10 September 2020 Clinical Leader, [PHO] By email Dear Colleague, Getting ‘new’ medicines for all Type 2 diabetics Pharmac has finally provided limited access to two ‘new’ classes of drugs that have long been the established standard of care in the first world to treat Type 2 diabetes; SGLT-2 inhibitors (empagliflozin), and GLP-1 receptor agonists (dulaglutide). The new drugs improve life expectancy, slow progress of diabetic kidney disease and reduce the incidence of side effects that patients have had to endure for so long. The most obvious are weight gain, hypoglycaemia and gastrointestinal upset. The new drugs are more convenient to take and there is no need for capillary (finger prick) blood glucose monitoring because there is no risk of hypoglycaemia. This makes the treatment of Type 2 diabetes far easier to administer and medication adherence is expected to improve. However, there is a big problem. Pharmac will restrict access to these new medicines by requiring clinicians to apply for a special authority for each patient. These are not expensive drugs, but only 1 out of every five patients will be eligible. This means the current old drugs (metformin IR, sulphonylurea, & insulin) will remain standard treatment for 80% of patients. This treatment regimen cannot be found in any other first world country, and is now only recommended for developing countries. Processing all the paperwork takes time that would be better spent in patient care. Disparities in care will widen even further, depending on knowledge, aptitude, and attitude of physicians in making special authority applications. Your GPs are going to face a very tough ethical situation; every patient would experience substantial improvement in lifespan and quality of life from these medicines. GPs will need to tell four out of every five patients that they are not eligible. For some patients, this ineligibility will be because they are not currently on the treatment regimen they should be. Therefore our Foundation urges PHOs to tell Pharmac that all patients should be able to use these drugs. You can do that by giving feedback that clearly describes the benefits that every patient would get from the medicines, and the challenges of patient differentiation and paperwork burden of the special authority process. Details of the proposal, including instructions on how to provide feedback, are available here: https://www.pharmac.govt.nz/news/consultation-2020-09-09-diabetes-agents. If I can be of any help, please contact me. Yours sincerely,
Dr John Baker Chairman Diabetes Foundation Aotearoa Attached: Summary of our submission to Pharmac describing advantages of these new medicines.