Getting Humira in NSW

[Geriatric Jukebox]

Hi All,

I'm an American who lived in NSW for 15 Years before returning to NY for the past 21 years.I was diagnosed with Crohn's a few years ago And have been on Humira for several months. My wife and I will retire next year and are thinking of moving back to NSW and would like to know if Humira is readily available through the medicare system and/or private medical insurance. I'd also like to know if the Drs. there are knowledgeable with regards to Crohn's.

Thanks,

Alan

 

[Catherine]

I am not sure how easy would be to obtain under Medicare, I have attached a link.

DustyKat do you have any idea?

http://www.medicareaustralia.gov.au/provider/pbs/drugs1/crohns.jsp

 

[DustyKat]

Hi Alan,

The link that Catherine has provided will give you all the information you require to determine if you are eligible for Humira under Medicare. BUT the key is you will need to be eligible for a Medicare card to access the system as the US has no reciprocal health agreement with Australia and even if it did it is only for a limited time.

In Australia Humira is subsided under the universal health system's pharmaceutical arm known as the PBS (Pharmaceutical Benefits Scheme) hence the restrictions to its access.

As far as I am aware PBS listed medication would not be eligible for rebate with a health fund but I have no idea what the story is if you had it prescribed on a private script. I imagine the health fund would likely baulk at covering it though??

The Medicare/health system is essentially the same as it was 21 years ago.

In what area of the state would you be considering moving to?

Yes, there are gastroenterologists here that specialise in IBD and those that don't generally have a good idea about it.

Perhaps it would be an idea to contact Medicare and also your current health fund to for advice.

Aussie, do you have any idea about this?

Dusty.

 

[Aussie]

Hi Dusty and Alan,

If you're not a citizen/permanent resident or from a reciprocal country (US isn't) then you won't get a medicare card, without which, you won't get the discounted price for the Humira.

Your options are:
- pay the full amount (will get very expensive),
- talk to your health insurance and see if they will cover your costs while you live overseas,
- talk to your doctor re alternative treatments that will be less expensive (unlikely),
- stay in the US, or a country where you can continue to receive the medications you need to keep your Crohns under control.

Best wishes.

 

[Geriatric Jukebox]

Hi Catherine, DustyKat and Aussie,

Thank you all for getting back to me so quickly. I will look carefully at the link you sent. I was a teacher in Sydney and had permanent resident status which I have kept up by returning to Australia within every 3rd year. I had a Medicare card back then but also had private coverage. I still have a house there and pay taxes although I don't pay the Medicare levy. I hope that by moving back I will be eligible to be on the Medicare roll once again. I doubt that with this preexisting condition the private insurers would want to insure me.

I have a Crohn's specialist at Mt. Sinai hospital in NYC and really like him. If I have to stay in the NY area to get good medical treatment I will. He was in Melbourne a few months ago at a conference and said that they are becoming more aware of Crohn's and the treatment options. Before I began seeing him I had a piece of small intestine cut out and my former Gastro kept me on Pentasa. Thankfully I listened to my GP who told me to see this specialist. He ran lots of tests and found that 7 months after the operation that an area of intestine about a foot long had become inflamed and stricturing had started. That's when he put me on Humira and so far so good!

Regards,

Alan

 

[Catherine]

Alan, you will get private insurance for Crohn's, there would be a 12 month awaiting period to claim on most policies as it is a pre-existing condition but I believe the only cover for humira would though medicare.

 

[Geriatric Jukebox]

Thanks...That sounds reasonable. I've got a lot to think about between now and next year!

Alan

 

[stefan]

Yes that's my understanding too, I'm not aware of any private insurers that will cover Humira or infliximab now its on the PBS. The only other option would be to get it from a public hospital, or on compassionate grounds from the pharmaceutical company directly, neither of which are incredibly easy. It sounds like you might be ok with the PBS criteria though, so good luck!

Edit: I'm not sure if you'd fall under the grandfather clause or how things work for those moving from overseas, hopefully you don't need to GP through the entire qualification process to get access to it!

4 Beta

 

[Geriatric Jukebox]

Hi Stefan,

Thanks for your input, I'll start making inquiries soon as I'm sure it'll take a while to sort it all out. If I can qualify for the medicare card and get Humira from the PBS that would solve a lot of problems...any idea how much Humira would cost without insurance?

Regards,

Alan

 

[stefan]

any idea how much Humira would cost without insurance?

Humira costs in the realm of $2000 per twin pack, which lasts 4 weeks on the standard dose.

Hopefully you can qualify for Medicare and get it on the PBS!



4 Beta

 

[Geriatric Jukebox]

WOW!!!!!!!!!!!! I pay a co-payment of 20.00 for the same twin pack.

 

[stefan]

With the PBS I pay $5.90 with the disability pension, but it may be more like ~$35 at the full price PBS price, not that you can really complain!

4 Beta

 

[Geriatric Jukebox]

35 dollars would be great...Ill see what I can do!