First, what is a non-Pharmac treatment?

Not every medicine available in New Zealand is publicly funded.

Pharmac (Te Pātaka Whaioranga) decides which medicines to fund, working within a fixed budget. That means a treatment can have Medsafe's tick of approval and still miss out on Pharmac funding.

And there are plenty of treatments waiting in line. As of August 2026(1), Pharmac had 159 medicine funding applications sitting on its “options for investment list” – treatments it has already assessed as worth funding, if and when the budget allows.

These span a wide range of conditions: cancers, autoimmune disorders, respiratory illness, neurological conditions, rare diseases.

If you need one of these, you may have to cover some or all of the (often substantial) cost yourself – unless your health insurance includes a meaningful level of non-Pharmac cover.

Not all health insurance helps the same way

Seeing “non-Pharmac” cover listed in your policy is a good start. But how much protection it gives you can vary enormously.

Different health insurance policies may:

• Offer non-Pharmac cover as standard or as an add-on

Some policies build in a level of non-Pharmac cover as standard. Others let you add it, or increase it, for an extra premium.

• Define what they’ll pay for differently

Cover may be restricted to particular treatments or circumstances. For example, some policies focus on non-Pharmac chemotherapy or cancer treatment, while others cast a wider net.

• Have different limits

Non-Pharmac cover can range from around $10,000 up to $600,000 a year, depending on the policy and any optional cover you've added.

• Have specific sub-limits and exclusions

Sub-limits can cap specific treatments lower than the overall limit, and exclusions or eligibility criteria can rule certain things out entirely. Some policies also set requirements around how a treatment needs to be prescribed or recommended before it's covered.

It’s the combination of all these things that determines how much the cover is actually worth to you when you need it.

What about trauma insurance?

Health insurance isn't the only type of cover that could help.

Trauma insurance (also known as “critical illness cover”) can pay you a lump sum if you’re diagnosed with one of the serious medical conditions listed in your policy. The list varies, but cancer, heart attacks and strokes are common examples. 

Unlike health insurance, the payment isn’t tied to a particular medical bill. It's yours to use however you choose, which could mean putting it toward a non-Pharmac medicine, other treatment costs, or anything else that comes with a serious diagnosis.

Interested in non-Pharmac cover?

At its core, non-Pharmac cover is about keeping more treatment options open if you ever need them. 

Not sure what your current health insurance covers? An Insurance Link adviser can walk you through the limits, exclusions and conditions that may apply.

And if you’re looking at health insurance for the first time, we can help you compare policies and understand the differences in non-Pharmac cover.

Source: 

1. Pharmac - Priority lists for funding applications

Disclaimer: Please note that the content provided in this article is intended as an overview and as general information only. While care is taken to ensure accuracy and reliability, the information provided is subject to continuous change and may not reflect current development or address your situation. Before making any decisions based on the information provided in this article, please use your discretion and seek financial advice.

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