Fate Of 250,000 Diabetics In Pharmac’s Hands
This week, a small group of bureaucrats and health professionals will meet to agree on the quality of life of at least a million people; the 250,000 New Zealanders with diabetes and their families.
The Board of New Zealand’s medical agency, Pharmac, will consider whether to fund two new medicines which will dramatically change their lives; empagliflozin and dulaglutide.
These medicines reduce blood sugars and protect patients’ kidneys and hearts – two organs that often fail because of diabetes. Using these drugs will prevent most from going on expensive dialysis. Instead of being bedridden, over-weight and ill, type-2 patients will spend quality time with loved ones and continue to be productive.
I called them new, but they are about 15 years old, and now fairly cheap. New Zealand and Serbia are the only developed countries in the world where these medicines are not the standard treatment.
Pharmac’s funding proposal, released in September, was not a cause for celebration. It would only cover the cost of drugs for 50,000 people - one-fifth of those who would benefit from them.
Pharmac was not trying to cut the price of the medicines. It was trying to cut the cost by giving it to fewer people.
Pharmac was inundated with submissions against the funding proposal from across the medical sector, including diabetes specialists such as myself.
We said the limitation would put General Practitioners and diabetes specialists in an ethical quandary; to choose from almost equally sick people, who would get the drugs and live a fulfilling life, and who should be relegated to a managed decline that could include dialysis, amputations, blindness and heart failure.
Only New Zealand’s best resourced clinicians would be able to confirm all of the eligibility criteria. Clinicians in under-resourced and poor communities will find these conditions much more difficult or impossible to fulfil. The result would add fuel to the fire of health inequity.
People from low socio-economic backgrounds feature disproportionately in diabetes statistics. Māori, Pasifika, and South Asians constitute 40 per cent of all type-2 diabetes patients. A recent study by Professor David Simmons of Western Sydney University, found that the ethnic disparity in diabetes outcomes among South Auckland patients had remained unchanged over ten years.
The Pharmac board was forced to delay a decision and continue consulting. They asked if it was possible to devise a system that ensured minority groups got equal access. There isn’t. Not unless Pharmac decides to apportion drugs based on race.
The only equitable option is to allow open access to the drugs for any diabetic patient.
This week, Pharmac can make a big difference to the lives of a million New Zealanders. If they don’t do it, I can’t predict what will happen next.
Dr John Baker is a diabetes specialist based in Ōtara and is the Chairman of Diabetes Foundation Aotearoa.