Australia subsidised five new heart drugs in three years. New Zealand funded one change

Australia and New Zealand are usually discussed as a single therapeutic region. They share cardiology guidelines, a joint professional society, and a broadly comparable burden of cardiovascular disease, which is a leading cause of death in both countries [s1]. They do not share a drug funding system, and a review published in Heart, Lung and Circulation in July shows how far apart the two have drifted over three years [s1].

What was counted

Publicly subsidised access to new cardiovascular medications is governed by the Pharmaceutical Benefits Scheme (PBS) in Australia and by PHARMAC, the Pharmaceutical Management Agency, in New Zealand [s1]. The authors note that no consolidated resource catalogued recent listings across both jurisdictions — which is itself part of the story, since neither country's clinicians had an easy way to see the divergence [s1].

The review examined all new cardiovascular drug listings and indications on both schedules from 1 January 2023 to 31 December 2025 [s1]. PBS data came from the PBS Pricing and Policy Branch via the Cardiac Society of Australia and New Zealand; PHARMAC data came from direct communication with PHARMAC, cross-referenced against public schedule information [s1]. Pivotal trial evidence, restriction criteria and prescribing considerations were extracted from published literature and regulatory documents [s1].

The Australian additions

Five new cardiovascular drugs were listed on the PBS across the three years: inclisiran, mavacamten, tafamidis, icosapent ethyl and migalastat [s1]. Two existing drugs received new cardiovascular indications — empagliflozin and dapagliflozin, both for heart failure with preserved ejection fraction — and prasugrel was relisted for acute coronary syndrome [s1].

The authors characterise the period as bringing notable additions to Australian cardiovascular pharmacotherapy: the first cardiac myosin inhibitor, the first transthyretin stabiliser, expanded lipid-lowering therapy options, and extension of SGLT2 inhibitor coverage across the heart failure ejection fraction spectrum [s1].

Each of those descriptions marks a category rather than an incremental product. A cardiac myosin inhibitor is a mechanistically new class for hypertrophic cardiomyopathy. A transthyretin stabiliser addresses a disease — transthyretin amyloid cardiomyopathy — that previously had no disease-modifying subsidised option in Australia. And the SGLT2 extension closes the gap between heart failure with reduced and preserved ejection fraction, the latter of which spent years being the form of heart failure without a subsidised drug therapy.

The New Zealand column

One major change occurred on the PHARMAC schedule over the same three years: empagliflozin for heart failure with reduced ejection fraction [s1].

That is a single funding decision against Australia's five new drugs, two new indications and one relisting. And the indication it covers — reduced ejection fraction — is the older and better established of the two heart failure phenotypes. New Zealand's one change during the window brought it to a position Australia had already moved past by extending coverage across the full ejection fraction spectrum [s1].

The review's stated conclusion is that a pronounced access disparity persists between Australia and New Zealand [s1].

What the comparison does and does not establish

This is a documentary review of schedule listings, not an outcomes study. It reports what each system funded; it does not measure whether Australian cardiovascular patients had better outcomes than New Zealand patients over the period, and no such comparison is reported [s1]. Drug listings are an input, and the gap between an input and a health outcome can be large.

The two agencies also operate under different mandates in a way the raw count does not capture. PHARMAC works within a fixed pharmaceutical budget and explicitly trades funding decisions against one another; the PBS operates under a different fiscal architecture. A count of listings therefore partly measures a design difference between the two systems rather than a judgement difference about any individual drug. The review documents the outcome of that difference without adjudicating the model.

Nor does the review establish that every one of the five Australian listings was warranted. Listing a drug is a funding decision made under restriction criteria [s1]; it is not a statement that the drug is effective for every patient with the condition.

Why a catalogue is useful

The most practical contribution here may be the least dramatic one. The authors built this because no consolidated cross-jurisdiction resource existed [s1]. A cardiologist practising across the Tasman — or advising a patient moving between the two countries — previously had to reconstruct that picture from two separate schedules.

There is also a policy use. A disparity that is documented in a single table is harder to leave undiscussed than one distributed across two national schedules, and the review's framing of the gap as "pronounced" and persisting [s1] is a deliberate contribution to a live New Zealand debate about medicines funding levels.

What to watch

Whether the 2026–2028 window narrows or widens the gap, and specifically whether PHARMAC funds any of the four PBS-listed agents New Zealand currently lacks. The review sets a baseline against which that can now be measured.

Sources

• [s1] Cardiovascular Drug Access in Australia and New Zealand: New PBS and PHARMAC Listings, 2023–2025, Heart, Lung and Circulation, available online 6 July 2026. https://doi.org/10.1016/j.hlc.2026.06.001