For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews
Pharmac won’t release the data that changed its mind on diabetes
Pharmac won’t release the data that changed its mind on diabetes

Diabetes Foundation Aotearoa will request the Ombudsman investigate Pharmac’s refusal to release public submissions which caused it to reconsider its controversial proposal to fund medicines for only 50,000 of the 250,000 people with type-2 diabetes.
Pharmac said in reply to an Official Information Act request that submissions would not be released because it would prevent conduct of negotiations with pharmaceutical companies ‘without prejudice or disadvantage’.
Chairperson of Diabetes Foundation Aotearoa, Dr John Baker, says Pharmac had already concluded negotiations for two new medicines and announced awarding of contracts.
“Releasing the submissions would not make the slightest difference because negotiations are complete.
“If Pharmac is considering a large change in volume or additional medicines, these submissions won’t affect re-negotiations because the views are well discussed in diabetes circles.”
Baker says Pharmac may be holding on to the submissions so the public does not become aware of the extent of the opposition if it later decides to proceed with the limited treatment proposal.
“We want them released because they would reveal the extent to which Pharmac’s plan is regarded as totally inadequate to the disastrous rates of diabetes, poor responses to treatment and unnecessary deaths,” Baker says.