Why Medical Insurance Might Not Be Enough
The recent budget announcement included a significant increase in funding for Pharmac, the agency responsible for subsidizing medicines in New Zealand. The government has committed $6.3 billion over the next four years, marking the largest Pharmac budget in its history, which would seem like great news.
However, there are concerns that this funding will not be sufficient to ensure the availability of new drugs through the public system. New Zealand has the smallest number of registered and publicly funded modern medicines when compared to 20 other OECD countries. This limits our access to the latest treatments for cancer and other chronic diseases.
Why is this important to you?
Around one in three New Zealanders will be diagnosed with cancer at some point in their lives. Ensuring you have access to the medications you need is crucial for your health and peace of mind.
Read more to uncover potential gaps in your policy and why it’s important to review your cover with a financial adviser.
Pharmac Funded and Non-Funded Drugs – How It Works
Pharmac, the Pharmaceutical Management Agency, plays a crucial role in determining which medications are subsidized by the New Zealand government. They don’t approve medicines, that’s Medsafe’s role, but they control what drugs are subsidised, administered and available under the public health system. Here’s a brief overview of how it operates:
- Pharmac-Funded Drugs: These are medications that Pharmac has reviewed and approved for subsidy, making them more affordable for the public. The process involves rigorous assessment to ensure cost-effectiveness and value for money.
- Non-Funded Drugs: Medications not approved by Pharmac for subsidy often include newer treatments and specialty drugs. Patients needing these drugs must bear the full cost, which can be substantial.
Why Medical Insurance Might Not Be Enough
While medical insurance provides essential financial protection, it might not cover all necessary medications, particularly non-Pharmac drugs. Some health insurance companies offer additional coverage for these drugs as an add-on, but it’s important to understand the specifics of each policy.
When analysing 13 different Health Insurance policies, from 7 different providers, we found that all plans covered Non-Pharmac Cancer Related costs, but to a maximum of $10,000. When it comes to Non-Pharmac Not Cancer Specific, only 3 of the 13 plans included cover.
Coverage amounts, limits, and the types of drugs covered can differ significantly, making it complex for policy owners to understand what cover they have in place.
Get Expert Advice
With an array of options available, getting expert advice ensures you fully understand your coverage. Discovering at claim time that your policy doesn’t cover what you expected it would is not where you want to find yourself when dealing with a critical illness.
Understanding the fine print and intricacies of different policies can be daunting. An Apex Adviser can clarify these details, making it easier to make informed decisions.
An Apex Adviser can also discuss whether you can get the cover you need through different protection plans, without relying solely on your Health Insurance.
