Trans-Tasman disparity in access to cardiovascular medicines

Cardiovascular disease remains a leading cause of death in Australia and New Zealand, with a persistent trans-Tasman disparity in access to cardiovascular medicines emerging as a key finding of a new review.

The Cardiac Society of Australia and New Zealand (CSANZ) has systematically catalogued new cardiovascular drug listings across the two jurisdictions between 2023 and 2025, highlighting significant differences in publicly funded access.

During the study period, the Pharmaceutical Benefits Scheme (PBS) listed five new cardiovascular medicines, granted two new cardiovascular indications for existing therapies and relisted the antiplatelet agent prasugrel. By comparison, PHARMAC funded only one new cardiovascular drug class, empagliflozin, with its funding restricted to heart failure with reduced ejection fraction (HFrEF).

The authors said the findings were particularly relevant in light of persistent differences in cardiovascular mortality between the two countries.

“Recent data comparing national mortality statistics between Australia and New Zealand reported higher age-standardised coronary heart disease and stroke mortality in New Zealand compared with Australia,” explained the authors. “While both countries have experienced ongoing declines, the persistent mortality differential lends urgency to the question of whether disparities in cardiovascular drug access contribute to differences in population-level cardiovascular outcomes.”

Expanding cardiovascular treatment options in Australia

Five new drugs and two new indications were listed on the PBS during 2023-2025, broadening therapeutic options across heart failure, lipid management and cardiomyopathy.

The extension of SGLT2 inhibitor coverage to heart failure with preserved ejection fraction (HFpEF) enables Australian prescribers to initiate an SGLT2 inhibitor across the full heart failure ejection fraction spectrum, simplifying treatment decisions for patients with symptomatic heart failure.

Inclisiran and icosapent ethyl further expand lipid-lowering options beyond statins and ezetimibe. Inclisiran provides a mechanistically distinct approach to PCSK9 inhibition, with twice-yearly dosing, while ongoing cardiovascular outcomes trials are expected to further clarify its clinical role. Icosapent ethyl targets residual cardiovascular risk associated with elevated triglycerides in statin-treated patients.

Mavacamten represents the first dedicated pharmacotherapy for obstructive hypertrophic cardiomyopathy (HCM) and has the potential to substantially reduce the need for septal reduction therapy. Echocardiographic monitoring is recommended to guide dose titration.

Tafamidis, meanwhile, provides the first subsidised disease-modifying therapy for transthyretin amyloid cardiomyopathy (ATTR-CM), reinforcing the importance of maintaining a high index of clinical suspicion, particularly among patients with HFpEF, unexplained left ventricular hypertrophy or bilateral carpal tunnel syndrome.

A widening gap in publicly funded access

The review identifies a substantial disparity in publicly funded cardiovascular drug access between Australia and New Zealand.

New Zealand patients lack publicly funded access to inclisiran, mavacamten, tafamidis, finerenone, icosapent ethyl, dapagliflozin (for any heart failure indication), and migalastat. The disparity is also evident in SGLT2 inhibitor access. PHARMAC funding for empagliflozin is restricted to HFrEF, whereas the PBS has covered HFpEF since November 2023.

Among the direct oral anticoagulants, apixaban remains unfunded by PHARMAC, leaving New Zealand reliant on rivaroxaban and dabigatran.

Future cardiovascular medicines

The cardiovascular therapeutic pipeline is entering an increasingly dynamic phase, underpinned by advances in genomic target validation, large-scale clinical trial infrastructure, more rigorous causal inference methodologies, and the emergence of novel therapeutic modalities.

Several important cardiovascular medicines are anticipated in the near term.

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, received a positive recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC) in November 2025 for secondary prevention of cardiovascular events in patients with obesity. The recommendation was based on the SELECT trial, which demonstrated a 20% reduction in major adverse cardiovascular events.

Bempedoic acid, an adenosine triphosphate citrate lyase inhibitor, remains unlisted on both the PBS and PHARMAC schedules. However, a licensing agreement between CSL Seqirus and Esperion covering Australia and New Zealand was announced in March 2025, suggesting that a future submission may be anticipated.

Sotagliflozin, a dual SGLT1/2 inhibitor with demonstrated benefits in heart failure and diabetes, is not TGA-approved.

Meanwhile, the ORION-4 cardiovascular outcomes trial for inclisiran is expected to report results in the near future. Aficamten, a next-generation cardiac myosin inhibitor evaluated in the SEQUOIA-HCM trial, received FDA approval in the United States in December 2025.

Taken together, the persistent divergence between the PBS and PHARMAC funding raises an important question for both health systems: whether differences in medicine access ultimately contributes to the observed trans-Tasman gap in cardiovascular outcomes.

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