Understanding Pharmac - The Definitive Guide
Our guide explains how New Zealand’s medicine-buying agency works, what it means for your health, and why health insurance helps to fill the gaps
Updated 9 March 2026
Important: Please note, this guide, as with all resources on MoneyHub, is not political - we are reporting the facts from Pharmac's most recent annual report
Key Findings
The Bigger Picture – What You Need to Know
Our guide covers:
Important Information:
Key Findings
- Medicines Budget: $1.69 billion – the fixed annual budget Pharmac manages for all publicly funded medicines, vaccines, and medical devices
- Total gross spending: $2.71 billion – Pharmac stretches the budget through commercial rebates, effectively doubling buying power as it uses the rebates to buy more medicines
- 4.182 million New Zealanders received funded medicines in 2024/25 – essentially the entire population
- 66 new medicines funded following a $604 million budget uplift – 33 cancer, 33 other conditions, benefitting ~248,000 people
- 89,436 additional patients benefitted from Pharmac decisions implemented in 2024/25
- 188,841 medical device line items under national contract, worth $655 million
- The gap matters: not every available medicine is funded – this is one of the primary reasons New Zealanders buy health insurance
The Bigger Picture – What You Need to Know
- Pharmac affects every New Zealander: Every prescription you collect, every hospital treatment, every vaccination – Pharmac’s decisions determine what’s available and what you pay, yet few people understand how the system actually works. For these reasons, we have published this Pharmac guide.
- The fixed budget creates trade-offs: Pharmac must deliver the best possible health outcomes from a set amount of money. Funding one medicine may mean another can’t be funded. This is why some medicines available overseas are not funded here.
- The gap drives health insurance purchases: Modern cancer immunotherapies can cost $50,000–$100,000+ per year. If Pharmac doesn’t fund them, you pay privately or rely on insurance. Understanding this gap is essential to deciding whether health insurance is right for you - and, our guide makes it clear benefits vary between health insurers.
- The system is changing: Pharmac received its biggest-ever budget uplift in 2024, funded 66 new medicines, and is undergoing a major organisational reset focused on transparency and consumer engagement.
Our guide covers:
- What is Pharmac?
- The Medicines Budget – Where the Money Goes
- How Pharmac Decides Which Medicines to Fund
- Understanding the Pharmaceutical Schedule (New Zealand’s Medicine Menu) and the NPPA Process
- Pharmac and Private Health Insurance – Why the Gap Matters
- How to Navigate the System and Your Rights as a Patient
- Pharmac 2024 - 2025 - A Year in Review
- Frequently Asked Questions
Important Information:
- This guide is for general information purposes only and does not constitute medical, legal, or financial advice. For information about specific medicines and their availability, visit Pharmac’s website or speak with your doctor.
- This guide is published by MoneyHub and references the Pharmac Annual Report for the year ended 30 June 2025 (published October 2025). MoneyHub is not affiliated with Pharmac, the New Zealand Government, or any pharmaceutical company. Current annual data: Pharmac Annual Report for the year ended 30 June 2025 (published October 2025).
Know This First: How Health Insurance Covers the Pharmac Gap
- Non-Pharmac cancer drug limits range from $10,000 to $20,000 depending on the insurer - when treatment can cost $50,000 - $150,000, the difference matters
- One insurer doesn't cover immunotherapy at all, and while some insurers offer optional add-ons to increase non-Pharmac cover, others don't
- Our Health Insurance Benefits and Limits Compared guide breaks down exactly what each insurer pays across cancer treatment, non-Pharmac drugs, surgical limits, and more
- Through LifeDirect, you can compare real quotes from Southern Cross, AIA, nib, Partners Life and Unimed side-by-side in under 30 seconds - no cost, no obligation
What is Pharmac?
Pharmac (the Pharmaceutical Management Agency, or Te Pātaka Whaioranga) is the New Zealand Crown entity responsible for deciding which medicines, vaccines, medical devices and related products are publicly funded. Established in 1993, Pharmac’s core role is to get the best possible health outcomes for New Zealanders from a fixed government budget for pharmaceuticals.
Know This:
- In simple terms, Pharmac is New Zealand’s medicine-buying agency. It negotiates with pharmaceutical companies on behalf of all New Zealanders, using bulk purchasing power to secure access to a wide range of treatments at the lowest possible cost.
- This means New Zealanders typically pay a maximum co-payment of $5 per prescription item for funded medicines (and many people pay nothing at all).
Know This:
- Every time you collect a prescription, visit a hospital, or receive a vaccination, Pharmac’s decisions directly affect what you receive and what you pay. Understanding how Pharmac works helps you navigate the public health system, understand when private health insurance adds value, and advocate for yourself or your family when you need access to specific treatments.
Understanding Pharmac’s Legal Objective
Pharmac’s purpose is defined in section 68 of the Pae Ora (Healthy Futures) Act 2022: to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the amount of funding provided.
This two-part mandate is important. Pharmac must deliver the best health outcomes possible, but it must do so within a fixed budget set by the Government. This means Pharmac makes trade-offs – funding one medicine may mean another cannot be funded, and decisions consider the total impact across all New Zealanders, not just individual cases. We continue to see media stories about how this affects New Zealanders when they most need help - this recent RNZ example shows how Pharmac can reverse some funding decisions.
This two-part mandate is important. Pharmac must deliver the best health outcomes possible, but it must do so within a fixed budget set by the Government. This means Pharmac makes trade-offs – funding one medicine may mean another cannot be funded, and decisions consider the total impact across all New Zealanders, not just individual cases. We continue to see media stories about how this affects New Zealanders when they most need help - this recent RNZ example shows how Pharmac can reverse some funding decisions.
How Pharmac is Governed
Pharmac is a Crown entity under the Crown Entities Act 2004, accountable to the Associate Minister of Health. Its Board is appointed by the Minister and is responsible for setting strategic direction, approving funding decisions, and overseeing the organisation’s performance.
The Board is supported by expert advisory committees made up of clinicians, pharmacists, economists, and consumer representatives. These include the Pharmacology and Therapeutics Advisory Committee (PTAC) and various specialist subcommittees covering areas such as cancer treatments, rare disorders, and vaccines.
The Board is supported by expert advisory committees made up of clinicians, pharmacists, economists, and consumer representatives. These include the Pharmacology and Therapeutics Advisory Committee (PTAC) and various specialist subcommittees covering areas such as cancer treatments, rare disorders, and vaccines.
| Fact | Detail |
|---|---|
| Established | 1993 |
| Type | Crown entity under the Crown Entities Act 2004 |
| Governing legislation | Pae Ora (Healthy Futures) Act 2022, section 68 |
| Reports to | Associate Minister of Health |
| Board Chair (2024/25) | Hon Paula Bennett |
| Employees | 195 (as at 30 June 2025) |
| Website | pharmac.govt.nz |
The Pharmac Medicines Budget – Where the Money Goes
Pharmac manages the Medicines Budget (previously the Combined Pharmaceutical Budget). This is a fixed annual allocation from the Government covering all publicly funded medicines dispensed through community pharmacies, hospital medicines, vaccines, medical devices, and related health products.
What the Budget Covers:
What the Budget Covers:
| Category | What’s Included | Examples |
|---|---|---|
| Community medicines | Prescriptions dispensed through pharmacies | Antibiotics, statins, inhalers, cancer drugs |
| Hospital medicines | Treatments administered during hospital stays | IV antibiotics, anaesthetics, chemotherapy |
| Vaccines | Childhood, adult, and pandemic vaccines | MMR, flu, COVID-19, HPV |
| Medical devices | Devices used in public hospitals under national contract | Hip implants, pacemakers, bandages, syringes |
| Related products | Other health products | Nicotine replacement, haemophilia treatments |
Understanding How the Budget Works
The Medicines Budget operates on a ‘fixed funding’ model. The Government sets the budget, and Pharmac must manage all pharmaceutical spending within that amount. This creates a strong incentive for Pharmac to negotiate competitive prices and use commercial tools such as competitive tendering and rebate agreements.
- Through these negotiations, Pharmac stretches the budget well beyond its nominal value. In 2024/25, the appropriation was $1.69 billion, but total gross expenditure reached $2.71 billion – the difference being recouped through supplier rebates, effectively more than doubling the Government’s buying power.
- Pharmac negotiates confidential rebate agreements with pharmaceutical companies, meaning the ‘list price’ of a medicine often differs significantly from the actual price paid. In 2024/25, rebates and adjustments totalled $1.086 billion. These arrangements are a key reason New Zealand can fund a broad range of medicines despite a relatively modest budget.
How Pharmac Decides Which Medicines to Fund
Pharmac’s decision-making process is rigorous and multi-stepped. Understanding this process helps explain why some medicines are funded and others are not, and why the process can take time.
The Factors for Consideration Framework
Pharmac assesses every funding application against its ‘Factors for Consideration’ framework:
| Factor | What Pharmac Considers |
|---|---|
| Health need | The severity and prevalence of the condition, and the health needs of the population who would use the medicine |
| Clinical benefits and risks | How effective the medicine is compared to existing treatments, including side effects |
| Cost-effectiveness | Whether the health gains justify the cost, relative to other medicines competing for the same budget |
| Budget impact | The total cost of funding the medicine and whether the budget can sustain it over time |
| Suitability | Whether the medicine is suitable for listing on the Pharmaceutical Schedule, including supply considerations |
| Health equity | How funding affects populations with the greatest health needs, including Māori, Pacific peoples, and those with socioeconomic deprivation |
Know This: Pharmac is also exploring the inclusion of societal impacts – broader effects such as productivity, informal care, and costs to patients beyond the health system. This follows international practice, particularly from the Netherlands, and has been piloted with Erasmus University’s Institute for Medical Technology Assessment.
The Assessment Journey
A typical funding application goes through several stages:
Know This: The average time from funding application to first decision is approximately 36 months (three years) for applications received in the past five years. The average across all applications (including older ones) is 95 months, reflecting a backlog of complex cases. Some urgent treatments can be progressed faster – Pharmac has been piloting rapid assessment processes.
- Submission: The pharmaceutical company submits its application with supporting clinical and economic evidence.
- Clinical assessment: Pharmac’s clinical team reviews the evidence. Expert advisory committees (such as PTAC) provide independent clinical advice.
- Economic evaluation: Pharmac’s economists assess the cost-effectiveness and budget impact of the proposed medicine.
- Commercial negotiation: Pharmac negotiates with the supplier on price, terms, and conditions of supply.
- Public consultation: For significant decisions, Pharmac seeks public input on its proposals.
- Board decision: Pharmac’s Board makes the final funding decision, weighing all evidence, advice, and public feedback.
Know This: The average time from funding application to first decision is approximately 36 months (three years) for applications received in the past five years. The average across all applications (including older ones) is 95 months, reflecting a backlog of complex cases. Some urgent treatments can be progressed faster – Pharmac has been piloting rapid assessment processes.
Understanding the Pharmaceutical Schedule (New Zealand’s Medicine Menu) and the NPPA Process
The Pharmaceutical Schedule is the official list of all publicly funded medicines and related products in New Zealand – essentially the ‘menu’ of treatments New Zealanders can access with government subsidy. It is updated regularly and publicly available on the Pharmac website.
| Schedule Component | Description |
|---|---|
| Community medicines | All nationally funded medicines and related products dispensed through pharmacies |
| Vaccines | Most government-funded vaccines, including those on the National Immunisation Schedule |
| Hospital medical devices | All public hospital medical devices with national contracts |
| Dispensing rules | Rules for dispensing or administering each medicine |
| Price and subsidy | The amount funded for each medicine (what the Government pays) |
| Access restrictions | Any rules or limits on access – some medicines are only funded for specific patient groups |
Important: Special Authority and Access Restrictions
- Some funded medicines have ‘Special Authority’ restrictions, meaning they are only funded for people who meet specific clinical criteria. For example, certain cancer treatments may only be funded for patients with a particular stage or type of cancer. These restrictions ensure medicines are targeted to patients most likely to benefit.
- Your doctor or specialist applies for Special Authority on your behalf. If approved, the medicine is funded at the standard co-payment rate.
- If you need a medicine that is not funded or does not meet Special Authority criteria, you would need to pay the full cost privately or access it through private health insurance.
Beyond Medicines: Pharmac's Funding Role in Vaccines and Medical Devices
Vaccines
Medical Devices
- Pharmac manages the funding, purchasing, and distribution of most government-funded vaccines in New Zealand, including those on the National Immunisation Schedule, influenza vaccines, COVID-19 vaccines, and vaccines for at-risk populations.
- While Pharmac purchases and distributes vaccines, Health New Zealand (Te Whatu Ora) is responsible for delivering vaccination programmes.
- If you have questions about getting vaccinated, your GP or pharmacy can help. If you want to understand which vaccines are funded and why, Pharmac is the relevant agency.
Medical Devices
- Pharmac’s role in medical devices has expanded significantly. Medical devices range from basic items (bandages, syringes, surgical gloves) to high-value equipment (hip and knee implants, pacemakers, MRI machines). Pharmac negotiates national contracts to improve consistency of supply, reduce costs, and ensure equitable access across the country.
- In July 2025, New Zealand’s first comprehensive list of medical devices used in public hospitals was published, supporting better patient care and long-term investment in devices.
Understanding the Named Patient Pharmaceutical Assessment (NPPA) - A Potential Safety Net
The NPPA process is a safety net for individuals with exceptional clinical circumstances who need access to medicines not funded through the standard Pharmaceutical Schedule. If a funded medicine doesn’t work for you, or the specific medicine you need isn’t funded at all, your doctor can apply for NPPA funding on your behalf.
How NPPA Works
Your prescriber submits an application to Pharmac, explaining your exceptional circumstances and why standard funded options are unsuitable. Decisions are made case-by-case, as our table outlines:
How NPPA Works
Your prescriber submits an application to Pharmac, explaining your exceptional circumstances and why standard funded options are unsuitable. Decisions are made case-by-case, as our table outlines:
Important: Advocating for Yourself
- If you believe you need access to a non-funded medicine, start by speaking with your specialist or GP about whether an NPPA application is appropriate.
- Patient advocacy groups for your condition can provide valuable guidance. Don’t assume the answer is ‘no’ without asking.
| NPPA Assessment Factor | What This Means |
|---|---|
| Exceptional clinical circumstances | The patient’s situation must be genuinely unusual – not simply a preference for a different medicine |
| Evidence for the requested medicine | There must be reasonable clinical evidence that the medicine will help |
| Funded alternatives unsuitable | Standard funded options must have been tried or be genuinely inappropriate |
| Timeliness | Pharmac targets deciding 67%+ of initial NPPA applications within 10 working days |
Pharmac and Private Health Insurance – Why the Gap Matters
It's essential to understand how Pharmac becomes directly relevant to your personal financial planning. Pharmac’s fixed budget means it cannot fund every medicine that exists. There will always be effective treatments available internationally that are not yet (or may never be) funded in New Zealand. This gap is one of the primary reasons many New Zealanders purchase private health insurance.
Our View: New Zealanders often buy health insurance without fully understanding why they need it. The answer, in large part, is Pharmac. The public system provides excellent core coverage, but it has limits – and those limits are set by budget, not by what’s medically available. Once you understand this, the value proposition of health insurance becomes much clearer.
What Pharmac Doesn’t Cover
Our View: New Zealanders often buy health insurance without fully understanding why they need it. The answer, in large part, is Pharmac. The public system provides excellent core coverage, but it has limits – and those limits are set by budget, not by what’s medically available. Once you understand this, the value proposition of health insurance becomes much clearer.
What Pharmac Doesn’t Cover
| Gap Type | What This Means | Impact |
|---|---|---|
| Pipeline medicines | Newly approved medicines not yet through Pharmac’s assessment | Average 3-year wait from application to decision |
| Declined medicines | Medicines that don’t meet cost-effectiveness thresholds | May never be funded publicly |
| Limited conditions | Conditions where funded treatment options are narrow | Standard treatments may not suit all patients |
| Latest therapies | Cutting-edge immunotherapies, biological medicines, gene therapies | Available overseas but not on the NZ Schedule |
The Cost of Going Without
If you need a medicine that isn’t funded by Pharmac and you don’t have private health insurance, you pay the full cost:
If you need a medicine that isn’t funded by Pharmac and you don’t have private health insurance, you pay the full cost:
| Treatment Type | Typical Annual Cost (Unfunded) | Context |
|---|---|---|
| Modern cancer immunotherapy | $50,000 – $100,000+ | e.g. pembrolizumab, nivolumab |
| Biological medicines | $20,000 – $40,000+ | e.g. for rheumatoid arthritis, Crohn’s, psoriasis |
| Targeted cancer drugs | $30,000 – $80,000+ | Varies by medicine and dosage |
| Uncommon condition medicines | $2,000 – $20,000 | Specialist medicines not on the Schedule |
Important
- Understanding Pharmac’s limitations is an important step in deciding whether health insurance is right for you.
- MoneyHub has comprehensive, independent guides covering health insurance comparisons across all major New Zealand providers, detailed policy and benefit comparisons, real claims data, and tips for choosing the right level of cover.
How Health Insurance Covers the Pharmac Gap
- Non-Pharmac cancer drug limits range from $10,000 to $20,000 depending on the insurer - when treatment can cost $50,000 - $150,000, the difference matters
- One insurer doesn't cover immunotherapy at all, and while some insurers offer optional add-ons to increase non-Pharmac cover, others don't
- Our Health Insurance Benefits and Limits Compared guide breaks down exactly what each insurer pays across cancer treatment, non-Pharmac drugs, surgical limits, and more
- Through LifeDirect, you can compare real quotes from Southern Cross, AIA, nib, Partners Life and Unimed side-by-side in under 30 seconds - no cost, no obligation
How to Navigate the System and Your Rights as a Patient
Suggested practical steps include:
Know This: Prescription Co-payments Summary
- If You Need a Funded Medicine: Visit your GP or specialist, who will prescribe the funded medicine. Collect it from your pharmacy and pay the standard co-payment (maximum $5 per item, or free if you qualify). After 20 funded prescription items in a year, you qualify for the Prescription Subsidy Scheme and pay nothing for the rest of the year. Children under 14 and Community Services Card holders receive funded prescriptions at no cost.
- If You Need a Non-Funded Medicine: Discuss alternatives with your specialist – there may be a funded option. Ask about NPPA exceptional circumstances funding. Check your health insurance policy. If paying privately, ask your pharmacy about pricing – costs vary significantly.
- If You Want to Advocate for a Medicine to be Funded: Contact the relevant patient advocacy group. Submit feedback during Pharmac’s public consultation periods. Write to Pharmac directly with your experience. Contact your local MP to raise the issue in Parliament.
Know This: Prescription Co-payments Summary
- Standard co-payment: Maximum $5 per prescription item for funded medicines.
- Prescription Subsidy Scheme: After 20 funded items in a year, all further prescriptions are free.
- Free prescriptions: Children under 14, Community Services Card holders, and some other groups.
- Non-funded medicines: Full cost to you unless covered by health insurance or approved through NPPA.
Your Rights as a Patient
Pharmac has been working to improve consumer engagement. In 2024/25, it held two consumer engagement workshops and appointed patient advocate Dr Malcolm Mulholland as Chair of a new Consumer and Patient Working Group. A five-year change programme commenced on 1 July 2025.
We outline patient rights:
We outline patient rights:
| Right | How It Works |
|---|---|
| Transparency | Pharmac publishes decision-making criteria, committee records, and consultation documents on its website |
| Consultation | You can submit feedback on proposals during public consultation periods |
| NPPA access | Your prescriber can apply for exceptional circumstances funding |
| Complaints | Raise concerns with Pharmac directly or through the Health and Disability Commissioner |
| Information | Request information about decisions through the Official Information Act |
| Consumer engagement | Pharmac has a Consumer and Patient Working Group and holds regular engagement workshops |
Pharmac 2024 - 2025 - A Year in Review
2024/25 was the biggest year in Pharmac’s history for new medicine investments. In June 2024, the Government allocated an additional $604 million over four years to fund or widen access to more medicines, including cancer treatments. This enabled Pharmac to progress 66 medicines – 33 for cancer and 33 for other conditions – with an estimated 248,000 people expected to benefit in the first 12 months.
Annual Update Note: This section is refreshed annually when Pharmac publishes its Annual Report. Current data reflects the year ended 30 June 2025. The next update is expected in late 2026.
Annual Update Note: This section is refreshed annually when Pharmac publishes its Annual Report. Current data reflects the year ended 30 June 2025. The next update is expected in late 2026.
Annual Report Summary
| Metric | 2024/25 Value | Context |
|---|---|---|
| Medicines Budget appropriation | $1.69 billion | Up from $1.595B in 2023/24 |
| Total gross expenditure | $2,713.1 million | Includes rebates and commercial arrangements |
| Net Medicines Budget expenditure | $1.627 billion | After rebates and adjustments |
| New Zealanders receiving funded medicines | 4.182 million | Essentially the entire population |
| Additional patients benefitting | 89,436 | From decisions implemented in 2024/25 |
| New medicines funded | 31 | New listings on the Schedule |
| Widened access decisions | 52 | Existing medicines available to more patients |
| Total decisions | 83 | Largest programme in Pharmac’s history |
| Medical device line items | 188,841 | Under national contract (+20,000 added) |
| Medical devices under contract | $655 million | Up $50 million from previous year |
Budget and Spending Data
| Component | 2022/23 ($m) | 2023/24 ($m) | 2024/25 ($m) |
|---|---|---|---|
| National Pharmaceutical Purchasing Appropriation | 1,186.0 | 1,595.0 | 1,689.6 |
| Interest | 16.9 | 10.1 | 16.9 |
| Rebates and adjustments | 743.3 | 933.0 | 1,086.3 |
| Total gross expenditure | 1,920.5 | 2,511.0 | 2,713.1 |
| Budget equity (reserve) | 131.8 | 90.5 | 170.2 |
What Drove Spending in 2024/25
| Spending Driver | Impact ($m) | What This Means |
|---|---|---|
| Volume changes (prescription growth) | +$207.4 | More people needing more medicines |
| Widened access decisions | +$116.5 | Existing medicines available to more patients |
| Subsidy increases | +$63.9 | Price adjustments on funded medicines |
| New listings | +$10.3 | New medicines added to the Schedule |
| Savings from commercial negotiations | -$151.8 | Price reductions through negotiation |
| Other changes | -$44.2 | Direct cost changes and adjustments |
New Medicines and Widened Access
| Decision Type | Pharmaceuticals | Estimated New Patients |
|---|---|---|
| Widened access (existing funded medicines) | 52 | 37,446 |
| New listings (not previously funded) | 31 | 51,990 |
| Total | 83 | 89,436 |
Treatments Funded Over Time (2014/15 – 2024/25)
| Year | Budget ($m) | New Listings | Widened Access | Total |
|---|---|---|---|---|
| 2024/25 | 1,690 | 31 | 52 | 83 |
| 2023/24 | 1,806 | 12 | 16 | 28 |
| 2022/23 | 1,186 | 20 | 22 | 42 |
| 2021/22 | 1,085 | 6 | 16 | 22 |
| 2020/21 | 1,045 | 13 | 19 | 32 |
| 2019/20 | 1,040 | 14 | 32 | 46 |
| 2018/19 | 985 | 10 | 10 | 20 |
| 2017/18 | 870.8 | 13 | 39 | 52 |
| 2016/17 | 849.6 | 18 | 8 | 26 |
| 2015/16 | 800 | 15 | 6 | 21 |
| 2014/15 | 795 | 21 | 20 | 41 |
Our View: The 2024/25 year saw 83 total decisions compared to 28 the year before. But this should be seen in context - it took a $604 million budget uplift to deliver it. Without increased government investment, Pharmac’s annual output is typically 20 to 45 decisions. This underscores how budget-constrained the system operates most years.
Key Medicine Highlights 2024/25
1. Cancer Treatments
| Medicine | Brand | Condition | Funded From |
|---|---|---|---|
| Atezolizumab + bevacizumab | Tecentriq + Vegzelma | Inoperable liver cancer | March 2025 |
| Bevacizumab | Vegzelma | Advanced ovarian cancer | March 2025 |
| Lanreotide | Mytolac | Neuroendocrine cancers, acromegaly | March 2025 |
| Nivolumab + ipilimumab | Opdivo + Yervoy | Clear cell kidney cancer (spread) | April 2025 |
| Axitinib | Inlyta | Kidney cancer (progressed) | April 2025 |
| Sunitinib | – | Kidney cancer (spread) | April 2025 |
| Inotuzumab ozogamicin | Besponsa | Acute lymphoblastic leukaemia | April 2025 |
| Crizotinib | Xalkori | ROS1+ non-small cell lung cancer | April 2025 |
| Venetoclax + azacitidine | Venclexta | Acute myeloid leukaemia | April 2025 |
| Pembrolizumab (widened) | Keytruda | Melanoma (widened access) | June 2025 |
| Dabrafenib + trametinib | Tafinlar + Mekinist | Stage 3B–4 melanoma (new) | June 2025 |
2. Diabetes: Continuous Glucose Monitors (CGMs)
From October 2024, Pharmac funded continuous glucose monitors for people with type 1 diabetes, alongside new arrangements for funded insulin pumps. Approximately 12,000 people are expected to receive CGMs in the first year, rising to over 18,000 after five years.
3. ADHD Medications
Lisdexamfetamine (Vyvanse) was funded from December 2024 as an additional once-daily ADHD treatment. Renewal requirements for existing ADHD medications were removed. From February 2026, nurse practitioners and GPs can initiate prescribing of some ADHD medicines.
4. Other Notable Additions
From October 2024, Pharmac funded continuous glucose monitors for people with type 1 diabetes, alongside new arrangements for funded insulin pumps. Approximately 12,000 people are expected to receive CGMs in the first year, rising to over 18,000 after five years.
3. ADHD Medications
Lisdexamfetamine (Vyvanse) was funded from December 2024 as an additional once-daily ADHD treatment. Renewal requirements for existing ADHD medications were removed. From February 2026, nurse practitioners and GPs can initiate prescribing of some ADHD medicines.
4. Other Notable Additions
| Medicine | Brand | Condition | Why It Matters |
|---|---|---|---|
| Desogestrel | Cerazette | Contraception | New pill with wider 12-hour dosing window |
| Denosumab (widened) | Prolia | Osteoporosis | Self-administered – no clinic visit needed |
| Oestradiol patches | Estradot / Mylan | HRT | Two brand options from December 2025 |
| Upadacitinib (widened) | Rinvoq | Eczema, UC, Crohn’s, RA | Covers four conditions from May 2025 |
| Ceftazidime + avibactam | Zavicefta | Antibiotic-resistant infections | Critical for hospital settings |
| Liquid nutrition | Ensure Plus / Fortisip | Crohn’s disease | Fully funded from July 2025 |
NPPA Performance 2024/25
The NPPA process showed significant improvement: 79% of initial applications decided within 10 working days, up from 68% in 2023/24 and exceeding the 67% target.
Organisational Changes
| Change | Detail |
|---|---|
| Chief Executive departure | Sarah Fitt left in March 2025 |
| Acting CE appointed | Brendan Boyle (March – September 2025) |
| New Chief Executive | Natalie McMurtry appointed September 2025 |
| Board Chair | Hon Paula Bennett (continuing) |
| Board changes | Dr Diana Siew departed March 2025; Anna Adams and Lucy Elwood joined |
| Culture review | External review by Debbie Francis completed early 2025 |
| Consumer engagement reset | Two workshops; Consumer and Patient Working Group under Dr Malcolm Mulholland |
| Five-year change programme | Commenced 1 July 2025 – 12-month initial reset phase |
| Workforce | 195 employees (168 permanent, 27 fixed-term); 20.5% turnover |
| Diversity | 61% women in leadership; 59% women overall; 21% Māori in leadership |
Frequently Asked Questions
How much does a prescription cost in New Zealand?
For funded medicines, the standard co-payment is a maximum of $5 per item. After 20 funded items in a year, the Prescription Subsidy Scheme makes all further prescriptions free. Children under 14 and Community Services Card holders receive funded prescriptions at no cost.
Can I get a medicine that isn’t funded by Pharmac?
Yes, but you pay the full cost yourself or have it covered by private health insurance. Your doctor can prescribe any approved medicine regardless of Pharmac funding status. In exceptional cases, your doctor can apply for NPPA funding.
How long does it take for a new medicine to be funded?
Approximately 36 months (three years) for recent applications. This varies significantly – some urgent treatments are faster, while complex applications take longer. The average across all applications is 95 months.
Does Pharmac fund all cancer treatments?
No. Pharmac funds a wide range and significantly expanded access in 2024/25 (33 cancer medicines). But not every available cancer drug is funded – they are among the most expensive pharmaceuticals, and new options are continually developed internationally. This gap is one of the most common reasons for private health insurance.
Is New Zealand’s system better or worse than other countries?
New Zealand’s single-buyer model is internationally recognised for value for money. Australia (PBAC), Canada (CADTH), and the UK (NICE) use similar approaches. The trade-off is New Zealand’s smaller budget means some medicines available in wealthier countries may not be funded here.
Can I appeal a Pharmac decision?
There is no formal appeal process. However, you can submit feedback during consultation periods, request information via the OIA, raise concerns through the Health and Disability Commissioner, or contact your MP. The NPPA process is available for individual exceptional circumstances.
How does Pharmac differ from Medsafe?
Medsafe approves medicines as safe and effective for use in New Zealand - Pharmac decides which approved medicines are publicly funded. A medicine can be Medsafe-approved but not Pharmac-funded – meaning it’s available to prescribe but you (or your health insurer) pay full cost.
What is the Pharmac Pharmaceutical Schedule?
It is the official list of all funded medicines, vaccines, and related products. It includes prices, subsidy amounts, dispensing rules, and access restrictions. You can access it on the Pharmac website and it's updated regularly.
How Health Insurance Covers the Pharmac Gap
- Non-Pharmac cancer drug limits range from $10,000 to $20,000 depending on the insurer - when treatment can cost $50,000 - $150,000, the difference matters
- One insurer doesn't cover immunotherapy at all, and while some insurers offer optional add-ons to increase non-Pharmac cover, others don't
- Our Health Insurance Benefits and Limits Compared guide breaks down exactly what each insurer pays across cancer treatment, non-Pharmac drugs, surgical limits, and more
- Through LifeDirect, you can compare real quotes from Southern Cross, AIA, nib, Partners Life and Unimed side-by-side in under 30 seconds - no cost, no obligation
Related Guides
- Health Insurance - Independent comparison of all major NZ health insurers with real claims data
- Health Insurance Benefits and Limits Compared by Insurer - Compare health insurance benefits from Southern Cross, AIA, nib, Partners Life and Unimed - we compare surgical limits, cancer cover, mental health and more side-by-side.
- Health Insurance Benefits and Limits Compared by Insurer
