Why Non-PHARMAC Drugs are Important

In New Zealand, it is presumed that if you get sick there will be funding provided under the public health system for the medicine and health care you need in order to get well.

Unfortunately, this is not quite true. There is a government agency called PHARMAC that is responsible for reviewing medicines confirmed safe and determining which ones they will provide funding for. While many drugs are funded, a limited budget and time-consuming process for considering new products make many potentially life-saving (or life-improving) drugs not funded under the public system.

The list of currently funded medicine is extensive, covering almost 1,000 medicines from a range of different areas. This includes your common household 'over-the-counters'; Paracetamol for headaches, Loratadine for hayfever, and antibiotics to manage a cold or infection. It also includes medicines for when you need to fight a life-threatening or chronic illness such as some cancers, diabetes, arthritis, and even vaccinations. You can view the extensive list here.

However, the funding provided by PHARMAC is limited and not all medicines are able to be approved. Some safe and effective drugs are approved by Medsafe but are not funded - these are known as non-PHARMAC drugs. Hospitals and pharmacies still have access to these drugs, however, have to pay full price, which gets transferred over to the patient in need.

This results in many New Zealanders not getting the funding for medicines they may need to live their healthiest lives.

The PHARMAC Dilemma

If we have a public health system and a government agency put in place to review medicines, why aren’t we getting more medicines funded and available for access as and when required?

This is due to:

The Pharmac budget includes paying for the medicines and treatments already approved for funding
If there is room left over to pay for something new, PHARMAC can only review medicines that have had an application made and approved for funding.
PHARMAC has a limited budget and the cost of healthcare rises with medical inflation and the development of new technology.

Needless to say, it can be quite a lengthy process from the time an application for new medicine and treatments are submitted, until PHARMAC is able to make a final decision (the range is from within 10 months to over 70 months!). The image below illustrates the complex and lengthy process for PHARMAC to consider funding a new product.

As PHARMAC works within a set budget, it is limited in what it can provide funding for. There is a constant shuffle with the medicines already on the OK list, with PHARMAC negotiating the price down and reviewing the relevance and use of the medicine in an attempt to open up availability for new items.

However, the wish list for medicines that have been approved but funding is not currently available is very long, click here for a lengthy read!

What's the Cost of Non-PHARMAC?

There are limitations on how much the government (through PHARMAC) is able to assist those of us who fall victim to illness and disease. The list of current treatments and medicines that could positively impact your medical journey but are not currently funded is long and daunting.

Some examples of seemingly common illnesses which have missed out on funding for some medicines are those for rheumatoid arthritis, Crohns disease, cystic fibrosis, inflammatory bowel disease, and even some life-changing cancer drugs including those for bowel, breast, and lung cancers.

Unfortunately, there is little regulation on pharmaceutical companies that determine the cost of the medicines they create. This means, especially for game-changing medicines or treatments, the financial cost can be unimaginable and out of reach for many.

If you dare, look at the image below for a glimpse of some costs related to specific non-PHARMAC drugs, as estimated by health insurer nib.

Having to locate the funding in order to pay the cost of a limited or completely unfunded medicine or treatment is a reality that many New Zealanders are forced to face. This adds an incomprehensible emotional toll to those who are already struggling to find ways to grapple with the life-shattering information they have been handed by their medical provider.

Limiting the Cost

There are options available to reduce the financial impact that unfunded medication and treatment can incur. You can:

Self finance, with savings or credit
Crowd fund with foundations such as Give-a-Little
Make a Named Patient Pharmaceutical Assessment (NPPA) application with Pharmac for exceptional circumstances
Move to another country where your medicine or access to health care is not limited, such as the UK or Australia
Seek Government Assistance with income, accommodation and care for you and your family
Seek Insurance Assistance with a Trauma or Income Protection Claim - Terms & Conditions do apply
Utilize a non-PHARMAC Benefit on a Health Insurance Policy

If you would like to further discuss your need for health and/or life insurance don't hesitate to reach out via phone (03) 374 9955 or email (hello@aynsley.co.nz).

If you would like to learn more about the content discussed, don't hesitate to check out the links below.