Diabetes Foundation Aotearoa says Pharmac's delay funding new diabetes drugs has led to many deaths in Māori and Pasifika.
A report involved in a review of Pharmac shows the agency was first asked to fund empagliflozin to treat type 2 diabetes in February 2015.
But it took almost six years for it to announce funding, along with dulaglutide, to treat an estimated 53,000 patients.
Diabetes Foundation Aotearoa chairperson John Baker, who has been a vocal critic of the agency, said such delays have cost lives.
"You only have to look at the cost to people who have suffered in South Auckland through a lack of access to these new drugs," Dr Baker said.
"And the people who have suffered from these delays have been Māori and Pacific Islanders. There needs to be some accountability for that.
"It's Māori and Pacific Islanders who are bearing the costs of death and dialysis," Dr Baker said. "It's led to untold suffering and countless patients progressing to renal failure."
Diabetes is the country's biggest and fastest-growing health condition and South Auckland is the region most affected.
Ministry of Health figures show in 2020 there were 277,803 people with diabetes - with 47,988 in Counties Manukau alone.
Last year, Dr Baker said funding drugs for one patient would cost between $696 and $1380 a year, compared with up to $90,000 for dialysis.
He said it did not make economic sense to not approve the drugs and they could reduce a patient's progression to end-stage kidney disease by 15 years.
The panel conducting the review of Pharmac released an interim report on last week, which highlighted major concerns with the agency's operations.
It said submitters had complained about Pharmac's "excessive focus on containing costs", while the agency's decision-making process was described as slow and lacking transparency.
It said there were also concerns New Zealand was falling behind other developed countries in delivering modern medicines.
Counties Manukau resident and Diabetes Foundation Aotearoa member Graham King (Ngāti Tai) was diagnosed with diabetes in 1990 and is taking empagliflozin.
King said the medicine can be life-changing for diabetics, and it should not have taken Pharmac almost six years to approve funding for something widely used in Europe.
"It has made a huge difference to my life and improved the control of my diabetes."
He said the drug had also reduced the amount of insulin he had to take.
Pharmac did not respond to questions about whether delays in funding had led to increased mortality and deteriorating health for patients.
But in a statement, Pharmac chief executive Sarah Fitt said it appreciated there had been calls to fund empagliflozin for some time.
"Pharmac operates on a fixed budget set by the government. There will always be more medicines we want to fund than we can afford," Fitt said.
"This means we have to make difficult choices about what medicines are funded.
"Competing markets, forecasting and introducing generic medicines and, when available, biosimilar medicines stretches New Zealand's medicine budget further."
Fitt said Pharmac would continue to work hard to fund more medicines for more Kiwis.
She said as of 7 November this year, 44,000 people have been prescribed empagliflozin or dulaglutide.
Local Democracy Reporting is a public interest news service supported by RNZ, the News Publishers' Association and NZ On Air.