Cardiac scientists within Health NZ say they are being prevented by their parent organisation from objecting to changes in the way diabetes treatments are funded.
According to its website, Pharmac is "proposing to change who can receive funded treatment with empagliflozin, dulaglutide and liraglutide".
"This includes widening access to these medicines by lowering the clinical threshold for heart disease risk and removing ethnicity-based eligibility criteria."
It estimates the change would see 23,000 more people each year get access to treatment, within half a decade.
But that is disputed by the Cardiac Network, which says the evidence showed Māori and Pasifika were more at risk of diabetes, regardless of their socio-economic status.
"I think that when resource is limited, as it is in our health system, that maximum benefit is gained when you target therapies to New Zealanders that are most at risk of disease and of disease complications," outgoing Cardiac Society chair Martin Stiles told RNZ's Midday Report on Friday.
Stiles is also part of the Cardiac Network, a group of specialists from Health NZ.
"And we have strong clinical data to suggest that the maximum health benefit for dollars spent is obtained by targeting Māori and Pacific Island New Zealanders for these new, effective and admittedly quite expensive diabetes therapies."
The new sticking point is that Health NZ says the Cardiac Network is welcome to file a submission on the changes, but it cannot object to the removal of ethnicity-based eligibility criteria.
"When Pharmac suggested that they might be removing these criteria, the Cardiac Network wished to put a submission in to say that we object to the removal of the ethnicity criteria. And this has gone to senior members of Health NZ, and they have interpreted a Cabinet directive as that we cannot submit concerns to Pharmac on the basis of ethnicity."
Cabinet in September 2024 issued a directive saying the Government expected that "public services should be prioritised on the basis of need, not race".
"The Government seeks to ensure that all New Zealanders, regardless of ethnicity or personal identity, have access to public services that are appropriate and effective for them, and that services are not arbitrarily allocated on the basis of ethnicity or any other aspect of identity," the directive said, citing the International Convention on the Elimination of All Forms of Racial Discrimination.
Stiles said Health NZ "may have been over-interpreting that Cabinet directive".
"I guess what I'm talking to you about is just letting the public know that there are political decisions that have been made that are influencing medical treatment, when the scientists and the clinicians at the coalface of New Zealand medicine are saying, 'No, this is not a good idea'."
He said it was "no different" to targeting melanoma treatments at "blue-eyed, fair-skinned people".
"Look, we're scientists. We provide the government with scientific expertise… We've got a Government who said they want to target money to where it's needed – whether it be roading, whether it be justice, whether it be health. And we're saying, 'We have identified a target where you're best to put your resource at', yet the Government is saying, 'No, because it's race-based, you can't do that'."
Individuals were able to make submissions objecting to the criteria's removal, Stiles said, but Health NZ said the Cardiac Network as a group could not.
Health NZ declined an interview but, in a statement, executive national director - clinical Richard Sullivan told RNZ Pharmac had received feedback from eye health, renal, and diabetes networks.
"Health NZ acknowledges the importance of this topic and looks forward to hearing Pharmac's decision following consideration of all feedback received."
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