nib has announced that members will be able to add the non-PHARMAC new Plus add-on when buying nib Hospital cover. This means members will have access to Medsafe-approved drugs not funded by PHARMAC. The add-on will also cover the cost of administering the drugs.

"Do you know the true cost of non-PHARMAC drugs?

Drugs are expensive. There’s nearly 1,000 of them that get funded by the government in New Zealand, which is great. But the reality is we have the worst access to funded modern drugs out of 20 OECD countries. 

This is because PHARMAC, the government agency who decide what drugs are funded, can only approve a selection of new treatment options each year. That means some effective drugs for some really serious conditions just don’t make the list.

For people with a range of diseases, from bowel cancer to Crohn’s disease, there are effective treatment options available that they can’t access. Because when they’re not subsidised, they can be simply too expensive for some people.

 

Introducing our non-PHARMAC Plus add-on

To ease the burden, we’ve launched our new non-PHARMAC Plus add-on option which you can add when you buy nib Hospital cover.

non-PHARMAC Plus gives you access to many Medsafe-approved drugs not funded by PHARMAC. It also covers the costs of administering the drugs. That makes treatment for cancer and other serious conditions more accessible, in either a private hospital or at home.

Add non-PHARMAC cover from $1.24 per week

Our Hospital plans start from $11.07 (3) weekly and are designed to help cover the big health costs like surgery or cancer treatment, giving you fast access to private healthcare. You can add non-PHARMAC Plus to our Hospital plans from just $1.24 per week (2).

You can choose the level of cover that’s right for you. The cover level is the maximum amount we’ll pay towards your eligible claims each policy year for each member covered."

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We have recently added nibs non-PHARMAC Plus option to our product range on Quotemonster. non-PHARMAC Plus ranges from $20,000 to $300,000, is available through both adviser and group business channels, and can be added to new or existing hospital covers (i.e. Ultimate Health Max) however only available to existing members on legacy products from 5^th July 2021. 

The Addon is designed to offer customers more access to potentially life-saving treatments not publically funded by PHARMAC, are Medsafe approved and have been prescribed or administered in line with Medsafe’s guidelines – not just cancer treatments.

The benefit covers the cost of these medicines where nib has accepted a claim for treatment and where the non-PHARMAC drugs 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. Additionally, there are no waiting periods when members choose to add this option to their policy.

You can select the nib non-PHARMAC Plus options in your Product Settings screen: 

Please email us should you wish to discuss this further or would like to provide feedback.

Doreen Dutt, Research Analyst, Quality Product Research Limited, researcher@qpresearch.co.nz

nib has announced the launch of a new health cover option, non-PHARMAC Plus, that is designed to offer members more access to potentially life-saving treatments not currently funded by PHARMAC. Members will be able to access treatments that are Medsafe approved and have been prescribed or administered according to Medsafe’s guidelines. Non-PHARMAC Plus is now available through adviser and group business channels. Members can add the cover to new or existing hospital cover. There is no waiting periods if members choose to add this option. Benefit limits range from $20,000 to $300,000 per member annually. nib CEO, Rob Hennin, has said that non-PHARMAC Plus was developed to offer members more flexible and affordable options. Through non-PHARMAC Plus members have access to new unfunded medicines. When future treatments for critical illnesses become available, members will be covered.  non-PHARMAC Plus covers the cost of using non-PHARMAC treatments in private hospital or at home up to six months after being admitted to hospital and any drug administration costs once a claim is accepted.

“Leading health insurer, nib New Zealand (nib), has today launched a new health cover option to provide Kiwis with greater choice and access to potentially life-saving treatments not publicly funded by PHARMAC – the government agency responsible for deciding which medicines are subsidised as part of our public health system.

The new add-on cover, non-PHARMAC Plus, is available from today through nib’s adviser and group distribution channels with members able to add to their new or existing hospital cover.

Benefit limits range from $20,000 to $300,000 per member per year, allowing members to choose the level of cover that best suits their health needs and budget.

nib New Zealand Chief Executive Officer, Rob Hennin, said the non-PHARMAC Plus option was developed in response to a growing need for cover that provides members with greater choice, affordability and flexibility when it comes to modern 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,” Mr Hennin 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.

It’s why we’ve introduced this add-on option which is designed to better protect our members’ health by making potentially life-saving treatments more affordable and accessible,” he added.

nib’s non-PHARMAC Plus option provides cover for all medicines that are not funded by PHARMAC, are Medsafe approved and have been prescribed or administered in line with Medsafe’s guidelines – not just cancer treatments.

“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,” Mr Hennin said.

“As these advancements in medicine innovations continue to take place, advisers will play a critical role in educating and informing the public of the various health cover products in market to help support their clients’ long-term health needs,” he added.

The benefit covers the cost of these medicines where nib has accepted a claim for treatment and where the non-PHARMAC drugs 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. Additionally, there are no waiting periods if members choose to add this option to their policy.”

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NZ Herald has reported on Mandy Grantley’s cancer story. After Mandy was first diagnosed with bowel cancer she underwent chemo for six months. After finding out that the cancer had spread to her lungs, an additional six months of chemo and an unfunded drug, Cytoxan was recommended by three oncologists working within the public health sector. Mandy was informed that she could have her chemo at her local DHB hospital. She was told that she had to pay $64,000 for the drug herself and was redirected to a private clinic to have the drug administered. The drug was intended to simply prolong her life. With a young family, a struggling business, and an existing mortgage Mandy and her friends decided to set up a Givealittle page to raise funds. The experience made Mandy reassess the public health system. National deputy leader Shane Reti is seeking MPs to support his bill that will allow privately-funded cancer medicines to be administered through DHBs. In response, Finance Minister Grant Robertson has said that Labour wouldn’t support the bill as it would be adding to existing inequalities. Instead, the Government would focus on funding more cancer treatments through Pharmac.

“A woman battling cancer says heartbreak has turned to anger at the way she was forced to pay $64,000 for treatment advised by public health oncologists.

Mandy Grantley was given two years to live after bowel cancer spread to her lungs last year.

"They found a tumour in my bowels and removed it, which was all good," she told RNZ. "I had six months worth of chemo. After that I had a scan and it all looked good. It wasn't until last year during lockdown I was told over the phone it had spread to my lungs."

Grantley said she was then told by three different oncologists working within the public health system that her best course of action would be another six months of chemo alongside being administered unfunded drug, Cytoxan.

She was told she would need to go to a private clinic to have the drug administered after paying for the drug herself, and then go to get chemo at her local DHB hospital. The news was traumatic and overwhelming.

"The chemo was bad enough, but then being told you had to pay $64,000 for a private drug, which won't cure me but will prolong my life, and a better quality of life, I just thought, I can't do this.

"I have three young kids and a husband with a struggling business, we don't have $64,000. We would be remortgaging the house, which we already had a huge mortgage on."

Concerned for her family, Grantley persevered and two friends set up a Givealittle page and managed to raise the money.

The private drug cost her $27,000. To get it administered she had to pay a private clinic $36,000.

Grantley says she knows how lucky she is, but remains angry others will not be able to access money or credit to save their own lives.

"It makes me sick to my stomach that others out there don't have that opportunity ...  those poor families behind me - it's just wrong," she said.

Having to go to two different medical facilities was also stressful and time-consuming, with Grantley relying on people to drive her to and from the clinic and public hospital, she added.

To add insult to injury Grantley had to pay $8000 GST on her treatment. The experience has made her reassess the merits of the public healthcare system and the Government's priorities.

"They're making money out of me dying. So much for a free health system. When you really need it, you're on your own and you don't know what it's like until someone close to you goes through it. I was really upset, I was heartbroken. But now I'm just damn well angry."

Grantley finished her treatment in November and her scans since have come back clear, the latest a scan in February. She has another scan this month and remains hopeful.

"I've never felt so good, never felt so healthy."

She said her health outcome so far had proved the efficacy of Cytoxan as an anti-cancer drug.

National deputy leader Shane Reti is asking MPs to support his bill seeking to allow privately-funded cancer medicines to be administered through DHBs, to reduce the financial burden on those with cancer.

However, Finance Minister Grant Robertson told RNZ the Government would not be supporting the bill when it comes before Parliament because it would only add to existing health inequalities.

"It is a challenging area where people are self-funding the drugs because obviously for the most part what we want to do is fund people's treatment through the public system and then all of the costs and so on associated with it are managed that way," he said.

"The reason that we're not looking to move in this area is because what effectively it would mean is that somebody who does have enough resources to fund their own treatment would end up taking up space in the public health system that would otherwise go to people whose cancer treatment is publicly funded.

"So actually it would have the effect of exacerbating inequality rather than creating fairness."

He said the Government was instead focused on funding more cancer treatments through its Crown entity Pharmac. Click here to read more

Dr. Graeme Jarvis has written a piece on Stuff about the Government’s plan to conduct a review into Pharmac. In the piece, Dr. Jarvis notes that the review should be seen as being for the good of the country, as long as the review is intended to update an outdated system, improve Pharmac’s performance, and expand access to publicly funded medicines. Transparency, timeliness and equity have been described as being the focus of the review. 

“That this Government has decided to have a review into Pharmac should be seen as positive by the country, and good public sector governance. This assumes, of course, that the review truly aims to look at ways to modernise a 27-year-old system and both to improve the way New Zealand accesses publicly funded modern medicines and to enhance the agency’s performance.

Performance for any health service should not be about PR, such as modelled graphs reporting assumed, rather than actual, savings. It should be about health outcomes achieved. Hopefully, the review can lead to the generation of meaningful health outcome measurements for patients, not myth-based savings indicators.

Transparency, timeliness and equity seem to be key areas of focus in the review. Safety of medicines is not – that is rightly a statutory role for Medsafe, not Pharmac. However, given recent deaths following an enforced brand switch of an epilepsy drug, now subject to a coronial investigation, the safety of Pharmac’s cost-driven decision-making processes should be within scope.

Timeliness of decision-making is an issue. New Zealand takes 2.5 times as long as the OECD average of nine months to publicly fund modern medicines, all of which have undergone rigorous review internationally, including assessment of clinical need and effectiveness. Why the delay? Hopefully the review will answer this question.

Despite New Zealand’s comparable wealth on a GDP per capita basis, it funds between two and 10 times fewer modern medicines than our OECD peers. Why the disparity? Is it technical or fiscal rationing? Only the former is considered in-scope for the review.” Click here to read more

nib has noted that New Zealanders can take Pharmac out of the equation by signing up to Ultimate Health with Easy Overlay promotion. The campaign begun April 1 and will continue until 30 June 2021. The promotion is only being offered on nibAPPLY.

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Naomi Ballantyne recently discussed concerns that advisers have brought forward in a video that Partners Life have published. Advisers mentioned that their clients were receiving contradicting advice from other advisers. In the video, Naomi discussed the options advisers have when dealing with similar situations.

“Recently we have been contacted by a number of advisers expressing concern about some of their Partners Life clients receiving advice from other advisers, which conflicts with the advice they gave their client to retain and amend their existing covers.

What should they tell their clients when asked why they would receive such conflicting advice from two different advisers? To help answer this question, Naomi has put together a short video explaining to clients the questions they might want to ask should they be faced with this dilemma.  You can easily share this video with your clients from our Facebook page, should you think this might be useful to any particular client.”

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Southern Cross has announced the launch of Cancer Cover Plus. The new cover is intended to give members broader chemotherapy options. Cancer Cover Plus will give members the option to upgrade to Chemotherapy 100, which has a benefit limit of $100,000 or Chemotherapy 300 which has a benefit limit of $300,000. Additionally, members will have the choice to access non-Pharmac cancer drugs.

“Southern Cross Health Insurance (SCHI) is launching competitive cancer care cover to give members more choice when it comes to chemotherapy, including increased access to cancer drugs not subsidised by Pharmac.

SCHI’s new Cancer Cover Plus has two optional upgrades - Chemotherapy 100 (benefit limit of $100,000) and Chemotherapy 300 (benefit limit of $300,000) – to help members during their cancer treatment journey. This covers the cost of Pharmac and non-Pharmac, Medsafe indicated chemotherapy drugs and their administration for the treatment of cancer.”

Nick Astwick has said that the new cover has been designed with the needs of members in mind. Cancer Cover Plus has been developed to complement the unlimited surgical and radiotherapy benefits. Astwick notes that the cover was created so more New Zealanders have faster and more access to affordable cancer treatment options.

“We understand that a cancer diagnosis, or the fear of one, can be scary for people so we wanted to give members peace of mind by providing them with more cancer cover options.

 

“We have developed them to complement the unlimited surgical and radiotherapy benefits we offer in most of our plans, and this will help to provide a comprehensive package to the vast majority of our members who have these products and also tell us their main concern is cancer care,” he said.

 

The Southern Cross Healthy Futures Report 2020 revealed that 79 per cent of New Zealanders are concerned about not having access to cancer treatment services and 59 per cent are worried about experiencing or developing an illness or disease.

 

“Not all cancer drugs are funded by Pharmac which makes them unaffordable for many people. We created this new cancer cover so Kiwis could have faster access and more treatment options to receive potentially lifesaving chemotherapy drugs if they need to,” said Astwick.” 

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I can't think of a better demonstration right now of the conflict that happens for me when evaluating insurance product than this one: 

I am sure many advisers could create similar versions based on different features of insurance policies, funded and non-funded treatments, and so on. The struggle is real. 

Dr Rosalie Stephens says it's crucial that PHARMAC moves more quickly when revolutionary treatments come along to prevent patients from deteriorating or potentially dying as they cannot personally afford the treatments.

According to this article it takes the UK on average 143 days to fund a modern medicine after it is registered for use, compared to 370 days in Australia. In NZ, patients wait on average 517 days for PHARMAC funding, with no time frame for decisions.