Understanding non-PHARMAC funded drugs coverage
Why do I need private medical in a nation that’s publicly funded? Understanding non-PHARMAC funded drugs coverage
The challenge of public health funding
PHARMAC is the government agency responsible for deciding which medications are publicly funded and accessible, while Medsafe, part of the Ministry of Health, approves and monitors medicines and medical devices to ensure their safety and effectiveness. However, not all essential medications approved by Medsafe are covered by PHARMAC, which can result in significant out-of-pocket expenses for patients who need these non-funded drugs.
In New Zealand, medical insurance typically covers PHARMAC-approved drugs as standard, but only a few policies include coverage for non-PHARMAC (yet Medsafe approved) drugs. This situation highlights the importance of knowing if your medical insurance includes Medsafe-approved drugs not funded by PHARMAC or consider obtaining such coverage if needed.
The importance of comprehensive medical insurance
Medical insurance becomes vital when you need treatment with Medsafe-approved drugs not covered by PHARMAC. These drugs can be lifesaving, especially for serious illnesses like cancer. A good example is Keytruda. It is approved by Medsafe and has shown great results but isn’t fully funded by PHARMAC.
Additionally, a full course of Keytruda treatments can exceed $100,000, with initial rounds costing up to $10,000 each and subsequent infusions between $1,500-1,800. For many patients, Keytruda has been a lifesaver when other treatments have failed highlighting the life-changing impact of having comprehensive health coverage.
However, it's important to remember that not all medical insurance plans pay for drugs that PHARMAC doesn't cover. This highlights the need to think carefully about what your insurance covers. Our team can help you understand your options and make sure you have the right coverage for your healthcare needs.
Benefits of private medical insurance
- Reduced wait times: Early diagnosis and treatment are crucial for recovery. Private medical insurance often ensures quicker access to medical professionals and procedures, significantly reducing the wait time compared to the public system.
- Privacy and comfort: Private insurance allows access to private hospital care, providing comfort and privacy during treatment.
- Access to additional services: Insurance can cover additional services and treatments not available through the public system, enhancing overall care.
- Choice and flexibility: With private medical insurance, you have the flexibility to choose your healthcare provider and treatment options, which may be important when dealing with complex conditions.
- Additional coverage: Beyond just treatment, comprehensive health insurance can cover a range of health-related expenses, providing broader financial protection. For example, some plans include alternative therapies like acupuncture, dental care, as well as drugs that are approved by Medsafe but not funded by PHARMAC.
Understanding what you’re covered for
To manage your healthcare expenses well, it's important to know what your insurance plan pays for, especially when it comes to drugs that are approved by Medsafe but not funded by PHARMAC. This understanding can greatly affect your treatment choices and financial plans.
- Check your policy: Keep an eye on your insurance policy to see what it covers and if there are any restrictions or things it doesn't cover.
- Talk to your insurer: If you're not sure about what you’re covered for, ask your insurer for clear details about what's in your plan, particularly for expensive treatments.
The broader impact
New Zealand's approach to funding medicines has led to significant disparities in access to the latest treatments compared to other member countries of the Organisation for Economic Cooperation and Development (OECD). This gap often places the burden on individuals to seek private medical insurance to cover essential but unfunded treatments.
- International comparisons: Studies show that New Zealand lags behind other developed countries in funding new medicines. For instance, New Zealand funded the fewest cancer medicines compared to selected other countries in a recent study published in Lancet Oncology.
Understanding your medical insurance coverage, especially for drugs that are approved by Medsafe but not funded by PHARMAC, is more than a financial decision; it’s an important step in ensuring you have access to the best possible care without facing debilitating costs. With the right knowledge and preparation, you can navigate the complexities of health cover and make informed decisions that safeguard your health and financial well-being.
For more information, talk to our expert advisers about how medical insurance can ensure you get the treatment you need, when you need it.
By choosing NZBritannia, it’s not just securing your health but also gaining peace of mind, knowing you’re prepared for a wider range of medical needs.