If health insurance doesn't cover non-Pharmac meds, what's the point?

Q: Our health insurer does not cover some GP-prescribed medicines. My husband doesn't tolerate anti-inflammatory Voltaren well, so is prescribed Celebrex by his GP. Southern Cross does not reimburse these medicines as they are not subsidised. Surely the reason to have medical insurance is to cover something not subsidised by the Government? — Tracey

A:

Southern Cross says it's basically a cost thing. To avoid large-scale premium increases, only drugs listed on the Pharmac schedule qualify for cover on most plans and benefits.

"Pharmac has to achieve a balance between getting good health outcomes for New Zealanders and ensure pharmaceutical costs do not spiral out of control. Southern Cross has a similar objective. Adding expensive drug treatments to our benefits would increase premiums to the extent they would become unaffordable for many members."

You can find policies that pay for non-Pharmac medications, such as from Accuro or nib, but most require that the medication be prescribed by a specialist.