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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.
Why Are the Cost of Prescriptions Drastically More Expensive 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:
- It will wreck my companies policy which will, in turn, affect us, with higher premiums next year
- There has to be another way
Onto checking out another way…
Filling Prescriptions in Canada
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.
Prices Vary in Canada
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)
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.
Bad News for Me But Some Good News for You
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…