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Doctors Resist Pharmac’s Diabetes Funding Plan

Diabetes Foundation Aotearoa says Pharmac’s plan for very limited funding for Type 2 diabetes drugs has met strong and unusual resistance from the medical establishment.

Pharmac called for submissions last month on a plan to fund 50,000 thousand patients for medicines that are now standard in the developed world. This would leave at least 200,000 patients on a regime now only practiced in the third world.

Chairperson of Diabetes Foundation Aotearoa, Dr John Baker, says the plan has been widely and soundly rejected in submissions as inadequate, likely to discriminate against Māori and Pacific Island patients, and presenting an insolvable “ethical dilemma”.

“The submissions are an embarrassment to Pharmac and the Government. Pharmac’s plan is totally inadequate to our disastrous rates of diabetes, poor responses to treatment and unnecessary deaths.

“It is rare to have the medical establishment so resistant to a Pharmac funding plan, but it is rare even for Pharmac to discriminate so savagely – over cheap drugs that are 15 years old.”

Dr Baker said submissions from PHOs, groups of medical specialists and individual clinicians had underlined how critical the drugs were to New Zealand. The Foundation estimates they would prevent the death of 800 people each year and prevent 99 renal replacement therapies (dialysis).

Of particular concern in many submissions is that the treatment of a disproportionate number of Māori and Pacific Islanders is so deficient that they would not be equally eligible to apply for Special Authority to use the new drugs.

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“Pharmac places equity at the centre of its principles, but the Special Authority conditions mean that only the best-looked after patients will be eligible.”

Dr Baker said doctors were deeply troubled by the ethical dilemma posed by the Special Authority.

“Doctors will have to choose between patients with the same illness, who would respond equally well to the new drugs. Pharmac is inviting them to choose who lives or dies, or who gets to live the next 15 years well, or in terrible discomfort and pain.

“It is unethical to withhold these medicines, now standard across the first world, and to keep four out of five patients on a regimen that makes their lives unbearable or short.”

Dr Baker thinks clinicians may feel morally bound to apply for Special Authority to treat every one of their patients. “These submissions signal that clinicians may refuse to take ‘no’ for an answer,” he says.

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