The Eye-Watering Costs Of Non-PHARMAC Drugs

Imagine being in need of a life-saving or life-extending drug that could set you back hundreds of thousands of dollars a year because it wasn’t government funded. The reality is that many Kiwis face challenges like this every year.

It’s not only people with rare diseases, many Kiwis with more common diseases such as bowel cancer and melanoma can miss out on effective treatment options because the drugs aren’t subsidised – and paying for them out-of-pocket is often simply unrealistic.

A series of tragic case studies have cropped up in the media in recent years, highlighting the difficulty many New Zealanders face when trying to access affordable treatment for life-threatening illnesses.

How drug funding decisions are made in New Zealand

PHARMAC, the government agency responsible for deciding which medicines are publicly subsidised, has a $1.186 billion annual budget and funds over 1,300 different medicines.

The agency undertakes a difficult balancing act to ensure the drugs it funds benefit the greatest number of people for the least amount of money. But it can’t fund everything.

In fact, the Medicines Landscape 2022/23 report from Medicines New Zealand found that New Zealand continues to rank last for market access to modern medicines out of 20 comparable OECD countries and is, on average twice as slow to publicly fund modern medicines as comparable countries.

Meanwhile, their 2023 Access to Medicines report revealed that between 2011 – 2023 Australia publicly funded more than 2½ times more modern medicines than New Zealand, they were funded on average faster in Australia, and there are 131 modern medicines publicly funded for Australian patients that are not available through the public health system to New Zealand patients.

In an attempt to improve drug access for Kiwis, advocacy groups such as Patient Voice Aotearoa and The Medicine Gap, and public figures, most notably, Rachel Smalley have been calling for change, but to little avail. Petitions have been submitted to Parliament, with thousands of signatures, all seeking funding for a broad spectrum of life-transforming or life-saving drugs.

Unfunded treatment options are often out of reach

Every year, over 5,700 New Zealanders are diagnosed with gastrointestinal cancers, making them one of the most common forms of cancer in the country - including cancers of the bowel, stomach, liver, pancreas, and oesophagus.

In an open letter to PHARMAC in August 2023, a group of oncologists urged for more funding for critical drugs for these cancers and in turn, to close the medicine gap between us and comparable developed nations. PHARMAC is yet to formally respond to the letter, leaving many Kiwis continuing to pay thousands of dollars a month to access unfunded, life-saving medications.

Here are some examples of treatment options and their potential out-of-pocket expenses without PHARMAC funding:

Tafinlar – one of the most advanced treatment options for melanoma, Tafinlar can cost over 80k per year. It’s often used in conjunction with Mekinist, another unfunded drug.

Trastuzumab - globally used to effectively treat breast, stomach and oesophageal cancer. In New Zealander it’s only funded for breast or GI cancers if you meet specific funding criteria. It can cost over $70k plus administration fees per year, depending on the brand used.

Avastin – an immunotherapy drug used to treat advanced forms of bowel cancer. The first application to PHARMAC for use in bowel cancer was 14 years ago. PHARMAC declined to fund for bowel cancer in 2012, and again in 2022. Avastin can cost up to $25-$30k plus administration fees for bowel cancer per year.

So what are my options?

Without health insurance, these daunting amounts often force people to move overseas for treatment, seek donations or forgo treatment all together.

To help bridge this gap, our non-PHARMAC Plus add-on option provides access to many Medsafe-approved drugs which are not currently funded by PHARMAC. It also covers the related administration costs, making treatment of cancer and other serious conditions with non-PHARMAC drugs more accessible, in a private hospital and at home*.

About non-PHARMAC Plus

Non-PHARMAC Plus can be added to nib’s eligible Hospital plans, and includes flexible benefit limits ranging from $50,000 to $300,000 per member per year. Together with our comprehensive health insurance benefits, we’re here to provide peace of mind for you and your family.

If you’d like to find out more about non-PHARMAC Plus, go to nib.co.nz/compare-plans

New members can buy non-PHARMAC Plus with a Hospital plan by heading to https://join.nib.co.nz

If you’re already an nib member with a Hospital plan, it’s easy to add an option to your existing policy — simply send us your details using our online form.

*The drugs must be prescribed by a registered specialist under the Medsafe guidelines, used in a recognised NZ based private hospital, day stay unit or a private wing of a public hospital or used at home for up to six months after you are admitted for treatment for an approved related treatment. Policy terms and conditions (including exclusions) apply.