’re proposing

We’re seeking feedback on a proposal to make changes to access criteria and widen access to empagliflozin, empagliflozin with metformin, dulaglutide, and liraglutide (branded as Jardiance, Jardiamet, Trulicity, and Victoza respectively) for people living with Type 2 diabetes and at risk of cardio-renal complications.

This proposal would mean that, from 1 August 2026, the special authority criteria for initiating these medicines would be amended to widen access based on a reduction to the 5-year cardiovascular risk criteria, reducing eligible 5-year cardiovascular risk to greater than or equal to (≥)10% (from ≥15% currently). Additionally, the existing criteria that enables access to these medicines for Māori and Pacific people living with Type 2 diabetes without the need to demonstrate specific cardiovascular or renal risk factors, would be removed.

Consultation closes at 5:00pm, Thursday, 28 May and feedback can be emailed to consult@pharmac.govt.nz or provided through our webform.

Online feedback form

What would the effect be? 

From 1 August 2026, the access criteria for these diabetes medicines would change. The special authority criteria for people with Type 2 diabetes initiating treatment with these medicines would be amended to widen the eligible 5-year cardiovascular risk to ≥10% (from ≥15% currently). Additionally, the existing criteria which enables access to these medicines for Māori and Pacific people living with Type 2 diabetes without the need to demonstrate specific cardiovascular or renal risk factors, would be removed.

People living with Type 2 diabetes who are accessing these medicines currently would continue to have access through their existing special authority approval. No one currently accessing these medicines through these criteria would lose access. The proposed criteria would apply only to new special authority applications from 1 August 2026.

We estimate that in the first year of the proposed changes being introduced an additional 10,000 people would be able to access these medicines, growing to 23,000 people over five years.

Who we think will be interested

  • Pharmacists, medical and nurse practitioners including general practitioners, endocrinologists, and other primary care and hospital staff who help people access and use medicines for the treatment of type 2 diabetes.
  • People with type 2 diabetes and their whānau, families, caregivers and partners.
  • Organisations with an interest in diabetes treatment(s)
  • Health New Zealand | Te Whatu Ora
  • Pharmaceutical suppliers and wholesalers
  • Iwi Māori Partnership Boards, hapū and whānau
  • Māori and Pacific health providers and support/advocacy groups.

About Type 2 diabetes and these treatments

Type 2 diabetes is a disease where the body can’t control blood sugar levels properly, either because cells have become insulin resistant or the body doesn’t produce enough insulin. Type 2 diabetes usually develops in adults, but it is becoming more common in younger people.

Uncontrolled diabetes has several serious long-term consequences. These include vascular complications (including kidney, nerve and eye problems, heart disease, stroke and peripheral vascular disease) The risk of developing diabetes complications generally increases with time since diabetes onset, but is reduced with good blood pressure, blood glucose and blood cholesterol control.

Diabetes and its complications have a significant impact on quality of life. The primary burden of diabetes is experienced in working-age adults (aged 20-60 years) which may influence their ability to work and engage in society in the same way as they would if they did not have diabetes.

In New Zealand, it is estimated that the number of people living with a diagnosis of Type 2 diabetes is more than 270,000 people. Within the New Zealand population, the prevalence of Type 2 diabetes in Māori and Pacific populations is estimated to be around three times higher than among other New Zealanders. Prevalence is also high among South Asian populations.

We acknowledge the desire to have both SGLT2i and GLP1a medicines funded for use in combination for the treatment of Type 2 diabetes; however, this is outside the scope of our current proposal but is something we would welcome an application for.

About empagliflozin

Empagliflozin belongs to a class of medicines called sodium glucose co-transporter 2 (SGLT-2) inhibitors. These medicines limit the absorption of glucose in the kidneys, increasing the amount of glucose that is removed from the body in the urine and therefore reducing the amount of glucose present in the blood. Certain medicines in this class, including empagliflozin, have been shown to improve heart and kidney outcomes in people with type 2 diabetes who are at high risk of these complications.

Empagliflozin with or without metformin is a tablet generally taken once or twice daily. For people who are already taking metformin this could mean a reduction in the number of tablets that need to be taken each day.

Further information about empagliflozin and empagliflozin with metformin can be found in the Medsafe datasheets for Jardiance and Jardiamet.

Jardiance datasheet | Medsafe [PDF](external link)

Jardiamet datasheet | Medsafe [PDF](external link)

About dulaglutide / liraglutide

Dulaglutide and liraglutide belong to a class of medicines called glucagon-like peptide-1 receptor (GLP-1) agonists. These medicines work by increasing the release of insulin and reducing the release of glucagon from the pancreas. GLP-1 agonists can slow digestion and reduce appetite. GLP-1 agonists are associated with gastrointestinal side-effects including diarrhoea, nausea and vomiting. Certain medicines in this class, including dulaglutide and liraglutide, have been shown to improve cardiovascular and kidney outcomes in people with type 2 diabetes who are at high risk of these complications.

Dulaglutide and liraglutide are administered via a prefilled injector pen device. Dulaglutide is generally given as a once weekly injection, while liraglutide is administered once daily. The medicines are packaged in a pre-filled pen device that is designed to be self-administered, without the assistance of a health professional.

Further information about dulaglutide and liraglutide can be found in the Medsafe datasheets for Trulicity and Victoza respectively.

Trulicity datasheet | Medsafe [PDF](external link)

Victoza datasheet | Medsafe [PDF](external link)

Why we’re proposing this

In 2025, Pharmac formalised its Access Criteria Policy. For every medicine considered for funding, we now define the target population, by clinical condition, and those most likely to benefit from the medicine.

Since then, we have reviewed the criteria for these medicines and have received further clinical advice about how these medicines work and who is most likely to benefit from them.

Clinical advice indicates that these medicines can provide greater health benefits for people with type 2 diabetes when used earlier, particularly for people at higher risk of heart or kidney problems.

Lowering the eligibility threshold from a 5-year cardiovascular risk of 15% to 10% means people may start treatment sooner - before their condition progresses to a higher level of risk. Treating people earlier can help reduce the likelihood of complications and support better long-term management of diabetes.

Anyone currently receiving these medicines would continue to have access and would not be affected by the proposed changes.

Details about our proposal

From 1 August 2026 empagliflozin/empagliflozin with metformin (branded as Jardiance/Jardiamet) would be listed in Section B and Part II Section H of the Pharmaceutical Schedule subject to the following access criteria.

Access criteria for specified diabetes medicines

The access criteria for the specified diabetes medicines would be amended as follows (additions in bold and deletions in strikethrough):

SGLT inhibitors: Empagliflozin (Jardiance) / empagliflozin with metformin (Jardiamet)

Special Authority for Subsidy

Initial application – (Type 2 Diabetes) from any relevant practitioner. Approvals without further renewal unless notified for applications meeting the following criteria:

Either:

  1. Patient has previously had an initial approval for a GLP-1 agonist; or
  2. All of the following:
    1. Patient has type 2 diabetes; and
    2. 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 10 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)*; and
    3. Target HbA1c (of 53 mmol/mol or less) has not been achieved despite the regular use of at least one blood-glucose lowering agent (e.g. metformin, vildagliptin, or insulin) for at least 3 months.

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

  1. 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.
  2. 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.
  3. Funded [empagliflozin / empagliflozin with metformin hydrochloride] treatment is not to be given in combination with a funded GLP-1 unless receiving (empagliflozin / empagliflozin with metformin hydrochloride] for the treatment of heart failure.

GLP1 agonists: Dulaglutide (Trulicity) / Liraglutide (Victoza)

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 10 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.

  1. 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.
  2. 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.
  3. 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.

To provide feedback

Send us an email: consult@pharmac.govt.nz by 5:00pm, Thursday, 28 May or through our online form.

Online feedback form(external link)

All feedback received before the closing date will be considered by Pharmac’s Board (or its delegate) prior to making a decision on this proposal.

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