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Health Cover For Unfunded Medicines

22 Jun 2021

non-PHARMAC high res

nib launches cover to provide Kiwis with greater access to unfunded medicines

Today we've launched a new health cover option to provide Kiwis with greater choice and access to potentially life-saving treatments not publicly funded by PHARMAC – the government agency responsible for deciding which medicines are subsidised as part of our public health system.

The new add-on cover, non-PHARMAC Plus, is available from today through nib’s adviser and group distribution channels with members able to add to their new or existing hospital cover. (1)

Benefit limits range from $20,000 to $300,000 per member per year, allowing members to choose the level of cover that best suits their health needs and budget.

Our Chief Executive Officer, Rob Hennin, said the non-PHARMAC Plus option was developed in response to a growing need for cover that provides members with greater choice, affordability and flexibility when it comes to modern medicines.

“New Zealand’s public healthcare system is often recognised for the level of care it provides, but we’re also ranked as having the worst access to funded modern medicines of the 20 OECD countries,(2)” Mr Hennin said.

“Without funding, these medicines can often cost hundreds of thousands of dollars, placing Kiwis who are already under significant stress dealing with an illness, with the added financial burden of paying for treatments out-of-pocket. It’s why we’ve introduced this add-on option which is designed to better protect our members’ health by making potentially life-saving treatments more affordable and accessible,” he added.

Our non-PHARMAC Plus option provides cover for all medicines that are not funded by PHARMAC, are Medsafe approved and have been prescribed or administered in line with Medsafe’s guidelines – not just cancer treatments.

“The great part about our non-PHARMAC Plus option is that the add-on benefit also enables our members to ‘future-proof’ their cover so that when new unfunded medicines become available to treat critical illnesses, they’ll be covered for it,” Mr Hennin said.

The benefit covers the cost of these medicines where nib has accepted a claim for treatment and where the non-PHARMAC drugs are used in a private hospital or at home for up to six months after being admitted to hospital for treatment. The benefit also covers any drug administration costs. Additionally, there are no waiting periods if members choose to add this option to their policy.

“By offering this benefit to our members and the New Zealand community we hope to provide some peace of mind knowing they can immediately access the treatment they need without the financial burden or the need to wait for public funding which can often take years to eventuate,” Mr Hennin said.

“An example of this is Tafinlar, a medicine that is used to treat melanoma which can cost over $100,000 per year. While this has been Medsafe approved since 2013, there is currently no public funding available for it through PHARMAC.

“That’s where we can help, by providing payment towards such treatments so our members can focus on what’s important, their better health,” he added.

Our non-PHARMAC Plus option will be available to all other eligible nib members later this year. Members are encouraged to chat to their insurance adviser to find out more information.

  1. The non-PHARMAC Plus option is available to new members from 21 June with existing members eligible for this option from 5 July. non-PHARMAC Plus is not available under nib’s Ultimate Health, Ngati Whatua Orakei or OneMediFund policies.