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News & Articles

26
September
2016

Private Health Insurance Cancer Cover benefit continues to provide value

Want to know what impact Pharmac’s funding decisions have on the value customers get from their health insurance?

Pharmac has recently started funding drugs for the treatment of advanced melanoma, Opdivo from 1 July 2016 and Keytruda from 1 September 2016. These drugs were previously only available to those with the ability to pay for them out of their own pocket or via a health insurance policy, such as Private Health, that offers cover for non-Pharmac subsidised chemotherapy drugs.

How does this change impact our Private Health Cancer Care benefit?

Because these drugs are now publically funded it would be natural to think this could reduce the value customers receive from our Cancer Care benefit, particularly the non-Pharmac chemotherapy component. However this isn’t the case and in fact reinforces the value of having a specific Cancer Care benefit.

When a drug is Pharmac subsidised this funding only applies if the treatment is delivered in the public system. If a patient chooses to have their treatment in the private system the price that patient is charged for the drug is based on the rate that Pharmac has negotiated with the drug company, despite the drug not being paid for by Pharmac. This means the patient needs to pay for it themselves, or through their health insurance.

Why would people choose to go private?

Because of this you might assume it would make more sense for people to just go public if the drug they have been recommended is Pharmac subsidised. However people often prefer to have their treatment performed privately as it gives them more options on where and when they will be treated. Additionally many Pharmac subsidised drugs are used in conjunction with other drugs that are not subsidised by Pharmac to improve treatment outcomes, for instance Opdivo is used in conjunction with Yervoy1, a non-Pharmac subsidised immunotherapy drug, for the treatment of advanced melanoma.

What about other types of cancer?

While Opdivo is Pharmac subsidised for advanced melanoma, it is not currently funded for treating lung cancer despite being MedSafe indicated for this condition. This means lung cancer patients who are prescribed this drug will still need to pay for it themselves or by using their health insurance.

We are also seeing claims for new non-Pharmac subsidised drugs that are MedSafe indicated. In the case of breast cancer we have received claims for a number of non-Pharmac subsidised drugs such as Kadcyla (Trastuzumab emtansine)2  and Perjeta (Pertuzumab)3 that are being used to treat HER2 positive breast cancers4.

Private Health Insurance Cancer Cover benefit continues to provide value

While Pharmac’s funding decision is fantastic news for New Zealanders facing a diagnosis of advanced melanoma, it in no way negates the value customers get from the Cancer Care benefit available under Private Health. We know there are a number of new drugs under development5 and that they aren’t always funded for every cancer type they are used to treat. For instance, there are over 700 new cancer drugs and vaccines in active clinical trials or with the Food and Drug Administration (FDA) for approval6. The reality is Pharmac will not be able to fund all of these drugs, so the value of non-Pharmac chemotherapy cover is likely to only increase over time as more advancements are made.

If you have any further questions please contact your BDM.

 

[1] Larkin, J. et. al. (2015) Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma.

[2]Peddi, P. F., and Hurvitz, S. A. (2013). Trastuzumab emtansine: the first targeted chemotherapy for treatment of breast cancer

[3]Fabi,A., Malaguti, P., Vari, S. and Cognetti, F. (2016). First-line therapy in HER2 positive metastatic breast cancer: is the mosaic fully completed or are we missing additional pieces?

[4]Breast Cancer Aotearoa Coalition. (2016) Exciting new breast cancer medicines now available to be used in NZ.

[5]Farkona, S., Diamandis, E. P. and Blasutig, I. M. (2016). Cancer immunotherapy: the beginning of the end of cancer?

[6]Buffery, D. (2015). The 2015 Oncology Drug Pipeline: Innovation Drives the Race to Cure Cancer

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Categories: News & Articles

11
July
2016

Does your medical policy cover this procedure? Ask us for advice

'A great leap forward for women' - advocacy groups demand more access to new breast cancer treatment

There are claims hundreds of New Zealand women are missing out on the latest technology to significantly speed up the treatment of early stage breast cancer.

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Categories: News & Articles

23
May
2016

Blended families — will your partner's new "friend" enjoy your inheritance?

 

Are you leaving your children's inheritance for your partner's new "friend" to enjoy?

 

This weekend the Sunday Star Times ran an article about estate planning gone wrong. There were a number of major issues with the situation — all of which are especially pertinent for blended families. Are you in this situation? Do you have clients or friends who you should share this with?

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Categories: News & Articles

23
May
2016

The pain of no medical insurance

Hundreds of patients are waiting too long for elective surgery and at some hospitals higher levels of pain and disability are being demanded just to get on the list.

At last count, in March, none of the 20 district health boards had managed to treat all the patients promised elective (non-urgent) treatment within the required four months. Some 750 patients nationally - more than 200 at Waikato DHB - waited more than four months.

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Categories: News & Articles

29
March
2016

Applying for insurance

What’s actually involved in the application process? Find out the five main steps, starting with where to begin the conversation.

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Categories: News & Articles

11
April
2016

Product Update – Are you covered for the new cancer treatment drugs?

Things change…


Insurance companies are making changes. New products and changes to older products mean an increased choice and greater flexibility to our clients – so they can be closely tailored to fit your circumstances.

Sovereign have introduced a new Cancer Benefit in the latest upgrade to their Medical Insurance policy which includes paying for non funded Pharmac drugs for cancer treatment.

Your present Health policy may have no provision to pay for non-funded Pharmac drugs for the treatment of cancer.

The melanoma & lung cancer drug Opdiva costs $235,000 for a year treatment. Yervoy  for previously treated or newly diagnosed advanced melanoma )is $204,000 for a 12 week course and advanced prostate cancer drug Provenge requires an outlay of $146,000.

The market for surgical and non-surgical Pharmac and non-Pharmac treatments and drugs is moving quickly. New innovative products, particularly for the treatment of cancer, are coming on to the market at a dizzying rate and at a price that is prohibitive for all but the wealthy.

Families already cannot access a range of medicines and treatments that are available in other countries, such as Australia, and funding constraints inhibit Pharmac's ability to fully resource the latest innovative, life-saving cures.

But we can be sure about one thing – prices will continue to rise, begging the question whether only the lives of the wealthy can be saved in this new inflationary environment.

Should you require further information,  please get in touch with me.
  

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Categories: News & Articles

29
March
2016

How an Adviser can help you

Do I need an insurance Adviser? Find out about the benefits of working with an Adviser to ensure you have the best cover for you now, and as your life changes.

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Categories: News & Articles

29
March
2016

The claims Process

If you’re making a claim, we understand something hasn’t gone to plan. To help you through this difficult time, here’s a heads up on what happens and how to make the process easier.

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Categories: News & Articles

23
March
2016

How an Adviser can help you

Do I need an insurance Adviser? Find out about the benefits of working with an Adviser to ensure you have the best cover for you now, and as your life changes.

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Categories: News & Articles

29
March
2016

Simplifying Insurance

Life insurance can sometimes be complex, so we're simplifying it.

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Categories: News & Articles

22
February
2017

How to Buy Health Insurance

It's easy to buy the wrong kind of insurance, fail to grasp limits on your cover, and even do things that legally entitle your insurer to tear up the policy. Here are 10 things to consider:

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22
February
2017

Are you making good financial choices?

In 2015, US insurer Prudential ran a series of ad campaigns highlighting the biases that lead people to make poor financial decisions. These biases, known as heuristics, are mental shortcuts that enable us to make quick decisions that are practical but not necessarily optimal.

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26
April
2017

KidSmart with Accuro

Now your family’s getting bigger, you might want to think about the benefits of health insurance. That way, if your little bundle of joy becomes ill, you can help them get the treatment they need when they need it.

 

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