Non-Pharmac drug limits by health insurer

Pharmac funds a defined list of medicines. A drug that is Medsafe-approved but not on that list is paid for privately, and the amounts are large enough to decide treatment. This is the single number that separates health insurance plans most sharply, and it is the reason a large share of policies are bought at all.

How often this changes: Limits change when an insurer republishes a policy wording; re-read on every republish of this page. Figures on this page were last checked on 9 Sep 2026.

Non-Pharmac cancer drug limit by health insurer

Non-Pharmac cancer drug limit by health insurer
Insurer	What the plan pays for non-Pharmac drugs	Where the limit is stated
Southern Cross	$10,000 each claims year within the base chemotherapy maximum; the Cancer Cover Plus upgrades remove that sub-limit	Published in the policy wording
AIA	Pharmac and non-Pharmac Medsafe-indicated cancer chemotherapy drugs sit inside the $500,000 cancer cover benefit	Published in the policy wording
nib	$20,000 for each insured person every policy year, with an optional Non-PHARMAC Plus benefit paying 100% of eligible costs up to a separate limit and no excess	Published in the policy wording
Partners Life	Prescribed non-Pharmac subsidised drugs up to $25,000 within the surgical and non-surgical limits, plus a Non-subsidised Drugs Option	Published in the policy wording
UniMed	$10,000 per policy year for Medsafe-approved non-Pharmac chemotherapy drugs inside the cancer limit, plus $2,000 for in-patient non-Pharmac prescription drugs	Published in the policy wording

Source: Each insurer's published policy wording, read 9 Sep 2026.

Pharmac funds a defined list of medicines. A Medsafe-approved drug outside that list is paid for privately unless a policy covers it, which is why this limit decides more claims than any other number on a health policy. The limits are not comparable line for line: some sit inside a wider surgical or cancer maximum and some sit on top of it.

Questions about non-pharmac drug limits by health insurer

What does non-Pharmac mean?

Pharmac decides which medicines the public system funds. A medicine can be approved as safe and effective by Medsafe and still not be funded, which leaves the patient paying for it. Insurers call that a non-Pharmac drug and cover it, if at all, up to a stated limit.

Are the limits above comparable?

Not directly, and reading them as a league table is the common mistake. Some sit inside a wider surgical or cancer maximum, so claiming the drug reduces what is left for everything else. Some sit on top. The structure matters as much as the number.

Is the limit per year or per condition?

It varies by insurer, and the wording says which. Per policy year, per claim and per condition are all used, and the difference is decisive in a long course of treatment. Ask for the wording before you apply, because a brochure is not the contract.

Do I need non-Pharmac cover if I am young and healthy?

The claims that use it are not age-selective in the way people assume, and the cover cannot be added once a diagnosis exists. It is bought before it is needed or not at all, which is the awkward part of the decision.

What happens when the limit runs out?

The rest is self-funded. That is the practical case for looking at the limit and the structure together rather than the premium alone, because the difference between two plans at similar prices can be tens of thousands of dollars at the point it matters.