Medical Tourism

Question

Hi All,

I've just been for my annual hepC checkup.  I learned that although Sovaldi is now licensed in the UK where I live, my wonderful doc only has the funding to treat the first 100 patients this year.  They will be those nearest to liver transplant.  I assume that is because they will be the best value for money considering their likely future medical costs if left untreated.

I am currently 64 and so far my liver is holding up, though who knows for how long.  So I have to wonder how long before my name gets to the top of the treatment list?  At 100 people a year it is conceivable that I would be 84, or dead, or mortally compromised by something else, making tx no longer an option for me.

This is not rocket science.  The drugs companies must realise that all the unmet need that they are currently salivating over is not going to translate into billions of dollars at the prices they are charging.  The need is going to stay unmet.  Each country is going to allocate what they want to spend for drugs, and however many people that reaches, well that is it.  Only a trickle will get the drugs, especially in countries that prefer to spend on weapons, nuff said.

Which brings me to Medical Tourism.  I cite the following articles which pertain to India, however many countries have facilities for the international community to access medical treatment in a country other than their own.

http://in.reuters.com/article/2014/04/08/health-hepatitis-gilead-idINDEEA370B920140408

http://in.reuters.com/article/2014/04/10/natco-pharma-sovaldi-idINDEEA3909920140410

I don't know about the US system but for people in my position it seems to me that they may have an alternative by seeking treatment in another country and paying privately for it.  That all depends on the cost in that country.  It is early days yet but where else is the mega, gigantic, humongous, need going to go?  I gather from my doc that he hopes that prices will come down once there are several non-ifn combos licensed and in competition.  He also hopes that the government will increase his funding.  For my part I hope that both these things happen.  Otherwise I could be applying for my Indian visa this time next year.  

All the best
dointime

gibsongal · Answer

Egypt!

http://dcprogressive.org/2014/08/17/gileads-drug-wins-u-k-backing-from-regulator/

susan400 · Answer

I feel so bad for you.  I wish I could push a button, or make it happen for you somehow.  It's just not fair!  I don't know why it has to be so expensive for people to get.  Have you checked into Canada?  I know sometimes American's go through Canada pharmacies because they are cheaper and they get their drugs shipped into the US.  I have no idea if this would even be possible or if these drugs are the type that could be purchased through Canada.  I am just trying to brain storm for you.   Susan400

dointime · Answer

I think that there's been a wave of euphoria about the arrival of drugs that have over a 90% cure rate, and now that Sovaldi is at last on the shelves the reality of the cost and the difficulty of funding is setting in, at least for me.  As you point out Susan, the cost of this drug may put it beyond the reach of many Americans too, not just the rest of the world.  So people who have been waiting for years, if not decades, will have to continue to wait until competition brings down the prices.  How many years will that take?  So not much really changed then. 

I am waiting for a non-ifn combo to be approved but it is not difficult to see that the funding is going to be my next hurdle.  As you say Frank, there are hazards with getting treatment in another country.  How to authenticate the drugs is my main issue.  Also travelling at a time when there are no travel warnings about political unrest.  I do, however, think it is possible to get good medical tx overseas, especially in the International hospitals which cater to the International community, including western women.  Orphanedhawk seems to have done just fine.

Thank you orphanedhawk for  your recommendation.  I am going to follow up on it.  I am encouraged by your success and that is important because I admit that I am finding all this a bit daunting.  But what's the choices?  Sit here and wait to get told there's no funding for drugs for me, while my liver goes bad?  I don't think so,

Surely there must be some astute business person out there who can see an opportunity to set up a hepC clinic to treat the vast hordes of the infected at a reasonable price.  There will be no lack of volume, guaranteed.  And as for all the enthusiastic lip service being paid worldwide to the ideal of the eradication of hepC, lip service is all it will ever be until the cost of these drugs is properly addressed.

dointime

susan400 · Answer

I believe dointime is in the UK.  So, not sure if she would be able to access the US healthcare charity care. Possibly, but not a guarantee.  I am not saying it's impossible as I've never had to go there.  I know that I read an article in just the last few days about how the insurance companies and even especially Medicare and Medicaid are clamping down on who they approve for Sovaldi.  In Oregon, the Medicaid and has gotten almost impossible to be able to be approved for Sovaldi.  I am fortunate in that I didn't have to rely on government health care to pay for my Sovaldi + SOC.  If I had been dependent on my Medicare advantage plan, I would have been screwed, out of luck.  Because it is a Medicare HMO and they are strictly formulary based with the GAP thing and the whole 9 yards.  They only cover generic drugs-that's it and during the GAP it's worse.  When I inquired initially of my Medicare Advantage plan, they informed me that they only add new drugs to their list once a year and only if they are considered a medically necessary drug.  This is their formulary and not something that's based on an individuals particular health needs.  Also, this Medicare HMO is only for people living in this county.  So, with all that in mind, I said screw that, I won't even use them.  So, fortunately for me, my husband's company insurance is really great and covered Sovaldi really great as well as the SOC.  I basically never use my government prescription drug coverage for anything because it's so crappy and doesn't cover most of my medications.  If I am prescribed something that is a generic, sometimes, it's not even on their list or it's in such a high tier, like a tier 4 or 5 and it's such a ridiculously high co-pay that I couldn't afford it.  Now, I don't know, but dointime might be able to get covered on the Gilead's patient assist program??  Susan400

orphanedhawk · Answer

You really should, though consider the costs. Here in the US you may have health insurance or the ability to get some kind of charity care that won't be available to you oversees.
Although general costs of labs and such are considerably less, the hep C meds will still be ridiculously expensive.

orphanedhawk · Answer

I saw a GI in Bangkok for a while who I can recommend. He was an upbeat, honest guy with a sense of humor. It doesn't cost much to make an appointment, even if you are going to be staying in Chaing Mai. He could give you information  and possibly a referral.

He's a BNH hospital and his name is DR. SUTHEP WANICHAPOL

I like Bangkok and have spent long periods of time there but it is a big city and can be off-putting at first. Chiang Mai is more laid back. I simply didn't see any doctors there so I can't recommend anyone.
( I did get a massage at a hospital in CM. They consider massage as part of health. I agree:)
Generally, Thai medical and dental care is top notch.

Frank J. Perrotta · Answer

I would take orphanedhawks advice - especially about India.

I have a friend, her parents are native of India while she was born in England but carries a British + USA passport. Her dad had some serious medical issues and my friend thought it would be easiest to bring him back to India. She thought it would be cheapest to get home help as well as medical help etc. WRONG!

Not only was it just the crowds/personal space/being a female!!! but it was all about money there in India! She was always upset that, being a strong independent woman, she couldn't get anything done unless she got a male to pay off someone!

Being a foreigner I would be nervous that you would have to pay off someone to get things done but not being sure that you ever did actually get what you paid for. Does that make sense?

My friend also said that Indians are such great rip off artist and give fakes of everything. They sell home make alcohol that killed hundreds! It was discovered that needles were being rinsed out in the river and repackaged!

... those are just a few of the stories she shared with me.

dointime · Answer

flyinlynn - many thanks for your suggestion, I have now posted over there too.

orphanedhawk - that's so interesting.  Thanks so much for your response.  You've travelled some, haven't you.  I have a friend who once lived in Chaing Mai, will go ask her about facilities there. 

susan400 - sounds like you've been around the block too - in how to pay for treatment in America.  The drugs companies say they have a compassionate program for Americans who can't afford treatment but I don't know how that really works out in practice and who qualifies.  Sorry you are having a problem with the neuts.  You must be feeling like a pin cushion with all the injections but once you start you just have to get on with whatever it takes.  Thanks for your response here and wishing you the best, as always,
dointime

susan400 · Answer

I've never been anywhere overseas, so unfortunately, I can't answer your question.  I did want to say, that I'm so sorry that you have to deal with a bunch of government bureaucrats in order to get the treatment you want and need.  It s*cks!    I was blessed this go around because my husband, at this time, for the past 4 yrs, is actually working for a decent company and has decent health insurance.  They picked up 95% of the tab for my Sovaldi and SOC and the Gilead support path picked up my remaining co-pay. Since, I don't work, our income was too high for the coupon, but low enough to qualify for the assist.  Although, it turned out that since his insurance company covered so much, they didn't need to cover much of it at all.  In the past over the years, when I wasn't in a clinical trial (which was on 6 of my other treatments), we had horrendously high co-pays.  I met with my treatment doctor today, just for a general 1/2 point check-in.  My only problem (other than just the general SOC sides), is with the neutrophils.  So far, I've had one Neupogen shot and I'll be getting another one next week.  This is because of the Neuts trending downward cycle.  We discussed the option of lowering the Interferon dose, or continuing with the CBC's and Neupogen.  We both felt that we/I didn't think it was a good idea to risk a virus breakthrough and that if was better if I stay on full dosage the full 12 wks and just do rescue drugs.  So, it was my choice, which his advice and agreement.Just like I'd do Procrit if the hemo drops. But, thus far, no hemo problem.  Anyway, I sort of got off course here.  I agree with the above poster though.  There is more posting/traffic on the other board, the main Hep C forum, as opposed to the Hep C social side.  Anyway, I hope you get the answer from somebody on the foreign medical question.  Susan400

orphanedhawk · Answer

If they are doing the treatment in Thailand, that is where I'd go. I had a dentist there for years who was excellent. 
My transplant was done in Taiwan only because Thailand was just beginning to do live liver transplants.

One reason I suggest Thailand, is that the people there are nice, the food there is great and massages are cheap and good.
India can be very overwhelming to those of us who are accustomed to personal space.
Turkey was a nice country to visit but I have no experience with the medical system there.

If given a choice, I'd head to Chaing Mai over Bangkok for doing treatment.

flyinlynn · Answer

Hi
You might want to repost your question in the Hepatitis C community more traffic over there

http://www.medhelp.org/forums/Hepatitis-C/show/75

I live US and was treated here. I know nothing about medical tourism so I can't help with your question

Good luck
Lynn

dointime · Answer

So ...... does anybody have a recommendation on where to go, name and address of a medical facility, name of a doctor?  So far I have India, Thailand and Turkey.  I can't be the only person who is thinking of doing this, or who has already done it.  I am talking about perfectly legal state-of-the-art facilities.  PM me please.
dointime

Medical Tourism

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