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1323278 tn?1298122488

Land of Oz

Dear all,

Good news to share with you:  I have a terrific job offer... in Australia! (My current contract is temporary and, after expiring, I would be without insurance and possibly need to leave the country and head back home to my home country where treatment for MS is even harder and more expensive to find).

The so-so news:  As I've mentioned before, I was diagnosed with a CIS (optic neuritis) last April, and now I'm under Copaxone.  I am currently in the process of finding out about access to medication in Australia to those of us who are in 'clinically isolated syndrome' limboland.  Apparently, the Medicare scheme does not cover clinically isolated syndromes.  Is anybody here from Australia?  Can anybody help me figure out if there is a way to buy the medication at a reduced price (the price there is about 1000 US$ a year).  

Thanks for your help!

Pablo
16 Responses
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987762 tn?1671273328
COMMUNITY LEADER
Sorry Pablo, i was trying to let you down about the costs of the drugs, i thought that was one of the main issues, and something i was still trying to get information on for you. I still think your current neuro is the best person to arrange continuation of treatment, whilst your here. If you get the cooperation of your neuro, getting him to make contact and request assistance, i'm sure getting your scripts through one of the melbourne MS clinics would be much easier that way.

I'm not sure i understand the concern regarding CIS, the restrictions are to do with access to the subsidised PBS, Copaxone for RRMS is covered if eligible but that doesn't mean you will not be able to get DMD's if your dx is CIS. The off label use options as Udkas mentioned, at the discretion of the treating dr will get you your script, especially if it is your current medication and your have a treating neurologist that is requesting continuation and monitoring of your condition whilst your here.

It may still be a hurdle finding a cooperative Australian neuro, but i do feel with out the input from your neuro and making the request, the hurdle will be much much higher.

Cheers........JJ



Helpful - 0
1323278 tn?1298122488
Dear jj,

Thanks for your post.  Don't worry,  I understand the restrictions on immigration policy, which make absolute sense and are similar to the restrictions in place in Canada, for example, where people also pay high taxes and also have a functional, well-organized socialized health care system (though most of Western Europe is different, yet the immigration policy is more restricted, too, so this makes sense).  However, in my case, I am not expecting access to Medicare.  I am aware that this is a restriction in place for temporal workers and foreigners.  My question concerns access to the medication for patients with a clinically isolated syndrome in general.  As Udkas mentioned, with or without Medicare, apparently CIS is not covered and DMDs and other medications need to be obtained privately (By the way, Udkas, thanks for your post as well and for trying to find out!)

Cheers,

Pablo

Helpful - 0
1323278 tn?1298122488
Dear jj,

Thanks for your post.  Don't worry,  I understand the restrictions on immigration policy, which make absolute sense and are similar to the restrictions in place in Canada, for example, where people also pay high taxes and also have a functional, well-organized socialized health care system (though most of Western Europe is different, yet the immigration policy is more restricted, too, so this makes sense).  However, in my case, I am not expecting access to Medicare.  I am aware that this is a restriction in place for temporal workers and foreigners.  My question concerns access to the medication for patients with a clinically isolated syndrome in general.  As Udkas mentioned, with or without Medicare, apparently CIS is not covered and DMDs and other medications need to be obtained privately (By the way, Udkas, thanks for your post as well and for trying to find out!)

Cheers,

Pablo

Helpful - 0
Avatar universal
Hi there,
I was reading your post about Copaxone and I am afraid that unfortunately in Australia they have only at this stage approved the MS disease modifying drugs for  people who have been diagnosed with MS and to meet this criteria you need to have had more than one episode.

They are trying to change the laws as they believe that it would be beneficial for all patients to begin on disease modifying drugs as soon as possible, when they have had the first attack.  So at this point in time the DMDs are not funded so would be incredibly expensive and at the moment they are not approved even for use for a CIS. Sometimes Drs can prescribe a medication through their outpatient clinic that is attached to the hospital and then the government will pay part of it even if it is not approved.  I take Gabapentin  (neurontin) and a drug called Vesicare and neither of these drugs are approved by the PBS, so they would cost me about $65 per month, but because my neurologist prescribes the Gabapentin from a public hospital MS Clinic (out patient clinic), I get them cheap, I know that people who wanted Tsabi sp? would travel to the clinic to get that one cheaper too, but my GP can prescribe Avonex etc. if you meet the criteria of MS.  My vesicare is expensive but I have private health insurance so that covers the rest of the cost, but my urologist prescribed that where if my neuro had i too could have got that at the hospital pharmacy for around about $20 and even cheaper if I had a low income or was on a pension etc.  Also if you spend a certain amount per year there is a safety net that helps out when you reach that target

My neurologist has worked in England, America Africa and here, but he sounds more American he understands both systems and how the USA system and the Aus. system works, pity you couldn't talk to him.  My friend who has a chronic illness just immigrated here and he said our system is easier and better for sick people, but he has a visa to live here now.

If I can find out something let me know and I will try and find out.
Best wishes,
Udkas (diagnosed with TM)
Helpful - 0
987762 tn?1671273328
COMMUNITY LEADER
Thats basically what i've been able to find out, though there still is the additional problem of eligibility to medicare, which will give you the considerable savings due to the PBS. The problem remains your entry into Australia, i believe refugee entry would get you access even as your application for residency is in process. A temporary working visa or student visa will not, unless your country is part of the scheme, Latin America is not, I checked.

None refugee people applying for residency, need to have at qualified 'skill' that is on the skilled workers list (this is the new list for 2010) http://www.immi.gov.au/skilled/sol/
and or family with residency, no criminal record and be financial independent and or sponsored employment etc etc but that will not necessarily get you approved because of the pre-existing medical condition.

For example, not long ago there was a British Dr, his wife a nurse and their 3 teenage children who got knocked back. He and his wife were providing a much needed service to a remote country town, they were financially independent, much loved as well as needed by the town etc all good except for one little issue, one of their children had Downs syndrome. His medical and educational needs if residency was granted, entitle him to publicly funded financial support for the remainder of his life. There was huge public outcry across the country, the country was behind this family staying and they eventually were offered residency but with restrictions that would affect his career, they opted on principal to not accept.

One of the main problems you have is your medical needs, it may seem unfair but you need to be aware of why the hurdles are getting so big. Approximately 200,000 people each year are granted residency, there are millions waiting and that doesn't include the hundred thousand refugees that country hop trying to get here illegally or the many more that land on neighbouring shores and use people smugglers.

"Australia’s immigration policy is global and does not discriminate on racial, cultural or religious grounds. Each year, Australia welcomes more than 120 000 migrants and resettles around 13 000 people under its humanitarian program. In 2006-07, nearly 192 000 migrants permanently settled in Australia and just over 14 000 were resettled under the humanitarian program."

If you were a refugee the medical issue would not be a negative, even more likely helpful but there would be few countries that would grant residency to an individual applying via a skilled workers scheme, who will most probably due to a (pre-existing) medical condition not be able to remain employed in that field. There are probably many thousands of people with the same skill, who do not have a medical condition, one person will be an asset to the country and the other may cost the country a considerable amount of money in medical and unemployment benefits that residency would entitle them too.

I'm sorry but that is the truth, the Australian people pay high taxes (eg 33%+ employment tax, average price of fuel is $1.25 litre, cigaretts are $20 a pack etc) so we have these benefits, many medicines including DMD's are heavily subsidised to approx $30 a month because of those paid taxes. It would be unfair to expect the peoples taxes (of any country) to pay medical costs for people from other countries who for what ever reason (excluding humanitarian) are only temporarily residing.

Sorry probably not what you want to hear but you will probably need to accept the cost of your drugs and not expect to find a loop hole to get them cheaper, its very unlikely to happen.

Cheers.........JJ

Helpful - 0
1323278 tn?1298122488
Update:  Mixed news.  The Avonex people in Australia apparently have a plan for compassionate access to Avonex to those who have been diagnosed with CIS (since the PBS scheme does not offer access for free).  The Copaxone folks, on the other hand, don't have any compassionate scheme at all, so the price of the medication would be AUS$ 1050 monthly.

I sent out a few other e-mails and waiting to hear from them.  With this picture at hand - this means that people diagnosed with a clinically isolated syndrome need to wait for a second episode to get access to Copaxone for 30 AUS$ a month.  Otherwise, it's terribly expensive!
Helpful - 0
1323278 tn?1298122488
Shell,

Thanks for your comment.  Yes, I am trying to find out through different ways.  I will also try to keep the US insurance for the first year in Australia, if we move:  It will cover me in case of an emergency and probably supplement the private insurance in Australia (which I would need until I get permanent residency, and probably keep afterwards to supplement Medicare).  That should give two different safety nets.  Just in case.  It's an unpredictable disease after all and if it fully develops, I want to have options to protect myself and my family from financial troubles.

twopack, I agree with you. Being away from home is hard when facing these issues.   But home to me is a politically unstable country in Latin America that I love deeply, but where my wife (and future kids? ;) ) will have less opportunities, and where taking care of MS might be even more problematic, especially if I might face the (uncertain) prospects of disability in the future.  Our first plan was to stay here in the US, but visa reasons force us to leave for a while before moving back.  Australia might be a place that if we like (and they like us!), we might stay.  If we don't, coming back to the US from Australia is easier than coming back from Latin America.

Imagine how stressful it is to make these choices, etc.  and focus on our current jobs at the same time.  But who said life is straightforward?  As long as there are options, energy and life, life goes on.  "La vida se abre paso" ;)

Thanks, guys!!
Helpful - 0
1045086 tn?1332126422
I've got to hand it to you Pablo.  I've never been a big traveler but I think I'd be scared to death to think about moving about and staying out of my home country for long stretches of time now that I have this chronic and unpredictable disease.  I wouldn't have a clue where to start but you seem to have a good handle on it all and be quite comfortable.

Good luck to you.  These ladies seem very capable to help you with the details.  It should be good to have a ready-made contact if you are able to work this out.  Did I understand correctly that you are in the US on a VISA now?  Mind if I ask where your original hat stand is located?

Mary
Helpful - 0
198419 tn?1360242356
Pablo-Mo!

Welcome back! This opportunity sounds fab! I'm so happy for you!

Supermum is all over this for you - your so good girl!

My only other thoughts are this;  would your US doc be willing to reach out to an Aussie doc? If it's just a matter of treatment for specific dx's, I have to believe the US doc has more than enough evidence to share with the Aussie doc for you to receive treatment.

ttys,
shell

Helpful - 0
1323278 tn?1298122488
JJ,

Thanks!  I certainly appreciate your help and efforts!

For my first few years (two/three?) I will be under a temporal visa, which means that I'll have to buy private insurance to ensure coverage.  This private insurance won't cover the medication, and will have a one-year exclusion of preexistent conditions (I'll also have to find out about the private insurance for expats!).  I was planning to keep my U.S. insurance for the first year through Cobra and be 'double-insured' just in case, provided the U.S. insurance covered Copaxone in Australia.  But apparently it doesn't, so I will probably need to buy it myself after being prescribed by a doctor.  I'm trying to find out if there is some kind of 'compassionate scheme' or sth similar to buy it at a preferential rate.  Apparently, there is, but the big question is how this scheme operates and if it includes foreigners.

Sometimes we wish things were easier, but heck... MS, even as a single episode, complicates things and I want to make sure that I have access to my current treatment, since I'm doing well with Copaxone.

Thanks again!  Best,

Pablo  

p.s.  You are right.  Last thing I would wear is a budgie smuggler.  So I'll bring several bordies ;)  
Helpful - 0
987762 tn?1671273328
COMMUNITY LEADER
OK, so far i've worked out that Copaxone is covered for RRMS under the PBS (public benefit scheme), still need confirmation USA is covered but it apears that if you are on a working visa you can apply for a medicare card. You can do this online see http://www.medicareaustralia .gov.au

HOW MUCH DOES Copaxone® COST (Australia only)?
If you are eligible for medications through the PBS, you will need to pay a contribution fee for each month’s supply. The Federal Government pays for the remaining cost. The amount of the contribution fee depends upon whether or not you have a pension or concession card and the number of prescriptions you have had dispensed in a year. The amount of this fee is set each year by the government . In 2009 the fee for people with a Medicare card is $32.90. The fee is $5.30 for people with a Medicare card and a pension or concession card.

If you are not eligible for Copaxone® through the PBS, for example if you are a visitor from overseas, your neurologist may write a private prescription. You will have to pay the full cost to the pharmacy that dispenses your medication. The cost is likely to be over $1000 per month. You will need to request a quote from your pharmacist for the price of any medication which is not subsidised by the PBS.

This below has all the basic questions regarding medicare, the what, how etc so worth looking at:

http://www.medicareaustralia.gov.au/public/files/1339-medicare-your-questions-answered.pdf

Look here for all the relevant websites you could contact the list is located in the last pages:   http://www.msaustralia.org.au/documents/ms-mysterydisease.pdf   also has good info and will give you a better idea of MS and the way MS things are done in Australia.

I'll get back to you regarding USA and working Visa access to medicare and all its entitlements.

Cheers.....JJ
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987762 tn?1671273328
COMMUNITY LEADER
G'day mate,

Welcome to the land of OZ (well fingers crossed) you are endeavoring to land in my neck of the woods, i'm a stones throw from the beach in sunny old Melbourne. I will Christen thee an honorary Melbourn-ite, please kneel whilst i gently slap your shoulders with a well cooked snag. I hope you like BBQ's its a prerequisite, they wont let you in if you dont lol.

I'll do some research for you and find out what i can, i do think if you are here on a working visa you might be covered medically, must check that for you. I would recommend contacting MS Australia and asking your questions, also might be worth contacting one of the Melb MS centres (eg Box Hill hospital) and requesting information or even getting your neurologist to request a colaborating neurologist whilst your here, worth a try and they maybe more willing to continue treatment if its requested by your treating neuro.

I'll get back to you with what i can find out, oh and dont forget to bring your bordies (board shorts) most guys wont be caught dead in budgie smugglers lol

Cheers.............JJ



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1323278 tn?1298122488
Melbourne:  Fantastic!

Hopefully will have time to get to know more of the country :)

Yes, that should probably work.  Thanks, Jemm.  I'm trying to contact doctors as well.  Hopefully there will be a way to make it work.  The job is really interesting, and I'm keeping my fingers crossed I can get to go.
Helpful - 0
Avatar universal
Cr*p that is a lot.

I don't know anyone personally with CIS but have just started going to the MS suport group thingo here, so maybe someone there will know.  Or I could ask my nurse....

You're going to Melbourne? Which part did you go to and fall in love with? Personally I prefer NZ, but that's me - always the rebel!
Helpful - 0
1323278 tn?1298122488
Jemm,

It's great to hear from you, though too bad you haven't been feeling terribly well.  It's Spring there, so take care of yourself!  We're just getting out of the chronic heat here, and it's amazing how my eye haze and paresthesias improved dramatically after the heat was gone.

Actually, it was a typo:  AUS$1000 a month!  That's actually a lot of money.  I guess I can put up with 500 AUS$ a month, but a thousand it's too much (well, here in the U.S. perhaps the biggest problem for those of us in limboland is insurance... you are aware of how insane it gets here!)

I look forward to keeping in touch with you.  In the mean time, a quick question:  Do you happen to know anybody with a clinically isolated syndrome in Australia?  Do you know if they received treatment, and whether they had to pay for it?

Thanks, and get well soon!!! :)

Pablo

p.s.  I loved your country.  Went there a month ago and fell in love with it.
Helpful - 0
Avatar universal
Hi Pablo.....I never managed to find out about that for you. Been feeling vile until the last 5 or so days (you know how it is!).

As for Aussies, there's me of course, Udkas, and SupermumSS that I know of. Maybe one of us can help.

The US dollar is neck and neck with the Aus dollar this week, in fact the US $ is set to be worth LESS very soon. Apparently your Federal Reserve are printing money like some tin-pot regime.........1000USD  per annum is 20 bucks a week......I don't think you'll get it cheaper!
'
Bar that, yell if you need help understanding Orstralian lingo (language), for example, "thongs" are NOT pants that floss your backside, they are footwear.

Cheers
Jemm
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