Previous Thread
Next Thread
Print Thread
Advice about access to medicine in the US #280386
05/17/18 04:55 PM
05/17/18 04:55 PM
Joined: May 2018
Posts: 2
Portugal
F
Francisco Offline OP
Registered Visitor
Francisco  Offline OP
Registered Visitor
F
Joined: May 2018
Posts: 2
Portugal
Hi to all in the forum!

I am Portuguese, currently with 45 years old, and I have been diagnosed with Ankylosing Spondylitis more or less 25 years ago. After several years doing treatment with Indomethacine (most times 150mg/day) my doctor transferred me for a program with Ethanercept (Enbrel 50mg / week) 9 years ago.

Next month I will be moving to the United States for more or less one year. During that year I would not want to stop doing the Ethanercept treatment.

I know that the medical system in the US is a lot different from that of Portugal. As an example, Enbrel is a medicine available for free in public hospitals after you pass certain health exams. Prescriptions are valid only for a period of 4 months and my hospital don't give me more than the medicine that I need for one month!

I would like to know if anyone can help me to understand how is it possible to continue my medication during my stay in the United States. I am going to Fargo, ND, and I will have health insurance. But I don't know if any doctor can pass me a prescription, if there are special criteria for it, where will I may buy the medicine, how much is usually the contribution of insurance companies, etc.

If anyone could help me on this matter, or put me in contact with someone who can do it, I would be very much grateful.

Thank you in advance for your help,

Francisco

Re: Advice about access to medicine in the US [Re: Francisco] #280387
05/17/18 06:07 PM
05/17/18 06:07 PM
Joined: Jun 2016
Posts: 363
W
Winston Offline
Registered Visitor
Winston  Offline
Registered Visitor
W
Joined: Jun 2016
Posts: 363
You ask tough questions. I have no idea if an American insurance company would honor a prescription written by a foreign doctor. You should ask the insurance company. If they won't honor your Portuguese doctor's prescription, then I think you would need to see a doctor in the US to get a prescription, and you should ask your Portuguese doctor's help in establishing such a relationship before you arrive in the US.

In the US, Enbrel is extremely expensive. Exactly how expensive depends on your insurance coverage because each insurance company negotiates a price for the drug with the drug's manufacturer or distributor. In other words, two Americans taking the same drug are likely paying drastically different prices for it.

I'm on Enbrel, and it costs my insurance company over $4000 a month. I am obligated by my insurance to pay a $100/month co-pay, but I'm enrolled in Enbrel's co-pay assistance plan, which reduces my co-pay to $10/month. So I pay $10/month out of pocket for it; Enbrel pays/absorbs $90/month; and my insurance pays the rest. How much it costs you will depend on your particular insurance plan. Are you working while in the US, and, if so, will you have commercial insurance (that is, insurance provided by your employer)? If that is the case, you should ask how your particular insurance plan will treat Enbrel -- how much will they pay, how much will you have to pay, and is there is a specific pharmacy that they will require you to use. My insurance requires that I buy Enbrel from a particular specialty pharmacy. That pharmacy ships the medication to me at my home once monthly. It is typical here to only get one month's supply at a time, but your doctor can write a prescription that is good for up to one year. Some insurance plans might require re-authorization every 6 months, but I think annual re-authorization is more typical.

I hope this helps. I'm sad to say that the American healthcare system is practically Byzantine in its complexity. Dealing with it is stressful and expensive, even for Americans.

Last edited by Winston; 05/17/18 06:12 PM. Reason: left something out
Re: Advice about access to medicine in the US [Re: Francisco] #280388
05/17/18 08:05 PM
05/17/18 08:05 PM
Joined: Jul 2004
Posts: 1,129
United States
N
NotMeToo Offline
Registered Visitor
NotMeToo  Offline
Registered Visitor
N
Joined: Jul 2004
Posts: 1,129
United States
Are you moving to Fargo for work, school, or other reasons? I ask because if you are moving for work, your employer should be able to assist you in working out all of the details ahead of time. Contact the Employee Benefits office or whomever you are working with to facilitate your move. If you are moving for school, the University should have a department that assists foreign students transition to the US. Call them and ask for help. If you are moving for personal reasons, unfortunately you may have a bit less support, but there are things you can do in advance of your move to make things run smoothly.

Will your health coverage in Portugal cover you for any period of time after your move? Regardless of the reason for the move, find out from them if there is any way to get an additional month or two of medication before your move. (What would you do if you were traveling on an extended vacation instead of moving?)

Prior to your move to the US, contact the insurance company and let them know that you are a long time Enbrel patient and ask for their help in making sure that there is no lapse in your shot schedule. They will be able to give you contact information for Rheumatologists in Fargo that accept your insurance. Call and make an appointment for as soon as you arrive. Let the appointments clerk know that you are a long time Enbrel patient moving to the area with no (or limited) overlap of medication. Have your doctors in Portugal send this rheumatologist your medical records now. You should also get a copy of the records for your self just in case of a problem.

Prior to your move, contact the Enbrel co-pay assistance plan. https://www.enbrel.com/support/fina....ds&dclid=CKCa5Pe8jdsCFY8ehwodsEIGPw
This program covers all of the cost of Enbrel for the first 6 months and all but $10 per month for the next 6 months. They can also be very helpful in helping you find a Rheumatologist, making sure your insurance covers Enbrel, and other forms of support.

When my son did his (high school) junior yer abroad, the copay assistance program for Remicade was an invaluable resource in helping us to make sure that he did not have a lapse in his care or his infusions. It is obviously a different company, but in my experience, they all pretty much operate the same way. In my son's case, it was simpler and easier to keep his Remicade treatment under our US Health insurance. He saw a French Rheumatologist for care and infusions, and our insurance company shipped the medication directly to the doctor and paid the doctor and infusion center charges. His case was different though since he wouldn't have qualified for Remicade treatment under standard the French healthcare system's protocol. I don't tell you that to worry you. From what I have seen, if you qualify for Enbrel treatment in Portugal, you will qualify in the US.

Your prescription from Portugal will not be valid in the US as the Portuguese doctor is unlikely to be licensed in the US. Generally, you will need to get a prescription from a Rheumatologist in North Dakota. Although there is no rule that General Practitioners can't write prescriptions for medications like Enbrel, generally they won't and generally insurance companies would question it if they did. Depending on your insurance, you will either fill the prescription at your local pharmacy or through a mail order pharmacy. Your Rheumatologist likely will have samples that they could give you to tide you over any delay in insurance approval. Enbrel is an expensive medication, but your insurance company will pay a large portion of the cost and, as mentioned above, Enbrel Copay Support will cover all or most of the remainder.

Good Luck with your move.


Not Me Too!
Re: Advice about access to medicine in the US [Re: Francisco] #280390
05/18/18 10:13 AM
05/18/18 10:13 AM
Joined: May 2018
Posts: 2
Portugal
F
Francisco Offline OP
Registered Visitor
Francisco  Offline OP
Registered Visitor
F
Joined: May 2018
Posts: 2
Portugal
Wow!!! smile

Thank you very much for your replies!

You can imagine that it is not easy for someone to change from an European health care system to the United States insurance system. So, both your answers were a very useful starting point and were exactly what I was looking for.

I will have an insurance plan from the university. My problem was that I really was stuck in not so useful information for a newbie. The practical experience from those who take such medicine was more important for me. Things like insurance companies may put questions if the doctor is not a Reumathologist or that your insurance company may require that you buy the medicine in a certain pharmacy, etc. were exactly what I was looking for.

I will take your advice and contact the insurance provider and Enbrel in order to find a doctor and then try to contact him to know what he needs from my doctor. I will probably may take medicine supply for one month (in fact I did it once during vacations) and hope that there is no need for interrupting the treatment.

Thank you again for your replies,

Francisco


Moderated by  ElinAslanyan, RyanMiyamoto 

Powered by UBB.threads™ PHP Forum Software 7.6.1.1