Ever wondered about non-Pharmac funded drugs in New Zealand? You may already be aware that Pharmac, officially known as the Pharmaceutical Management Agency, operates as a Crown entity in New Zealand. Pharmac acts on behalf of Te Whatu Ora – Health New Zealand. Pharmac is responsible for determining which medicines and pharmaceutical products receive subsidies for use within our community and public hospitals.
But have you ever wondered about the differences in Pharmac vs Non-Pharmac drugs?
A critical aspect of New Zealand’s healthcare landscape is the way our pharmaceutical drugs are funded. Established in 1993 as a response to the escalating costs of medicine, Pharmac plays a vital role in organising the Pharmaceutical Schedule and fostering competition to drive down prices. Pharmac’s budget has remained relatively stable with an increase of between 0 and 1.74 per cent over the past four years. The combined Pharmaceutical Budget (CPD) was increased by $5 million in 2014/15 to reach $800 million.
The decision to fund a drug depends on Pharmac’s assessment of three broad assessment areas. These are clinical, economic and commercial. This includes the answers to questions such as: Are there alternatives? How big a population will it treat? What is the opportunity cost?
Having health insurance that provides non-Pharmac cover can be beneficial when Medsafe has approved the drug as safe, but Pharmac won’t provide funding. This can occur because the agency deems the drug too costly or when there is uncertainty about the drug’s effectiveness. If the drug is new, long-term data has yet to be accumulated.
What is Keytruda?
Keytruda® (Pemrolizumab) is a biologic drug used to treat terminal melanoma patients. It was approved by Medsafe in September last year, however is not funded by Pharmac in New Zealand and can cost upward of $200,000 for a year’s treatment.
Ultimate Health Max™ by Nib provides cover for non-Pharmac funded drugs that are Medsafe approved for treatment in a Private Hospital. In October last year, they upgraded the product to include non-Pharmac funded drugs for treatment at home (for up to six months after admission). With Nib’s Ultimate Health Max you’ll have peace-of-mind with guaranteed wording. This means you know exactly what you are covered for when it’s time to claim.
If you’d like a quote for health insurance, send us a message and we can help you look over your options.