Who are PHARMAC?
PHARMAC is the New Zealand government agency that decides which medicines and related products are funded in New Zealand. PHARMAC is the only agency in the world that both decides what medicines to fund and manages a fixed budget for those medicines. In simple terms, PHARMAC decide what medicines are their priorities to fund.
But what happens if I need a drug not funded by PHARMAC?
This is the million-dollar question - unless you have access to lots of surplus cash and are prepared to spend it on unfunded drugs, the only answer is medical insurance. This is a great solution for many, maybe even most Kiwis.
The solution is health insurance
Private medical insurance is probably the most important type of insurance for protecting against unfunded drug treatments, so long as the right product is chosen.
Not all health insurance is the same
There are health insurance products available that don't cover drugs not funded by PHARMAC, either at all or sufficiently to cover a possible six-figure expense.
The right medical insurance will pay (and continue to pay) for the drug treatment you need, as long as it’s medically necessary, and of course, as long as the treatment and the condition is covered by the policy wording This is why it’s so important to get the right advice.
What Health Insurance doesn’t cover
Health insurance will cover you for treatments and drugs for conditions like cancer, cardiac conditions and a whole lot of other non-acute problems requiring hospitalisation or surgery but it does not pay for all medical treatments.
Pre-existing conditions may be excluded (especially the big ones) and so too are congenital and preventative conditions. Always check the small print for what is not covered or discuss this with an adviser.