How health insurance can pick up the non-Pharmac tab

11 May 2021

You’ve probably heard about non-Pharmac medications and the cost involved in accessing them. Here’s how health insurance could help, if you were to need them.

Not all treatments are funded yet

No one wants to become seriously ill. But if you did, being able to access any treatment that might be available could make a big difference.

In New Zealand, the bulk of the medicine we use is subsidised by Pharmac.

The centralised drug-buying agency makes access to medicines affordable even for those people who have to fill a lot of prescriptions in a typical year. But because Pharmac only has a limited budget, it tends to keep its resources for medications that have proven successful through extensive testing, as well as those that are beneficial to a large number of people.

If you find yourself suffering a relatively rare illness, or need a treatment that's new, you may discover that while it's approved for use in New Zealand, it's not yet funded.

That leads many people to turn to crowdfunding to ask friends and acquaintances to help them cover the cost – an experience that can be unnecessarily stressful during an already tough time. This is where you can sometimes call on your health insurance for help, depending on your cover.

Health insurance and non-Pharmac funded treatments

Some health insurance policies provide cover for non-Pharmac treatments. However, not every policy includes this option, and the limits available can vary a lot – from about $10,000 through to about $500,000.

Whether you’re looking for this type of protection, or have health insurance already in place and would like to check if unfunded treatments are covered, please feel free to contact us anytime: we can talk you through the solutions available.

How much do you need?

It’s important to think about how much non-Pharmac cover you may need and what you're willing to pay for.

Insurance providers warn that, while people might not need to spend $500,000 on non-Pharmac treatment at the moment, that's not to say that new treatments might come in that are more expensive in the future.

Other options

Depending on your needs and circumstances, trauma cover may provide the flexibility you’re looking for. This type of policy pays out if you suffer one of the specified trauma conditions and you can use the payout any way you wish – including paying for unfunded medical treatments.  

Thinking about replacing your existing health cover?

When you've had an insurance policy in place for a while, it's important to be careful about replacing it. If you've developed a pre-existing condition in that time, switching in search of more non-Pharmac cover could see those excluded, reducing the level of protection you currently have.

Please get in touch. We can talk you through your options keeping your needs and budget top-of-mind.

Like to talk?

Insurance is designed to take the worry away. If you’d like to know that you and your family could access the treatment you need, no matter what Government funding is available, give us a call. We can talk about the different ways you can structure your policy to ensure peace of mind.


Disclaimer: Please note that the content provided in this article is intended as an overview and as general information only. While care is taken to ensure accuracy and reliability, the information provided is subject to continuous change and may not reflect current development or address your situation. Before making any decisions based on the information provided in this article, please use your discretion and seek independent guidance.

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