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A change to prescription time-frames isn’t a win for all whānau, writes Brandi Hudson.

I understand why some people welcomed the policy change extending the prescribing period to 12 months. It means fewer repeat appointments. Less admin. Less cost. More convenience.

But where I work, at Te Tiratū Iwi Māori Partnership Board, we’re deeply concerned.

Without strong equity and safety safeguards, this change risks widening Māori health inequities, increasing under-care, delaying diagnosis, and causing medication-related harm.

The policy itself sounds tidy. Prescribers can issue prescriptions for up to 12 months for some medicines, while dispensing at the pharmacy still occurs in maximum three-monthly periods. Controlled drugs are excluded. It’s framed as a way to reduce unnecessary appointments and ease pressure on the system.

The trouble is, medicines sit inside real lives. And for many whānau, those lives include multiple conditions, inconsistent access to care, and long gaps between clinical reviews.

It’s easy to imagine a “stable patient” who takes one medicine and has no complications as the basis for policy change. But many of our whānau are managing complex comorbidities, such as diabetes alongside asthma, cardiovascular disease alongside kidney issues, chronic pain alongside depression, and respiratory illness alongside poverty-related stress. Even the presence of two conditions can create risks, interactions, and side effects that need regular review.

For those whānau, prescribing is not just a matter of being told: “Here’s your tablets for the year.” The prescription is part of a care plan that should include monitoring, blood tests, screening, follow-up, and the chance to adjust treatment before harm occurs.

That’s why Te Tiratū supports reducing barriers, but we can’t support a change that reduces the number of touchpoints without putting in place safeguards to protect those who are already missing out.

Māori face significant barriers to accessing medicines. Despite higher rates of chronic conditions such as diabetes, cardiovascular disease and respiratory illness, Māori are overall less likely than non-Māori to access dispensed medicines. In some cases, prescriptions aren’t collected at all because cost, transport, and system barriers make it too difficult.

Extending the length of a prescription doesn’t automatically fix those issues. In some cases, it could even mask them. On paper, a person might look “covered” for 12 months. In reality, they might still be missing doses, skipping follow-ups, not getting blood tests done, or deteriorating quietly until they end up in hospital.

There’s another risk we need to talk about honestly, and that’s the assumption of “clinical stability”.

Who will get labelled stable enough for a 12-month prescription? And who won’t?

In a health system where bias can shape decision-making, sometimes unconsciously, our whānau may be less likely to receive careful follow-up, or more likely to be deemed “fine” without the monitoring that should come with long-term medicines.

Māori don’t experience ill-health in isolation. We live with higher rates of the country’s top five killers — cancer, diabetes, heart disease, stroke and respiratory illness — often all at once. These conditions don’t arrive one by one. They stack, interact, and compound over time.

Add to this the realities many whānau face, such as not always having enough kai, stable housing, or financial security. These are not side issues — they directly affect whether medicines are taken as prescribed, whether follow-up appointments are kept, and whether pain or deterioration is noticed early.

For many of our whānau, poor oral health and chronic foot problems are not minor inconveniences. They affect mobility, sleep, ability to work, and self-esteem. Pain becomes normal. Limited mobility becomes normal. Struggling through becomes normal.

And when complexity becomes normal in a health system under strain, it can quietly slip through the cracks.

Instead of prompting closer monitoring, long-term medicines and complex conditions can be treated as “baseline”. Symptoms are more likely to be interpreted as expected rather than concerning. Whānau may be assessed as “stable” or “fine” not because they’re well, but because their level of unwellness has been unconsciously normalised.

This is how bias can operate without intention. Not through overt neglect, but through lowered expectations of recovery, stability, and follow-up.

Equity in healthcare doesn’t mean treating everyone the same. It means recognising when people are carrying more medical, social, and economic burdens, and responding with more care, not less.

Dr Leanne Te Karu, our expert advisor, has warned that reducing prescribing touchpoints can reduce opportunities to detect deterioration, review side effects, adjust treatment, or optimise medicines. And while community pharmacists are essential, they can’t replace comprehensive clinical review and diagnostic reassessment.

That’s why the solution isn’t simply to provide longer prescriptions. The solution is to build stronger systems around them.

We need national guidance on who isn’t clinically-appropriate to receive a 12-month prescription, and we need equity-focused monitoring that shows what is happening for Māori, not just what is happening on average across the whole population.

We need transparent reporting of adverse events, hospitalisations, medication changes, and wastage. We need Māori-led evaluation of safety, trust, communication and cultural safety.

Most importantly, we need to stop treating medicines as isolated clinical decisions and start treating them as part of a Treaty-aligned system of care.

Te Tiriti obligations of partnership, equity and active protection aren’t optional extras. Partnership means Māori are involved in designing and governing the processes that provide access to medicines, not merely consulted after decisions are made.

Equity means Māori achieve the same access to subsidised medicines and support services as everyone else, with real-world barriers like transport and culturally appropriate information addressed directly. Active protection means outcomes for Māori are monitored, and the policy is adjusted quickly if harm is emerging.

There is a better way forward. Māori pharmacy experts like Dr Te Karu have long advocated for a Te Tiriti-aligned strategy, grounded in Pae Ora and mātauranga Māori, to bring all the right expertise into the room and design medicines pathways that reflect whānau realities, not just administrative convenience.

A 12-month prescription might reduce hassle. But it won’t keep you well if the system stops checking in.

If we want this change to succeed for whānau, we have to measure success by whether Māori are safer, healthier, and better supported — not whether the paperwork got lighter.

Brandi Hudson (Ngāti Maniapoto, Ngāti Rarua, Ngāti Pikiao) is the tumu whakarae (chief executive) of Te Tiratū Iwi Māori Partnership Board, providing strategic leadership across the Waikato rohe to strengthen Māori influence in health system design, planning and service delivery.  

She has held senior roles across community, government and not-for-profit sectors, including inaugural CEO of the Independent Māori Statutory Board in Auckland.