nib has launched a prescription medicines cover in New Zealand with individual benefits up to NZ$300,000 per year for treatments not reimbursed by PHARMAC.
The new benefit is an add-on cover called 'non-PHARMAC Plus' under which it will provide annual coverage of NZ$20,000 to NZ$300,000 per member per year for prescription medicines not reimbursed by the controversial procurement agency.
The insurer offers a limited pharmaceutical benefit for its Australian customers, providing an annual benefit of around $500 per year. The Australian government regulates private health insurance policies, including their pricing and benefits paid.
Successive international studies have shown New Zealand reimburses far fewer prescription medicines than comparable countries. The country's government recently announced a review of PHARMAC and one of its decisions have also been the subject of a coronial inquest.
nib New Zealand chief executive Rob Hennin said the non-PHARMAC Plus option was developed in response to New Zealand's low standing when it comes to access to new 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," he 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."
He said the cover will apply to all non-PHARMAC funded medicines that have been approved by the country's regulator.
“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.
“As these advancements in medical innovations continue to take place, advisers will play a critical role in educating and informing the public of the various health cover products on the market to help support their clients’ long-term health needs,” he said.
The new benefit covers the cost of medicines where nib has accepted a claim for treatment and where the non-PHARMAC therapies 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.
“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,” said Hennin, who used the example of Novartis' melanoma therapy TAFINLAR (dabrafenib). He said it is approved for use in New Zealand but not reimbursed.