# US citizens buying drugs in Canada



## David in Seattle

At my request, my new GI has given me a prescription for Xifaxan/Rifaximin.  The cash cost here is about $1,000.  I am hoping my insurance will cover it, and I plan to check with them this week.  But in case the bastards won't pay, I'm looking for an alternative to shelling out a grand for this medication.  I know there are online pharmacies located in Canada which will process US prescriptions, often at significant savings.  My understanding is that one thing required is for a Canadian doctor to basically evaluate & re-write the script for use in Canada.  I'm wondering if anyone has had any experience with this that they could share.  If this is an option, I would prefer to carry out the whole transaction online/through the mail (cheaper), but living in Seattle, I could also drive up to Vancouver without too much difficulty.  Any thoughts?


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## DMS

As far as I know Rifaximin is not available in Canada, I tried to get my son's GI to prescribe it, although he knew about it, he said it was not available in Canada.
Have you tried Mexico?   I'm interested in knowing if anyone has gotten drugs from there.  My parents are heading down in a couple of weeks (snowbirds) and have told me to make a list of anything my family needs, but I'm not sure of the quality of the drugs there.  

Can I ask how long a $1000 prescription of Rifaximin would last you?


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## David in Seattle

I've found conflicting statements regarding its availability in Canada, so I'm not sure if it is or not, but I thought I'd get some input on the question of Canadian pharmacies, just in case.  If I find my insurance won't pay, I'll contact the manufacturer directly and ask them about Canadian availability.

I would be reluctant to get a drug like an antibiotic (one which you can't really tell subjectively if it's working, as opposed, say, to an analgesic) from Mexico.  

The ~$1000 (cheapest price I've round so far is $946.79) is for 42 550 mg tablets.  Taken 3/day, this would be a 2 week course.


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## glum chump

I had asked my GI about Rifaximin about eight months ago, and at that point, he had said it wasn't available in Canada. I haven't asked him since about its availability.

I'd be interested in knowing what the manufacturer says about Rifaximin in Canada...that's a route/option I hadn't considered.


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## David in Seattle

glum chump said:


> I had asked my GI about Rifaximin about eight months ago, and at that point, he had said it wasn't available in Canada. I haven't asked him since about its availability.
> 
> I'd be interested in knowing what the manufacturer says about Rifaximin in Canada...that's a route/option I hadn't considered.


Although they have conducted clinical studies with the drug in Canada, I see it does not appear on the Health Canada web site, so I'm guessing at this point it can't be prescribed there.


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## braveheart

Rifaximin is not expensive at all here in Buenos Aires.

It is a special kind of antibiotic, but in the end it is an antibiotic.
http://en.wikipedia.org/wiki/Rifaximin
Your doctor may found something similar and more affordable in the US.


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## Nytefyre

Alldaychemist.com sells Rifaximin (or its generic equivalent) 200mg 10 for $3 or something like that.  I know people have used alldaychemist without problems before, but it wasn't for any crohn's-type meds.  Just thought I'd post this info.


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## Mayflower537

Hi, David,

My doctor just put me on my 2nd round of Xifaxan.  Same amount as you - 42 550 mg pills.  I got mine the first time from Target Pharmacy but I shelled out $826 or something.  GI warned me it'd be expensive but my insurance was reimbursing me at the time so it wasn't a huge deal.

This time I told him I couldn't really afford to pay that much for medication (deductible started over) and he did two things for me - first, he loaded me up with samples.  Gave me 30 pills that he had.  Then he gave me a Xifaxan savings card from the manufacturer that can save you up to $100 a month or something b/c I was going to have to buy the other 12.  He gave me the Rx for 42 (said the drug rep's numbers get screwed up if he writes a Rx for some funky number) and I took it into Target and told them I only needed 12.  That came up to $231 or something and then the Rx card took $100 dollars off.  I thought that was nice b/c I was expecting that it'd only take $100 off if I filled the whole Rx, but apparently it takes $100 off for whatever you buy for the month.  Much more affordable that way!

Anyway, hope this helps.  It is possible to get it discounted here in the States.  

Hope it also works for you after you get it.  It seemed to help me.  I am thought to have IBS and not IBD.   

May


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## hopeful

In Italy where its been available for many years, it costs around 10 Euros ($13) for 12 pills of 200mg.

Its called Rifacol or Normix


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## saidinstouch

The problem in the US is that Xifaxan (the brand used to treat IBD) has a patent for the use in treating IBD specifically.  Normally patents are only given for the drug's structure and method of preparation, but in this one case (at least the only one I know of), the company managed to get a patent for an indication.  Essentially, rifaximin is available as a generic for traveler's diarrhea which it was developed for many years ago.  However, no generic can really succeed in the US because of this other patent and the risk of a lawsuit from the manufacturer.

I'm somewhat torn on the issue because the company payed for the expensive clinical trials and deserves to earn the money back for it.  However, the cost (mostly due to insurance companies not covering it very well) makes the target population unable to afford the drug.  Its a catch-22, without the research and cost of it, we don't know the drug works, but with the research comes an added cost that affects the consumer because of insurance companies.


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## Mayflower537

saidinstouch said:


> The problem in the US is that Xifaxan (the brand used to treat IBD) has a patent for the use in treating IBD specifically.  Normally patents are only given for the drug's structure and method of preparation, but in this one case (at least the only one I know of), the company managed to get a patent for an indication.  Essentially, rifaximin is available as a generic for traveler's diarrhea which it was developed for many years ago.  However, no generic can really succeed in the US because of this other patent and the risk of a lawsuit from the manufacturer.
> 
> I'm somewhat torn on the issue because the company payed for the expensive clinical trials and deserves to earn the money back for it.  However, the cost (mostly due to insurance companies not covering it very well) makes the target population unable to afford the drug.  Its a catch-22, without the research and cost of it, we don't know the drug works, but with the research comes an added cost that affects the consumer because of insurance companies.


Interesting.  Wondered why it was so expensive.  Only thing I've ever taken where the drug info sheet said "No known side effects."


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## MADiMarc

David,
Like you I do not think I would head to Mexico for this type of thing.  How about other countries?  Some one mentioned Italy.  Would it work like it does Canada, if a doc there signed the script?  How about the UK?  So many people are on this forum from the UK perhaps they have ideas?
Good luck,
Michele


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## hopeful

The pharma world is one big business. Investors are looking for high returns. So someone has to pay the price. Costs of trials in the US are 20 - 40 times as expensive as in Europe. Besides, Europe has price controls, governments set drug prices (and don't worry, the drug companies still make a profit...)


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## Absentminded

Assuming I'm answering the right question. In the uk, when you get a prescription from your doctor you only pay £7.20 per prescription. It doesn't matter what drug it is or how many pills you have, it's always £7.20 per prescription. And that's only if you are over 18, under 65?, and not on benefits (in which cases it's free).

It's also free if you are given drugs in the hospital. I don't have to pay anything when I get my remicade. 

The NHS does have it's bad areas, but when it comes to things like this it really is an amazing institution, that I'm proud to have in my country.


P.s. I don't think it would work in the uk as they're quite strict about what they prescribe. I'll have a flick around the web.


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## Absentminded

As far as i can see Xifaxan/Rifaximin is still under clinical trials in the UK.


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## Sue-2009

What is Xifaxan/Rifaximin?  I see up on one of the posts its an antibiotic?  What makes it different than others?  Sue


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## David in Seattle

I found out today that my insurance will pay all but $50, which is great.  Xifaxan is not sold in Canada, several Canadian pharmacies I contacted do have/will supply to the US a 200mg generic which is made in India.  ~$100 for 100 tablets.  

Xifaxan has "orphan drug" status in the US, for treatment of hepatic encephalopathy.  I think this is where it gets its extended protection from competition, rather than from the patent itself.  

You hear the argument that pharma needs its huge profits for research, but as someone who has worked in that field I can tell you that's largely untrue.  For one thing, it stands to reason if they were sinking all that $$$ back into research, it wouldn't be showing up as PROFIT and increased share price.  Also, the industry is a lot more inclined to invest in developing a "proven money maker" ("me too" drugs like Levitra and Cialis to cash in on the huge market revealed by Viagra, as though the world needs 3 such drugs) than it is to do pure research for some obvious need.  But there are a lot more people looking for an easy solution to erectile dysfunction then there are IBD sufferers.  "Orphan drug" efforts are aimed at addressing this, but many say the approach is not terribly effective in that regard, and simply ends up being yet another hand out to big business.  

Sue - Antibiotics vary tremendously in the microorganisms they will kill, and this varies constantly as the bacteria evolve immunity through exposure to the drug in question.  The main thing that separates Rifaximin/Xifaxan from most other antibiotics is that it is non-systemic; very little of the drug leaves the GI system and absorbs into the blood. 

Thanks everyone for your thoughts and suggestions!


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## Sue-2009

Oohhh....Thank you!  I learn something new everyday...So it is your choice "antibiotic", it works well for you? Sue


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## effdee

I've been keeping up with the thread, David, and I'm happy that your insurance company will cover the bulk of your prescription. Here's hoping it does the job for you.


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## MADiMarc

Fabulous!  David please keep us posted.  I hope it works wonders for you.
Good luck,
Michele


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## bryan

I have PBC, Rifaximin is the only way to slow its progress and is not available here in the UK, so I ordered from India.

I got a pre-paid credit card to limit my vulnerability, and gave a false telephone number as I have read that you can be hassled by aggressive sales staff cold calling from Indian pharmacies. I set up a new Hotmail account to make the order and emailed them about availability, they used my temporary address to keep me informed on my orders progress through the post. 

It arrived in ten days. They used a rubber stamp to fill in the customs declaration, it is almost unreadable, but you can just make out the words "health products"

The 200mg pills were 30 cents each, I bought 400 (I take four a day). 

I hope this helps

Bryan


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## Mark in Seattle

David, did you ever try the rifaximin, and if so did it help?  I'm assuming for CD?


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## Judith

Expensive!!

I do not know if this will help everyone but hopefully it will help some. Salix Pharmaceuticals has a webpage that your doctor can fill out and obtain free samples of Xifaxan / Rifaximin from their Sales Representative. I think it is reasonable to ask your doctor. If you explain the cost for a 2 week supply hopefully they will be willing to help you out.

https://www.salix.com/products/request-samples.aspx


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## Judith

Salix Pharmaceuticals Patient Assistance Program for Xifaxan / Rifaximin 550 mg Tablets. * Check to see if you qualify before shelling out your cash. 

Website:
http://www.salix.com/about-us/corporate-responsibility/patient-medication-assistance.aspx

Form to be Filled Out:
http://www.salix.com/assets/pdf/pharmacists/salix-patient-assistance-program-application.pdf

Patient Assistance Program Telephone Number:  1-866-282-6563

Medications Covered by Salix Pharmaceuticals Patient Assistance Program:

Apriso / mesalamine Extended-release Capsules .375 g
Azasan / Azathioprine Tablets, USP 75 mg
Azasan / Azathioprine Tablets, USP 100 mg
Colazal / balsalazide disodium Capsules 750 mg
Metozolv ODT / metoclopramide HCI Tablet 5 mg
Metozolv ODT / metoclopramide HCI Tablet 10 mg
Relistor / methylnaltrexone bromide Subcutaneous Injection 0.6 mL
Xifaxan / Rifaximin 550 mg Tablets


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## Judith

Xifaxan 550mg Reimbursement Program by Salix Pharmaceuticals, Inc.

**Make sure you know if you qualify of not before filling your Xifaxan / Rifaximin Prescription.*
Instructions for Forms:
http://www.salix.com/assets/pdf/pharmacists/xifaxan550-patient-form-instructions.pdf

Telephone Number: 1-866-XIFAXAN

*Important Things To Ask:*
- What Diagnosis Codes Qualify for the Reimbursement Program?
- Is the ICD-9 Code Required for Reimbursement and Do You Qualify under ICD-9 Code Status (according to your physician)?

Phone: 1-866-XIFAXAN
Fax completed Form to: 800-387-5807 1-866-943-2926

Website for More Information:
www.Xifaxan550helpline.com
and
http://www.xifaxan550.com/hcp/physician-resources/index.aspx#reimbursement


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## Judith

If your Xifaxan / Rifaximin Claim is Denied Salix Pharmaceuticals Inc. May be able to help you:

According to the Salix Pharmaceuticals, Inc. Website http://www.xifaxan550.com/hcp/physician-resources/index.aspx#reimbursement



> Call 1-866-XIFAXAN (943-2926) to connect to the Xifaxan 550 mg Reimbursement Helpline.
> 
> This free support service connects your office and patients to trained reimbursement analysts to answer questions you may have, and to help negotiate appeals should your patients’ claims be denied. Open Monday–Friday, 8:30 am–5:30 pm EST.
> 
> The helpline can also provide a timely solution to address issues you may encounter, including:
> •Receiving current reimbursement policies for private payers, Medicaid, and Medicare
> •Verifying individual patient coverage
> •Verifying insurance coverage associated with the patient assistance program
> •Assisting with prior authorizations
> •Managing negotiation of appeals on denied claims
> •Receiving customized information to assist with coverage or appeals


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## Judith

Salix Pharmaceuticals Inc. also has a Rebate Card Program:

From Salix Pharmaceuticals Website:
http://www.xifaxan550.com/hcp/physician-resources/index.aspx#reimbursement



> If you would like a sales representative to discuss our Rebate Card Program with you, please call us at 1-866-669-SLXP (7597).


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