Pharmac vs Non-Pharmac and Keytruda
Spotlight on non-Pharmac funded drugs
Pharmac was established in 1993 in response to the escalating cost of medicine. Its purpose is to organise a list of subsidised medicines (the Pharmaceutical Schedule) and to promote competition to achieve price reductions.
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: 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 does not 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.
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 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, and in October last year we 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, which means you know exactly what you are covered for when it’s time to claim.
If you’d like a quote for health insurance just email, call or text me.
Thanks,
Mike Bennett
