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[Opinion] Debate on funding cancer drugs good time to spread the word on health insurance

Funding cancer drugs – has there ever been a better time to demonstrate the value of health insurance?

Wednesday, June 5th 2024, 1:46PM

by Steve Wright

The Government has been in the news a lot since Budget over funding certain cancer drugs not currently publicly funded by Pharmac.  Even if Government does eventually fund these 13 cancer drugs, there is always something else not funded. 

Surely all this airtime and attention, given to what is a patently dreadful situation for anyone to find themselves or their loved ones in, means now is a good time for advisers to spread the message that private health insurance may be the answer for many?

Surely now is an opportune time to help clients and prospective clients, buy-into the value of private health insurance, to buy-into the mindset that they can, and should, stop relying on someone else to dictate what treatment they can and cannot get, and to buy-into taking control over their health care needs themselves?

The issue of unfunded drugs has been around for decades, and I don’t see that changing anytime soon. Even if those 13 cancer drugs are eventually funded, there will always be newer and better ones not, or not yet, funded.

Private health insurance can give people the financial freedom to choose who treats them, when, where and with what treatments, should life threatening cancer strike – but it must be a suitable health insurance policy.

Not every health insurance policy covers drugs not funded, either adequately or at all, so these policies are unlikely to be fit-for-purpose.

A few policies will cover unfunded treatments for cancer to substantial limits, but then one must ask: can the insurer take away that benefit for existing policyholders?  In other words, is that policy’s wording guaranteed? 

If not, then again, in my opinion, that policy is not fit-for-purpose: it may not do tomorrow what it promises to do today.

I’m not saying every health insurance policy that’s not guaranteed, or that doesn’t cover unfunded drugs, is not fit-for-purpose, it depends on the client’s needs and what they want out of their health insurance.

For me and my family however, certainty of cover for unfunded drugs is the most important reason to have health insurance, precisely because it’s not just a question of waiting: unfunded drugs may not be available at all publicly.

Some might say we are in a financial crisis and people can’t afford it.

I don’t think that should put you off.

Even though some may have to wait until the financial pressure reduces, the news may have distressed them. Now is a great time to show clients a possible solution, to show them your true value as an adviser and, to show them that you have their best interests at heart. \

Do your research, investigate what cover for unfunded cancer treatments might be suitable and affordable. I know of at least one provider whose health insurance product has very good cover for unfunded drugs and guaranteed wording.

This policy also offers a range of excess options, up to $10,000, which dramatically lowers the cost. The best news of all is that this policy does not apply the excess to the drugs and certain other treatments necessary for treating life threatening cancer – possibly a  financially effective answer to funding the very high costs of unfunded cancer treatment for your clients, even with the maximum excess! (As always read the policy wording carefully to see what exceptions there might be).

One more thought

I’ve heard it said that private health insurance is unfair and allows ‘wealthy’ people to jump the queue for health services.  I don’t buy this view. 

I see two separate queues, one for public health and one for private health. I believe health insurance has a positive effect for all of us. More people having private health insurance will mean fewer people in the public health queue, taking strain off the public health system and freeing it up to reduce waiting times for those who rely on public health.

As such, I suggest that having private health insurance is not entirely self-serving, it also serves an important social purpose.


Steve Wright – Has qualifications in economics, law, tax, and financial planning.  He has spent the last 20 years in sales, product, and professional development roles with insurers.  He is now independent and helping FAPS to mitigate advice risk through training and advice coaching.

This article is for information purposes only, its content is the writer’s opinion and intended to be of a general nature, does not take into account any person’s specific circumstances, and is not financial, legal, or other advice. It is recommended you seek advice from a suitable expert before taking any action in relation to anything contained in this article.

Steve Wright has qualifications in economics, law, tax, and financial planning. He has spent the last 20 years in sales, product, and professional development roles with insurers. He is now independent and helping advisers mitigate advice risk through training and advice coaching.

Tags: Opinion Pharmac

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