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New medicines for the management of type 2 diabetes became available internationally in 2005, yet only in 2018 did the first of these become available in New Zealand. Access to these new medicines in New Zealand is largely dependent on decisions made by the Pharmaceutical Management Agency (PHARMAC).   Aim  This study sought to describe the decision-making processes to better understand access to new medicines in New Zealand.   Methods  We conducted an analysis of publicly accessible information on therapeutic committee deliberations, prices of medicines and registration and formulary listing dates.   Results  Prices for the new diabetes medicines in New Zealand are lower than comparator countries, but access to them takes longer.   Discussion  Given that knowledge on efficacy, safety and quality is widely available to support decision-making on new medicines, differences in access to them between nations appears to depend on the fourth hurdle of cost. However, we suggest that a rush to market is the norm, that activities of the pharmaceutical industry and regulatory agencies are less transparent than desirable, and that greater focus on availability of safety data is required. Deliberations of PHARMAC therapeutic committees are robust yet protracted. Opportunities to expedite decision-making, as well as resolving inequities, may be worthy of examination.

Decision-making on listing new medicines for public funding in New Zealand: the case of ‘new’ type 2 diabetes medications