Also, for leukaemia too, if the commentary in the media is to be believed. This new medicine on the market, approved for use in New Zealand, is currently not funded. The indications from the commentary, this medicine is one of the only options for melanoma patients to be successfully treated.
I am not clear on the survival rates, but the results to date appear to be miraculous when standard chemotherapy has been less than useful in treating melanoma to date according to the many articles on the subject. The problem is the cost, somewhere in the region of $300,000 over two years to access this new treatment.
That is substantial in anyone's book, not quite half a house in Auckland but still up there when compared to average incomes and the ability to save this sum.
Did you know that medicines which are discovered and manufactured by a drug company for a specific treatment have the right to be exclusive in the market for a period of time to recover their development costs?
This is called the branded medicine and tends to be where the most expense in your treatment is incurred this is where Keytruda sits at the moment. Given it is new the costs for it are not going to drop for a very long time.
Once this initial cost recovery period is up, the other drug companies in the market can manufacture a generic version of the medicine, it will probably have a few minor differences to the branded original but works pretty much in the same way.
Why do you need to know this?
Medsafe New Zealand has approved Keytruda for use in New Zealand, but Pharmac has not approved funding for it.
Given the extreme costs, it may not be able to until it has reached the generic stage of the drug life cycle. Politically it seems unlikely to take that long, just like the Herceptin debate back in 2003.
So why do you care?
This is where the gap in your treatment starts if your doctor only presents to you the Pharmac funded options then you may be missing out on potentially life-saving treatment if there is a new medicine which is approved for use in New Zealand but it is not yet funded.
Even if you are told about the 'new' medicine it may not be accessible due to the very high cost you will have to pay for it. In 2003 it was Herceptin, today in 2015 it is Keytruda, in the future it will be something else. The point is while you may not need these today, you may in the future. Relying on the government to front up, when it has significant financial pressure everywhere is akin to playing Russian roulette.
As an insurance adviser, I regularly hear about funding shortfalls for treatment; un co-ordinated treatment and just plain old frustrated that someone decided Russian roulette was an ok idea and didn't take cover.
Ok, so what does this mean for you?
This could mean you have to find 10's if not 100's of $000's to pay for the treatment yourself or do with the lesser option a hope it all works out fine.
I wrote an article back in December 2013 on Pharmac funding, which is still relevant today, and what it shows is the landscape of medical treatment in two years has not improved, if anything we have better treatments that are now less affordable.
This article, from March 2015, demonstrates how bad this situation really is. With only 13% of new medicines that have been approved for use are funded by Pharmac.
Add to this the government budget for this is not getting any better, as this article also in March 2015, demonstrates.
What has become quite a media debate is the new Keytruda drug treatment, this article from June 2015 highlighting this promising new drug and funding for this is likely to be some time away.
Further to this in November 2015 this article outlining the financial balancing act Pharmac has to operate with, effectively treating your health care with similar ROI you would use in business.
In December 2015, steps up the commentary
- This article discusses Pharmac giving Keytruda a low priority
- This article highlights the struggle for one woman and the costs associated with accessing the Keytruda.
- This article speculates that Keytruda will be funded.
- Also, this article, a few days later, pours cold water on it happening.
- Also, this article highlights another use for Keytruda in fighting blood cancers, like leukaemia, which will also struggle to be funded for this use
How do you fix this and avoid the costs?
If you are in the situation of requiring treatment which is approved for use but is not funded or the generic is not suitable, and you need the unfunded branded option, you are going to have to find the money to pay for this yourself. This is where I come in as your insurance adviser.
To solve this potential shortfall in treatment, you can do 1 of 2 things;
- Use the assets you have to pay for it, sell up your home and other things of value
- Insure it before you get sick or develop a condition.
I know you do not like don't like option 1, You've worked hard for what you have! How does option two work?
This situation can be tackled in two ways. Accessing a good medical insurance policy which covers unfunded drugs and medicines or take out a trauma policy for enough money to cover this off for you, or both.
There are many ways to approach this, what is right for you will depend on your situation, age, stage, income, financial resources, etc. What I can say is it is possible to limit your exposure to unfunded medicine costs and maintain the affordability of the cover for this purpose. In some cases as little as $9 per month through to around $50 per month for older lives.
Assuming the higher end, $50 per month, at that rate of saving it would take you 500 years to save the $300,000 indicated for Keytruda for a two-year course of treatment. It makes sense to offload it to a quality insurer who will cover the risk and ensure you do not have to play Russian Roulette with your health.
What to discuss your options more specifically to your situation, get in touch
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