This information is intended as a guide for those seeking access to treatments not funded by Pharmac. Your first step is always to discuss with your haematologist whether you are likely to benefit from an unfunded treatment. They can provide guidance on the need for a specific medication and prescribe, as required.
Free access to non-Pharmac funded medicines
Special Access Schemes
Named Patient Pharmaceutical Assessment (NPPA): In specific circumstances, Pharmac may consider funding an unfunded drug for an individual patient through the NPPA process. This typically applies to rare or unusual cases where no alternative funded treatment is available.
Clause 8.1b of the Pharmaceutical Schedule: This clause provides clinicians with full decision-making authority to prescribe medicines not usually funded by Pharmac to children diagnosed with cancer.
Clinical Trials
Clinical trials are studies that test new treatments or medications. Participation in a clinical trial may provide access to new or experimental drugs at no cost to you.
Clinical trials have specific eligibility criteria based on factors like your medical history, age, and the stage of your condition. If you qualify, participation can provide early access to promising treatments.
Discuss with your haematologist if there are any relevant clinical trials available for your condition. You can also search for trials in New Zealand through the ClinTrialRefer App (https://web.clintrialreferapp.com/searchTrial/list)
Understand that clinical trials come with risks, as the medications being tested may have unknown effects. Your haematologist can help you weigh the potential benefits against these risks.
Health insurance
If you have private health insurance, it can be worthwhile checking what medicines are covered in your policy, noting that most private insurance policies in New Zealand only partially cover the costs of medicines. Private insurers are unable to provide access to medicines not registered by MedSafe.
Funding out-of-pocket
Where a drug is unfunded, not available via a clinical trial, and not covered by an insurance policy - you may need to consider paying out-of-pocket. Prices can vary depending on the medication, pharmacy, and whether it is sourced from within New Zealand or imported.
Sometimes a specialist is required to administer the therapy, this comes at an additional cost to the medicine and should be discussed with haematologist before seeking to fund a medicine out-of-pocket.
Pharmaceutical Cost-Share Programs
Pharmaceutical cost-share programs are initiatives offered by pharmaceutical suppliers where they share the cost of a medication with the patient. This can significantly reduce the out-of-pocket expense for unfunded drugs.
Your haematologist can help determine if the drug you need is part of a cost-share program. They will also assist in the application process if a program is available.
Raising Funds for Medications
Fundraising platforms: Some people turn to crowdfunding platforms such as Givealittle to raise money for unfunded treatments.
KiwiSaver will allow withdrawal for serious health issues, or you can apply to your bank for a mortgage repayment holiday or a reverse mortgage.
It is natural to seek access to the best treatments available, particularly if Pharmac-funded options for your situation are limited. Each of these opportunities will depend on your personal situation and financial position. For further information, see the following resources:
