New Zealand’s public healthcare system was renowned for it’s accessibility and quality. However, for non-urgent medical procedures, the waiting time treatment can be in excess of six months.
Navigating the intricacies of drug coverage can be a bit daunting. One area our clients often raise question about is the availability of coverage for non-Pharmac subsidised drugs within the private medical insurance plans we recommend.
What are Non-Pharmac Subsided Drugs?
In New Zealand, the Pharmaceutical Management Agency, commonly known as Pharmac, is responsible for deciding which drugs and medicines are subsidised by the Government. Pharmac’s decisions are based on a combination of factors, including cost effectiveness, clinical effectiveness and budget impact. However, not all drugs which may be prescribed to treat disease are subsidised by Pharmac. Drugs that are not included in Pharmac’ schedule are referred to as Non-Pharmac subsidised drugs.
How Do Non-Pharmac Subsidised Drugs Affect Medical Insurance?
1. Role of Private Medical insurance
Private medical insurance in New Zealand can provide coverage for a range of services and treatments that are not covered by the public health system. This includes non-Pharmac subsidised drugs. Policies vary widely among insurance providers, so it’s essential to understand the specifics of what each plan offers. As Life and Medical advisors, we are well aware that there are over fifty different types of medical plans available to New Zealanders.
We use a customised computer program to analyse all these plans. Less than 10% of these medical plans provide adequate cover for Non-Pharmac drugs.
“Not all medical policies are made equal”
2. Coverage for Non-Pharmac Drugs
Some private medical insurance plans include coverage for Non-Pharmac subsidised drugs. This means that if you require a medication that isn’t subsidised by Pharmac, your insurance might cover the costs, either partially or fully. This is particularly relevant for treatments involving newer medications or those that are not included in the Government subsidy list.
3. Financial Implications
If you are prescribed a Non-Pharmac subsidised drug and your insurance does not cover it, you may face significant out of pocket costs. This is where private medical insurance can provide financial relief, especially for expensive or ongoing treatments. The extent of coverage will depend on your plan so it’s worth checking the fine print.
We currently have two clients who’s combined Non-Pharmac drugs are costing over $180,000 each year and they are fully funded by the insurer that their medical plans are with.
Some of these drug’s cost in excess of $10,000 per month. Kiwis are either having to sell assets or downsize assets to privately fund these drugs if they have no medical insurance plan. The cost of a simple tonsillectomy operation is around $10,000.
The medical insurers provide up to $600,000 per annum Non-Pharmac drug cover, including surgery and other benefits. With medical insurance plans, it is better to have and not need, rather than not have and need medical treatment.
Tourelle Life Brokers
Here at Tourelle Life Brokers it is our job to navigate the world of Non-Pharmac subsidised drugs within New Zealand’s medical insurance plans. This can be complex, we can help you understand your coverage options, which is crucial for managing your healthcare expenses.
We welcome the opportunity to review your existing medical plan. Just because it’s cheaper doesn’t mean it’s better. You need to look at the fine print and assess the advantages and disadvantages before changing your medical plan.
The Tourelle Life Brokers team are here to assist you with the claim process. We have a claims manager who cares and has empathy for our clients at their most vulnerable and uncertain time while undergoing their medical treatment.
Do you want a complimentary review and comparison of your existing medical plan?
Phone Karen or Andre Tourelle on 0800 865 855 or email us at karen@tourelle.co.nz to arrange a suitable time.
