How to pay for a non-Pharmac medicine in New Zealand: every funding route

Written by Henry Smith · Reviewed by Smiths Insurance & KiwiSaver, licensed Financial Advice Provider (FSP712931) · Updated 2026-09-09 · Reviewed annually, or sooner if the rules it describes change.

Financial advice is provided by Craig Smith Business Services Limited, trading as Smiths Insurance & KiwiSaver, a licensed Financial Advice Provider (FSP712931). QuoteHub is a trading name.

A medicine that Pharmac does not fund has at least seven possible funding routes in New Zealand: an insurer's non-Pharmac benefit, Pharmac's own exceptional-circumstances process, a hospital's own budget, a drug company access programme, a clinical trial, charitable or crowdfunded support, or paying yourself (Pharmac, retrieved 9 September 2026). This guide covers every route; for what health insurers specifically cover, see the companion post health insurance non-Pharmac drugs NZ.

The seven routes, at a glance

The realistic starting point for most people is Pharmac's own exceptional-circumstances process, since it is free to apply and does not require existing insurance.

Route	How it works	Who applies
Health insurance non-Pharmac benefit	Insurer pays toward a specific non-Pharmac medicine under your policy	You, via your insurer
Pharmac Named Patient Pharmaceutical Assessment (NPPA)	Pharmac funds an individual case outside the Schedule	Usually your specialist, on your behalf
NPPA Rapid Hospital Assessment	A hospital funds an urgent case directly, reporting to Pharmac	The hospital/treating team
Hospital or district budget	Some hospitals fund a medicine from their own local budget	The hospital's own clinicians
Drug company access programme	Manufacturer supplies the medicine directly, case by case	Your specialist, direct to the company
Clinical trial	Free access to a not-yet-funded drug if you are eligible and enrolled	Your specialist refers you
Charity, crowdfunding or self-funding	Cancer Society, Blood Cancer NZ, Givealittle, or paying the full published price	You or your family

(Pharmac; retrieved 9 September 2026; see References.)

Going through your insurer first

Does health insurance cover non-Pharmac drugs?

Some comprehensive New Zealand health insurance policies include a specific non-Pharmac medicines benefit, usually with its own annual or lifetime dollar limit, separate from your main surgical or specialist benefits. Exact limits and eligible medicines vary significantly by insurer and policy, so this is covered in full, insurer by insurer, on health insurance non-Pharmac drugs NZ and non-Pharmac drug cover cost NZ. If you do not already hold a policy, cover taken out after a diagnosis will not pay for that condition, so this route only works if you were insured beforehand; see the health insurance guide for how cover works generally, and health insurance specialist appointments NZ for the wider specialist-cost picture.

Applying through Pharmac itself

What is Pharmac's exceptional circumstances process?

Pharmac's Exceptional Circumstances Framework, which includes the Named Patient Pharmaceutical Assessment (NPPA) Policy, is how Pharmac considers funding a pharmaceutical treatment for an individual patient when that treatment is not on the standard Pharmaceutical Schedule, under its legislative function in section 69(1)(b) of the Pae Ora (Healthy Futures) Act 2022 (Pharmac, retrieved 9 September 2026).

How does an NPPA application work?

An application is assessed first against the NPPA Policy's core principles, then against Pharmac's published Factors for Consideration, before Pharmac approves or declines funding; outcomes are published where appropriate (Pharmac, retrieved 9 September 2026). Applications are made through Pharmac's NPPA application process, and in practice your specialist or treating clinician normally prepares and submits it on your behalf.

What happens if my case is urgent?

For particularly urgent hospital cases, Pharmac's framework includes an NPPA Rapid Hospital Assessment: the hospital itself assesses the application against the same core principles and Factors for Consideration, approves or declines funding directly, then reports the decision back to Pharmac (Pharmac, retrieved 9 September 2026). This route exists specifically so an urgent case is not held up waiting for the standard NPPA process.

Is there a fixed timeframe or fee for an NPPA application?

Pharmac does not publish a fixed universal decision timeframe or an application fee in its public Exceptional Circumstances Framework material; the process depends on the individual case, the evidence supplied and whether it goes through the standard or rapid hospital route (Pharmac, retrieved 9 September 2026).

Are there other exceptional-circumstances routes besides NPPA?

Yes. Pharmac's framework also covers a Special Authority waiver or a Hospital Medicine Restriction waiver, which relax an existing funding restriction for an individual patient's case rather than funding a completely unlisted medicine (Pharmac, retrieved 9 September 2026). Pharmac also retains general discretion to consider a funding application outside any of its named processes.

Pharmac's Exceptional Circumstances Framework actually contains three separate mechanisms, and which one applies depends on urgency and whether an existing restriction, rather than a full listing gap, is the problem.

Mechanism	What it does	Who decides
NPPA (standard)	Funds an individual case outside the Pharmaceutical Schedule	Pharmac
NPPA Rapid Hospital Assessment	Funds a particularly urgent hospital case	The hospital, reporting to Pharmac
Special Authority or Hospital Medicine Restriction waiver	Relaxes an existing funding restriction for one patient	Pharmac or the hospital

(Pharmac, Exceptional Circumstances Framework, retrieved 9 September 2026.)

Hospital budgets, drug companies and trials

Can a hospital just fund the medicine itself?

Sometimes. Beyond the formal NPPA Rapid Hospital Assessment route, some hospitals can fund a non-Pharmac medicine from their own local or regional budget for an individual patient, at clinical discretion; there is no published national list of which hospitals do this or under what circumstances, so this is a conversation to have directly with your treating team.

What is a drug company access programme?

Pharmaceutical manufacturers sometimes run their own compassionate-use or "named patient" supply arrangements, separate from Pharmac, where the company supplies a medicine directly to a patient's prescriber outside the normal funding system. There is no single published New Zealand-wide list of these programmes; your specialist would need to approach the manufacturer directly to find out if one exists for your medicine.

Could a clinical trial give me free access to the medicine?

Potentially, if a relevant trial is recruiting and you meet its eligibility criteria: enrolling in a clinical trial can give free access to a medicine that is not yet funded, or not yet approved, anywhere in New Zealand. Ask your specialist whether a suitable trial exists, since eligibility and availability change constantly and are not something a general guide can state as fixed.

Charity, crowdfunding and paying yourself

Can a cancer charity help pay for the medicine itself?

Not usually the full drug cost. Cancer Society NZ's role is largely referral and information-based rather than paying medicine costs directly (Cancer Society NZ, retrieved 9 September 2026), and Blood Cancer NZ's financial assistance is described as support such as food and petrol vouchers, assessed case by case, with no fixed amount published (Blood Cancer NZ, retrieved 9 September 2026). Full detail on both is on cancer financial support NZ.

Is crowdfunding a realistic option?

Some families do raise money through platforms such as Givealittle to cover a non-funded medicine directly, but there is no published success rate or typical amount raised: it depends entirely on the individual campaign and network, not on any scheme with fixed rules.

What if none of these routes work?

The remaining option is paying the medicine's full published price yourself, which for a genuinely novel, unfunded treatment can run into tens of thousands of dollars depending on the drug; no general New Zealand-wide published price list exists across all non-Pharmac medicines, so ask the prescribing specialist or the manufacturer directly for the current cost of your specific medicine.

How this fits your wider financial picture

Where does this sit alongside everything else I might be dealing with?

If the medicine cost is one part of a bigger income and treatment picture, financial help when sick NZ sets out every income source in order, National Travel Assistance NZ covers travel to specialist appointments, and if the condition is cancer specifically, cancer financial support NZ brings the government and charity routes together in one place. If you also need to sort out leave from work while this is happening, see sick leave entitlement NZ, medical certificate NZ and returning to work after illness NZ, and if the absence is injury-related rather than illness-related, ACC vs sickness benefit NZ explains which system applies.

Could trauma insurance help pay for this instead?

If you hold a trauma (critical illness) policy taken out before diagnosis, its lump-sum payout on a covered condition is paid to you directly and can be used for anything, including an unfunded medicine, unlike a health insurance benefit which is usually paid toward the specific treatment. See the trauma cover guide, best trauma insurance NZ, trauma insurance definitions NZ and the trauma calculator to understand how a lump sum works, and do I need income protection insurance if lost income is the bigger risk.

Where each route sits in your wider cover

The table below places every route in this guide against what it actually protects, since a few different QuoteHub pages cover the insurance side in more depth.

Route	What it protects	Read next
Health insurance non-Pharmac benefit	A specific medicine cost, up to your policy limit	Health insurance non-Pharmac drugs NZ, non-Pharmac drug cover cost NZ
Trauma insurance lump sum	Your income and any cost, spent however you choose	Trauma cover guide, trauma insurance cost NZ
Income protection insurance	Lost income while you are unable to work	Income protection guide, income protection calculator
Work and Income benefits	Weekly living costs while unwell	Financial help when sick NZ
Cancer-specific charities	Referrals, vouchers and information	Cancer financial support NZ

(Each route sourced on its own linked QuoteHub guide.)

The bottom line

Start with Pharmac's own exceptional-circumstances process through your specialist, since it costs nothing to apply, then work through insurance, hospital budget, trials and charitable options in parallel rather than in strict sequence, because timeframes for each vary. Financial advice is provided by Craig Smith Business Services Limited, trading as Smiths Insurance & KiwiSaver, a licensed Financial Advice Provider (FSP712931). QuoteHub is a trading name. If you want to check what your own health or trauma cover already includes, start a free comparison.

Adviser's view

The gap QuoteHub sees most often here is stopping after a single refusal. A Pharmac decline is not the end of the road, it is one of at least seven routes, and insurance, hospital budget, drug company programmes, trials and charity support are usually worth pursuing together rather than waiting on each one before trying the next, since each moves on its own timeframe.

Henry Smith, Financial Adviser (FSP1010699). General information, not personalised financial advice.

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Cite this page QuoteHub NZ (2026). Paying for a Non-Pharmac Drug in NZ: Every Route. www.quotehub.co.nz/guides/off-work-sick/paying-for-non-pharmac-drugs-nz. Updated 2026-09-09.