Sober Women Managing Money & Mental Wealth
This is part 6 of my series titled, brain health. I’ve found this topic so fascinating as a person in recovery. My initial interest came from the selfish concern of wanting to know if my brain would heal from the abuse of drugs.
Now I like to share what I’ve learned and continue to learn about the brain because it’s quite fascinating.
I’ve done a little experiment in medical tourism specifically as it pertains to prescriptions. While it didn’t work out for me, I learned a lot in the process and will share the details here for your benefit. My big takeaway from this experiment is that many Americans are filling their prescriptions in Canada for a fraction of the cost in the U.S.
I think the short answer is that they can be. The pharmaceutical companies are pretty powerful and if they know they can get private insurance companies to foot the bill, they charge more.
I recently wrote an article about the astronomical costs of prescriptions in the United States. In the article, I get transparent about a condition I’ve been diagnosed with. Additionally, I’ve been prescribed an expensive specialty medication. It was a bit of a rant article where I share my growing frustration of how the pharmaceutical companies get away with charging such exorbitant prices in the U.S.
Anyway, with the help of my doctor and boss, I set out on an experiment.
Once I learned that the price of Humira (what I’ve been prescribed) is drastically less expensive in other countries, I decided to give medical tourism a try.
Before I set out on an exploration of filling my script in other countries (namely Canada), I applied for a grant with the manufacturer, AbbVie. Interestingly, someone sent me this article about a class action lawsuit AbbVie is facing. Apparently, Humira has an array of patents protecting it from U.S. competition until 2023. Hmm…
My doctor is completing his portion of the application so it’s yet to be seen if this will pan out. Maybe, just maybe I’ll get approved. However, I know what I’m asking for is rather outside the box.
You see, I have private insurance and I’m refusing to let these exorbitantly priced prescription claims go through my insurance policy because:
Onto checking out another way…
I decided to focus on Canada because, well, it’s relatively easy and inexpensive to get to Canada from the U.S.
My first step was getting my doctor to write me a paper prescription for a one year supply of Humira to take over the border.
Secondly, I called pharmacies in Canada and asked how this works. I was told that Canada has a law that they can only fill prescriptions which are written by a Canadian doctor. Snag #1
However, when I inquired more with a few Canadian pharmacists via the phone I found out how it can be done. Any American can bring their U.S. prescription, their drug history, and their medical history to a clinic in Canada.
Upon paying out of pocket for a clinic visit, a Canadian doctor will review your situation. More times than not the Canadian doctor will rewrite you a prescription which can be filled in Canada.
Thirdly, I called my insurance company to find out if I could file a direct claim for any prescription filled in Canada. I was told that as long as the prescription has a U.S. equivalent, it can be submitted for reimbursement via a direct claim form (which they mailed to me).
Mind you I called three different times to ensure I was given the same story by different people. I even spoke to supervisors. Additionally, I asked them to notate my account with the information given to me.
If you are trying this experiment for yourself, I recommend calling your specific insurance company because it can vary.
After calling several pharmacies for their prices of Humira, I discovered that Walmart had the lowest cost for this particular drug. Additionally, the Walmart in the Niagra Falls area has a clinic right inside of it. I was told that I could pay $100 Canadian dollars ($74.32 U.S dollars) to be seen by a Canadian doctor at the clinic.
I figured that was a reasonable price to pay considering Humira is 72% cheaper in Canada. Yep, you read that right – 72% cheaper! Isn’t that a racket?!?
The price of Humira in the U.S. is $4,842.95. In Canada, at Walmart, it’s $1,797 or $1,335.56 in U.S. dollars.
Because I’m a fan of killing a couple of birds with one stone, I planned my Canada trip when I was going to be in Niagara, New York for a client meeting. I went up a day early, crossed the border, and went straight to Walmart.
I paid my $100 to be seen by a doctor at the clinic and then came the bad news. The doc told me that because Humira is a specialty med, he could not write me a script. Snag #2
He said, he could refer me to a specialist but I’d have to wait for weeks (or months) to be seen. I had no problem waiting; however, he said the specialist would have a similar problem in writing me a script for Humira.
Being that it’s a specialty drug and a biological agent, the ordering doctor is required to follow my care. I explained that I have a U.S. doctor following my care.
However, Canadian doctors cannot write me a script for this specialty drug without following my care. They could risk losing their license. Snag #3 (strike out)
Fair enough.
The kind doctor refunded me my money paid at the clinic. 🙂
Should I attempt to allow a Canadian doctor to follow my care? Moreover, will the cost of frequent trips to Canada eat up the savings in filling my script there? I don’t know but currently, I’m exploring other avenues.
Sure this may not be working out the way I hoped it would for me. However, I want to let you know of some good news about utilizing Canada for prescriptions.
The staff (and doctor) at the clinic in Walmart, in Canada, let me know that Americans come over the border all the time to fill prescriptions for a fraction of the U.S. costs. In particular insulin, the EpiPen, and more.
I ran into a snafu because I’m on a specialty biological drug; however, if you are not, you might be able to get your Rx in Canada for cheaper than in the U.S.
You’ll need to follow the same steps I listed above and then it should work. If you have any stories and/or decide to give this a try, please let me know. I’d love to hear about it.
I’m so glad I did this because I learned that our friendly neighbors to the north are happy to help us with lower prescription costs for the most part.
Additionally, I got to see the falls again. 🙂
So what am I going to do? I’m going 1.) see if AbbVie (the manufacturer) approves me for a grant and 2.) Additionally, I’m going to explore a holistic route.
I’m one week into a 21-day gut health cleanse. In this cleanse, I will eliminate foods that can trigger inflammation (which is the issue with my condition). Then I will add them back in one at a time to identify potential culprits. Depending on the results, I’ll adjust my daily diet.
I suspect doing a cleanse yearly will be a healthy addition to my lifestyle.
Of course, I will continue to exercise and stretch.
Medical tourism is a very viable option. I’ve only scratched the surface as I know there are some very real examples of people getting tests, dental care, surgeries, and other treatments overseas for a fraction of the cost here in the U.S.
I’m certain we can also seek care in Canada by specialists but you will need a referral from a doctor at one of these common clinics. Additionally, there is a wait to be seen.
If I ever need any other major treatment, I’m now more willing to explore overseas options. This experiment has opened my eyes to the possibilities.
Maybe my experiment didn’t end the way I thought it would but perhaps the holistic route will be even better than I could have imagined…
Questions? Stories of your own? Please share…
Theme pic by Ali Tawfiq on Unsplash
“Every brain is wired differently.” – Dr. John Medina
I’m excited to continue with my series on brain health. In my sobriety, I’ve focused on understanding how to aid in the healing of my brain. I’m always fascinated by what science says; hence this series.
I’ve been reviewing the book, Brain Rules by Dr. John Medina. Additionally, one of my friends and readers has gifted me the book, Brain Food – The Surprising Science of Eating for Cognitive Power by Lisa Mosconi, Ph.D., INHC. As I read and unpack this book, I will be, no doubt, inspired to write some articles in this series on brain food.
For the purposes of this article, we are going to learn a little bit about how brains are wired and most importantly how we can change them. Spoiler alert: it involves learning new things.
And the really good news is that if you are on the path to better financial health through education, you are changing your brain!
I’ve read a rant or two in the personal finance blogosphere recently and now it’s my turn! I’m infuriated at the cost of prescriptions here in the United States. My fury is a personal one and I’m going to make it my personal mission to find alternatives.
Before I begin, I should remind you all I work for a broker/third party administrator so I know a thing or two about health insurance.
Okay so I’ll get personal (like I haven’t done that before – haha!) to give a backstory to my rising frustrations. When I was 23 years old I was diagnosed with Ankylosing Spondylitis (AS). My dad has it too so like father like daughter.
It’s an autoimmune disorder that results in inflammation. That inflammation is primarily in the sacroiliac joint and spin; however, it can also affect the chest, eyes, and some other joints as well.
Flare-ups are generally treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Although, I’ve been treated with steroids for eye flare-ups.
So if you ever hear the term miracle drug, just think high cost. There are a series of biological medications which are made from living organisms. The Tumor Necrosis Factor alpha (TNF -α) inhibitors are very effective at treating AS as well as slowing the progression of the disease.
Wonderful, except that miracle drug = $$$
I was prescribed Humira in the fall of 2018 as I’d been having a lot of flare-ups this past summer. I’ve been taking it since with great results.
I have a high pain tolerance but my biggest concern is the progression.
You see my father’s spine is mostly fused and while he no longer has back pain, he is crippled. That is the typical progression.
So since this is a personal finance blog let’s get into the dollars & sense of it all. Guess how much this miracle drug costs for one month’s supply? Seriously go ahead and guess. I’ll wait…
Yeah, so it costs $4,842.95. Not too high, right?? That is almost $60k per year. That is OUTRAGEOUS!!
What’s even more outrageous is the game one must play with the manufacturer and insurance companies. When I was approved by the insurance company for the drug, I was also approved for a manufacturer’s coupon. The manufacturer gives me up to $12,000 per year in coupons as long as I have private insurance.
I order the Rx, the insurance company applies the coupon, and I only pay $5. Lovely, right? Well, there’s one problem and that is someone is paying for it…
The coupons will cover you until you meet your insurance deductible. Good deal, right? There are two issues with this and the latter one is what concerns me most.
Firstly, insurance companies are doing something called true payment processing. They will only give members deductible credit if they actually pay for the drug themselves. Coupons don’t count towards deductibles. Fair enough.
There is a workaround, though, and it was explained to me by the manufacturer. All I had to do was pay the full cost of the drug, submit my receipts to the rebate program (manufacturer), and be reimbursed for all by $5. I tested it and it worked. Additionally, I got deductible credit for this.
The word on the street is that the insurance companies are onto this game and will be figuring out how to not give deductible credit for such episodes. This game will keep going on and on…
Not that I typically feel bad for the insurance companies, but I can see they are the ones getting the raw end of the deal here. Think about it – the manufacturer gives you a coupon and then sticks the insurance company to cover this drug for the rest of the year.
When the Affordable Care Act was passed, small groups (under 50) were forced to go on community-rated plans. Exceptions were made when President Obama said, “if you like your current plan, you can keep it.” Insurance companies allowed groups to stay on their old plan and called it grandmothering.
However, any new plans had to be community rated which meant the policy could not be rated based on risk. Isn’t that how insurance works??? Anyway, they could only rate groups on the following:
Insurance companies had no idea what kind of risk they were getting so they raised their rates. The Affordable Care Act turned out to not be so affordable.
When rules are made, people find loopholes. Insurance companies found creative ways, at least here in Ohio, to underwrite risk again. Multiple Employee Welfare Arrangement (MEWAs) and level funded plans emerged in the market place and were approved by the Ohio Department of Insurance.
Don’t worry about exactly what these plans are (or look them up if you must) but just know that it’s a way for insurance companies to underwrite risk again.
With the emergence of these plans, competitive rates came back around!!
The small company I work for has a medically underwritten MEWA plan with attractive rates. We bought a high deductible plan ($6,550) but some of that is funded by my employer. I’m on the hook for the first $1,350.
I actually met my full deductible ($6,550) early on this year because of a little medical mishap. That being said, I can fill Humira all year long and pay nothing. What is so bad about that?
I will wreck our policy and cause mine & my colleague’s premium rates to drastically increase next year.
My single premium for this policy is $361.84 (which is paid 100% by my company). Let’s see how this shakes out for the insurance company.
Bottom line – the insurance company ends up paying out way more than it takes in. I know that this is what insurance is for but this is the curse of me knowing too much. I don’t want to wreck our policy.
My conundrum is that I want to continue to take this drug and preserve my future. What’s a girl to do?
Here is where I get really mad about this stuff. I saw my rheumatologist this week and told him I need an alternative. He shared this article with me from the New York Times:
Anger Over High Drug Prices in U.S.
That title basically sums up how I feel. In case you don’t feel like reading it (though you should it’s short), let me share a little paragraph from it:
“Top drugs, no matter how profitable to start, are routinely increased in price up to 20 percent annually in the United States. A patient could fly first class to Paris, stay at the Ritz, dine at a top Michelin restaurant, buy A one-year supply of Humira at local prices in France, fly back home and finish with enough profit to hire a registered nurse to administer the injection every two weeks.”
Um, whaaat?!? There is something very wrong here.
Additionally, we googled the average prices of Humira in the world. We found some stats from 2015 which shows South Africa as the country with the lowest costs.
This brings me to considering medical tourism. The challenge I forsee currently is that Humira needs to be refrigerated. I’m not quite sure how I’ll get past customs with a year’s supply of Humira on ice.
Anyway, I’m investigating it and my doctor encouraged me. Additionally, he joked that I needed to take him with me wherever I go. Travel reward miles anyone??
I’m going to doing some research and then my boss & I will work out some kind of arrangement. If I can figure out a way to make this work and preserve our policy, it’ll be a win/win.
I’m all about thinking outside the box so I consider this a fun little experiment.
I realize there is an incredible amount of research behind these miracle drugs. Additionally, I recognize they need to be paid. However, with the drastic disparities in costs all over the world, I see that there is a BIG problem here in the U.S.
Before I explore medical tourism, I will approach the Humira foundation to see if I can be approved for some type of discounted program outside of my insurance. I’d like to think there is some altruism behind the creation of this drug and they’d want to help me. Furthermore, it’s in their best interest in me being a continuous customer.
We’ll see if anything turns up here. Doubtful but worth asking.
It’s incredibly frustrating to find a solution for a condition but then to be faced with the outrageousness of it all. I’m writing this as I imagine there are others who’ve been faced with high-cost prescriptions and similar frustrations.
My doctor said something that really stood out to me – the most important thing is my health. He said everything else really doesn’t matter if we don’t have our health. How can I argue that?
I’m going to embark on this experiment but if nothing really pans out maybe I’ll be forced to just take it as it is. However, it cannot hurt to try. Things don’t really change if we never challenge them, right? I’ll share my progress and results with you right here on my blog so stay tuned.
Have you experienced outrageous costs with your healthcare? Would you be willing to consider medical tourism?