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What is Pharmac New Zealand? Pharmac vs Non-Pharmac Drugs and Keytruda

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What is Pharmac New Zealand? Pharmac vs Non-Pharmac Drugs and Keytruda

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.

Mike Bennett

Mike Bennett

In 1985, after 7 years in the banking industry in NZ & London, Mike Bennett joined the Life Insurance Industry as an adviser. In 2001 he started “Acorn Insurance & Investment Ltd” with the key principle; “to satisfy the insurance and investment needs of New Zealanders with the best products and service possible”. To achieve the guiding principle of “best products and service” the “Acorn” uses various industry research tools to identify the best products and prices to meet our client’s needs. Acorn has agencies with most of New Zealand’s major insurance companies which means we are free to use whichever products best meet our client’s needs. Believing that if we get it right for our clients we will achieve win-win solutions. We also recognise that nearly all insurance solutions are a compromise between the benefits you’d like to have versus the premiums you’re prepared to pay – with this in mind we WON’T be trying to sell you more insurance than you need or want !!


  1. Hi we have had insurance with Unimed for many years, however, with the recent controversy surrounding NZ poor cancer care and access to new drugs this has caused us to look elsewhere just in case.
    I am a Nurse so am well aware of the costs of for example Immunatherapy.
    Please can you outline which non pharmac drugs are available and how much these policies are?

    • Hello Gillian. Thank you for your question. I have emailed you directly with an answer but I will say here for the public record that your question is very timely because there are only 2 health insurance providers that give full coverage for ‘Non-Pharmac’ drugs in NZ. That is Partners Life and ‘Nib Ultimate Health Max’ plus as from 11th February 2021 AIA are releasing a new product called ‘Cancer Care’ which will provide specific treatment for cancer care and pay for up to $500,000 for non-pharmac drugs.
      I’ll let you know when it is available and I can give you prices. The price is expected to be 25% of a normal health insurance.
      Best wishes, Mike Bennett


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