The Pharmac vs Private Drug Reality
Pharmac funds about 50-60% of cancer drug needs across patient populations. These are established drugs proven to work. If your cancer is one of the common types and Pharmac covers treatment, the cost to you is minimal.
But if your cancer is rare, advanced, or you develop resistance to Pharmac-funded drugs, non-Pharmac options exist that could extend your life. These cost $2,000-5,000 per month. Without health insurance, these drugs are unaffordable for most Kiwis.
Oncology Waiting List Reality
Your public oncologist will recommend Pharmac-funded options. These are excellent drugs, but they're limited by what Pharmac decides to fund.
If your cancer progresses on Pharmac drugs, you have options: - Wait for Pharmac to possibly fund the next drug (could be years) - Pay privately for non-Pharmac options if you can afford them - Join a drug trial if available - Travel for treatment
Private cancer specialists can access and recommend non-Pharmac drugs immediately.
The Cost of Treatment Without Insurance
A newly diagnosed patient with advanced ovarian cancer might progress through: - First-line Pharmac drug (funded): 12 months - Second-line non-Pharmac drug (not funded): $3,000/month × 8 months = $24,000 - Third-line drug: $2,500/month × 6 months = $15,000
Total non-Pharmac costs: $39,000. For a Kiwi earning $60,000/year, this is financially impossible without insurance.
Health Insurance Limits and Cancer
Most health insurance policies have an annual limit on cover (typically $20,000-30,000 per year). So insurance might cover the $24,000 second-line drug treatment, but leaves you exposed if a third-line drug is needed the following year (your new year limit applies).
However, even partial coverage of non-Pharmac drugs is dramatically better than zero coverage.
Accessing Non-Pharmac Drugs
If your oncologist recommends a non-Pharmac drug:
- Check if it's available on Pharmac (unlikely if recommended privately)
- Ask your insurer for confirmation of cover before proceeding
- Confirm the total cost including oncologist consultation, drug cost, and monitoring
- Consider whether you should use insurance for this or wait/self-fund
Some insurers have specific cancer drug policies. AIA, for example, covers some non-Pharmac cancer drugs up to specified amounts. Southern Cross and Partners Life have different policies.
The Bottom Line
For cancer specifically, having good health insurance is one of the most financially protective decisions you can make. The drugs that extend life by months or years — the ones that aren't on Pharmac — are affordable only with comprehensive private cover.
Don't wait until you need it to find out you don't have it.