Are You Really Covered? The Truth About Non-Pharmac Cover
It's a frightening reality that many Kiwis face the incredibly challenging decision of choosing between potentially life-saving medical treatment and financial upheaval. Sadly, this is not a rare situation affecting only a few hundred individuals; rather, it impacts thousands who desperately need access to medications that Pharmac does not fund.
What does this actually mean?
When a medication or treatment plan is not funded, individuals who need access to them are required to carry the costs, which can surge into the hundreds of thousands of dollars—frightening, isn’t it? And without comprehensive health insurance coughing up the funds may not be possible for many.
So, is it worth getting health insurance in NZ with good non-Pharmac coverage?
Most definitely, your health and that of your family is a priority, and you’ll want to ensure you’re covered during medically challenging times. As not all health insurance providers come with robust non-Pharmac coverage it’s crucial to understand what your health policies cover and to what extent they cover non-Pharmac medications.
Reassessing Your Health Insurance Needs
Recently, there has been significant discussion in the Rapson office and among my current clients surrounding the government’s decision not to fund certain cancer drugs.
The coalition government has since announced a substantial $600 million cash injection for Pharmac, spanning over four years and enabling Pharmac to fund 26 new cancer treatments and 28 other treatments, potentially benefiting about 175,000 people annually.
Health Minister Dr Shane Reti mentioned that up to seven treatments from the government’s campaign list of 13 cancer treatments would be funded. The rollout plan is expected to commence right around now, with the final decision on which drugs will be funded resting with Pharmac.
Given these developments, individuals must re-evaluate their health insurance plans and ensure they have adequate coverage, especially non-Pharmac options, to protect against any gaps in funding or treatment access.
As an insurance specialist, I am here to guide you through the process, help you make informed decisions, and stress the importance of reviewing your health insurance plans, particularly focusing on acquiring good non-Pharmac coverage. If you have any questions feel free to get in contact with me, Diana, and I’ll gladly support you through this process.
What is Non-Pharmac Cover?
Non-Pharmac is essentially the drugs/medications that are not subsidised by the government, via Pharmac. Often it is referred to as ‘unfunded drugs’ in health insurance. This coverage becomes particularly important when patients require access to treatments not listed under Pharmac’s subsidised medications. While Pharmac provides a wide array of essential drugs at reduced costs, it does not cover every possible treatment.
The Importance of Having Quality Non-Pharmac Coverage
Quality non-Pharmac coverage is essential, especially considering that non-Pharmac drugs can be incredibly expensive, with treatment courses potentially reaching six-figure sums. Health insurance can significantly impact your ability to access these necessary yet unfunded treatments. Many people assume they are fully protected, but in reality, they may find themselves inadequately covered when faced with significant medical expenses. Some health policies don’t include any non-Pharmac cover and others do little better with only $10,000 worth of cover available.
Not All Medicines Are Subsidised in New Zealand
While Pharmac subsidises nearly 1,000 medicines, from paracetamol to more complex treatments and devices, there are still gaps. Coverage is indispensable for treatments and medications that fall outside Pharmac’s remit.
Gaps in their funding can leave patients vulnerable, particularly when it comes to newer, cutting-edge medications that may not yet be subsidised. Often essential for treating serious or chronic conditions, these medications can be prohibitively expensive without appropriate insurance coverage.
The Cost of Accessing Medicines That Aren’t Funded
With limited regulations in place when it comes to how Pharmaceutical companies price their medications, costs can soar—especially for treatments that are revolutionary and effective for many individuals.
For example, bowel cancer, a condition for which New Zealand has some of the highest rates globally, leads to the deaths of over 1,200 Kiwis annually. Access to a non-Pharmac drug that may double survival rates could cost $50,000 for two rounds of treatment, with ongoing costs of $500 per week.
The list of treatments not currently funded is extensive and encompasses treatments for autoimmune disease, as well as various non-funded drugs for cancers that include breast, lung, and bowel.
Why You May Require a Non-Pharmac Funded Option
The costs associated with some medical conditions can be overwhelming without the right insurance.
Additionally, certain cancer therapies, which are not always included in Pharmac’s list, can cost tens of thousands of dollars per course. These are not hypothetical scenarios but real situations that families in New Zealand face, and with $117,408 (Gross) being the average income of households across the country, this is just not feasible!
How Do I Ensure My Family and I Are Covered for Non-Pharmac Medications?
Ensuring that your family is covered for non-Pharmac medications involves a few key steps. They include…
- Review your current health insurance policy to understand its scope concerning coverage.
- Consider whether your existing policy meets your family’s health needs. If it falls short, you might need to upgrade to a more comprehensive plan.
- Stay informed about your potential future medical requirements.
- Keep abreast of new treatments and medications that Pharmac may not yet subsidise.
- Seek advice from medical professionals and insurance experts.
- Enrol your children early for comprehensive health insurance. (Early enrolment can cover a wider range of conditions, many of which might be deemed pre-existing if insurance is sought later in life.)
Secure Your Family's Future Health
Life is full of surprises. A sudden illness, an unexpected injury, or a chronic condition can disrupt your life and financial stability. While government health insurance provides essential coverage, it doesn’t always cover the full spectrum of healthcare costs.
We work with reputable health and life insurance providers like Nib, AIA, and Partners Life, ensuring you have access to a wide range of quality products. Don’t let non-Pharmac drug costs hold you back!
Contact me, Diana McIntyre, your trusted insurance adviser, today and ensure your family’s healthcare needs are covered!