American needs Meds in Europe

[dnl.phillips]

Hi All,

I'm in a predicament and hoping to get some insight. I'm an American, recently diagnosed Type 1 moving to Rome later this year for an extended work related trip. I'll be there for a year. My problem is that my insurance won't cover any cost of prescriptions filled internationally, and my mail order RX service won't ship internationally. I've also been told not even to try shipping Meds of any kind into Italy (as they rarely get through customs/etc). I will go over with about 3 month supply but I'll need to get a hold of more after that.

The meds I currently use are: Novolog 250 Unit Pen (Called Novorapid in EU I think) and Levemir 250 Unit Pen.

One of my options at this point is to get a prescription from a local Endocrinologist and then go pay out of pocket, FULL RETAIL price for the Pens, but I can't seem to find any info online about what they cost in that local market (Rome).

Does anyone have any idea what this stuff costs outside of insurance? My guess is that it's probably way too pricey for this plan to be realistic (I'm not rich), but I really have no clue. Are there other options I'm not thinking about? Is it cheaper in other places like Switzerland or France (IE would it be worth taking a trip every few months to pick some up elsewhere?).

Sorry so lengthy! PLEASE HELP!

-Danny


P.S.-Please excuse one final note- I really didn't come here to get sidetracked comparing the relative merits of our home country's healthcare systems (I know ours is far inferior!), so telling me that you get your insulin for free or near free is not going to help. I'm not a citizen so I'm not going to be covered. I need some insight asap as I'm taking off in about 6 weeks and need to get a plan together asap. Forgive me for mentioning this, I wouldn't bother if it wasn't an issue in other forums I've looked to for insight.

 

[Jaylee]

Hi Dnl,

I'm based in the UK, though understand your dilemma. (I have a friend with a T1 pumping daughter in the South of you country.)

So, getting that out the way & throwing ideas around..?!

Do the pens you use come "pre filled" disposable units.. Or are the Novopens you use just reloaded with a cartridge of insulin..??

I'm T1 myself & have over 25 years expeiriance of these pens...
Another point of reference is Switzerland is a non EU country which may have some bearing on the "insulin" supply logistics...?
I have also driven to North Italy (the lakes) via Germany, Austria & know Switzerland too through work.. (I'm in a band.)

Another idea that springs to mind with insulin supply in Rome is the American embassy..? I'm thinking along these lines... http://italy.usembassy.gov/mobile//acs/professionals/doctors/doctors-main.html

There's alway a work around on these issues..!

 

[gorillamark]

Both those are made by NovoNordisk so have you contacted them to find out what they cost in Italy, France; and Switzerland?

"Novo Nordisk has offices in more than 75 countries. Choose a country in the drop down menu if you need to get in contact with a local office."

Ask them at the head office in Denmark first if they can give some indication of how much you can expect to pay in each of those countries and if not contact the branch offices. Danes tend to have good English, it's very hit and miss in France and Italy although as NovoNordisk is multinational I suspect they use English as a working language.

You've also checked the extent of coverage provided by your employer while you're in Italy - who the provider is, and what benefits they will provide in return for the contributions paid by you and your employer? If not you need to find that out as a matter of urgency as you may not be covered either for diabetes (pre-existing condition, or complications arising therefrom - can also be considered a pre-existing condition).

 

[jackois]

Hi there.

How much is a 3 month supply? Could you not take a full year's supply? I've just checked my nonorapid & lantus pens and they both have an expiry date 2 years into the future.

 

[phoenix]

I can give you the fixed price of the insulin in France
Levemir 100UI/ml 5 pens or cartridges (3ml) 63,73 €.
Novorapid 100UI/ml 5 pens 40,58 €., 5 cartridges 37,28 €. (3ml)
Novorapid 100U1/ml, vial (flacon) 10ml : Prix : 20,12 €.
http://www.eurekasante.fr/medicamen...oire-619-Novo-Nordisk-Pharmaceutique-SAS.html
A vial of rapid insulin works out cheaper but you would need syringes also.
I suspect Italian prices will be similar but don't really know.
In France you would also have to pay upfront to a GP for the prescription, this should cost 23€ but they are allowed to charge more (and particularly in big towns there are some that do)

 

[Daibell]

Hi. I can only talk about the UK. In general diabetes meds are cheaper in Europe than the USA (why?). You might want to consider refillable cartridge Novo pens as an alternative to disposable Novo pens. I was offered either by my nurse when I started insulin. I would expect the pricing to be similar? I bought my most recent spare refillable cartridge Novo pen on eBay much cheaper than retail. Yes the insulins are called NovoRapid and Levemir in Europe. The cartridges for the pens are 300ml and come in packs of 5. They have a very long expiry date but obviously need to be kept in the fridge.

 

[dnl.phillips]

Hi Dnl,

I'm based in the UK, though understand your dilemma. (I have a friend with a T1 pumping daughter in the South of you country.)

So, getting that out the way & throwing ideas around..?!

Do the pens you use come "pre filled" disposable units.. Or are the Novopens you use just reloaded with a cartridge of insulin..??

I'm T1 myself & have over 25 years expeiriance of these pens...
Another point of reference is Switzerland is a non EU country which may have some bearing on the "insulin" supply logistics...?
I have also driven to North Italy (the lakes) via Germany, Austria & know Switzerland too through work.. (I'm in a band.)

Another idea that springs to mind with insulin supply in Rome is the American embassy..? I'm thinking along these lines... http://italy.usembassy.gov/mobile//acs/professionals/doctors/doctors-main.html

There's alway a work around on these issues..!

Thanks I currently use disposable pens but aren't opposed to using reloadable if that's cheaper in the long run. I appreciate your input.

 

[dnl.phillips]

Hi there.

How much is a 3 month supply? Could you not take a full year's supply? I've just checked my nonorapid & lantus pens and they both have an expiry date 2 years into the future.

I would but there's only so much I can get at a time with my insurance in the states (60 day "vacation supply")

 

[dnl.phillips]

Both those are made by NovoNordisk so have you contacted them to find out what they cost in Italy, France; and Switzerland?

"Novo Nordisk has offices in more than 75 countries. Choose a country in the drop down menu if you need to get in contact with a local office."

Ask them at the head office in Denmark first if they can give some indication of how much you can expect to pay in each of those countries and if not contact the branch offices. Danes tend to have good English, it's very hit and miss in France and Italy although as NovoNordisk is multinational I suspect they use English as a working language.

You've also checked the extent of coverage provided by your employer while you're in Italy - who the provider is, and what benefits they will provide in return for the contributions paid by you and your employer? If not you need to find that out as a matter of urgency as you may not be covered either for diabetes (pre-existing condition, or complications arising therefrom - can also be considered a pre-existing condition).

Thanks, I should have specified that I'm actually self employed, so I don't have a company plan unfortunately. I'll reach out to Nordisk if I can't get a hold of a local pharmacy in Rome.

 

[Nyxks]

You might won't to connect with http://www.aemmedi.it for help with your stay in italy you might need to use google translate if you can't read italian though

Chemists’ are privately owned in Italy, often passed from one generation to another within the same family, and the number is strictly controlled. Prices of medicines aren’t controlled by the government and vary considerably according to the brand, and many medicines are available without a prescription in Italy that would require one in some other countries.

Visiting Italy and take a medicine regularly, you should ask your doctor for the generic name, as the brand names of medicines vary from country to country. If you wish to match a medicine prescribed abroad, you need a prescription with the medicine’s trade name, the manufacturer’s name, the chemical name and the dosage. Most medicines have an equivalent in Italy, although particular brands may be difficult or impossible to obtain.

It’s also possible to have medicines sent from abroad, for which no import duty or VAT should be payable. It’s also recommended to bring your favourite non-prescription medicines (e.g. aspirin, cold and flu remedies, lotions, etc.), as they may be difficult or impossible to obtain in Italy or more expensive.

 

[Nyxks]

@dnl.phillips I assume that you've already applied for your residence permit since you are staying more then three months (or so it does sound)

EU and non-EU nationals registered with the Servizio Sanitario Nazionale (S.S.N. - National Health Service) are entitled to receive health care provided for by law and have equal treatment as Italian citizens regarding compulsory contributions, health care given in Italy by the S.S.N. and its time limit.

1. Foreign nationals required to register with the S.S.N.

• Foreign nationals with a residence permit having a regular subordinate work, or self-employment, or being enrolled in the unemployment listings;
  
  
• Foreign nationals with a regular residence permit or those who are renewing their permits for the following reasons: subordinate work, self-employment, family, asylum, asylum application, adoption, foster care, citizenship or religion;
  
  
• Foreign nationals’ dependent family members (with a valid residence permit) included in the above list.
  

Foreign nationals not falling within the above-mentioned categories do not have to register with the S.S.N.. Nevertheless, they have to take out a sickness, accident and pregnancy insurance policy, valid throughout Italy and extended to their dependent family members as well.



2. Where to register

In order to register with the S.S.N., you should go to the Azienda Sanitaria Locale (ASL - Local Health Unit) in your place of residence or where you currently live (as stated in your residence permit) and must produce the following documents:

• Identity card
  
  
• Fiscal code
  
  
• Residence permit
  
  
• Self-certification regarding your residence or abode (a hosting centre where you have lived for more than three months can be considered your habitual abode).
  

When registering with the S.S.N., you will be able to choose your family doctor or paediatrician.


3. Registration validity

• Registration with the S.S.N. is valid for the whole length of the residence permit, as well as during its renewal. This registration can be extended by simply producing all the papers proving the residence permit renewal application to the competent ASL.
  
  
• In case of lack of renewal or revocation of the residence permit, as well as in case of expulsion order, the registration is no longer valid, unless the foreigner involved proves to have filed an appeal against the above measures.
  

4. Health care provided

On registering with the S.S.N., you will be given a Tesserino sanitario personale (Personal Healthcare Card) entitling holders to receive medical assistance either without payment or by paying a contribution (called ticket), the amount of which may vary according to the region they live in. This medical assistance consists of check-ups in out-patient departments, specialist examinations, home visits, hospitalization, vaccinations, blood tests, X-ray examinations, ultrasound scans, medicines, rehabilitative and prosthetic treatment.


FOREIGN NATIONALS NOT

REGISTERED WITH THE S.S.N.

If you have a valid residence permit, but you are not among those having to register with the S.S.N., you have two opportunities:

a) you may voluntarily register with the S.S.N. along with your family members living in Italy. You may register voluntarily if:

• You have a residence permit longer than three months (with the exception of a permit for study purposes);
  
  
• You and your family members are on the list of the patients who can be treated by your residence ASL or, should it be your first registration, the ASL of the address stated on your permit.
  

You are are not eligible for this registration if you have a residence permit for treatment purposes. Under those circumstances, you will receive medical assistance after paying the ASL the fees provided for by law, the amount of which may vary according to the region you live in. If lacking sufficient financial resources, in the event of accidents or sickness, you will be granted all out-patient treatments, as well as emergency or ongoing basic hospital assistance and all preventive medicine programmes (such as vaccinations) in accredited public and private health structures.

b) you may purchase an insurance policy - valid throughout Italy with an Italian or foreign insurance company - which covers sickness, or accidents and prenatal care, as well as in case of pregnancy.


Medical assistance is always provided

• During pregnancy and motherhood;
  
  
• For child health purposes;
  
  
• Through vaccinations, according to regulations in force and within general disease prevention campaigns approved by the different regions;
  
  
• Through international disease prevention programmes;
  
  
• Through infectious disease prevention, diagnosis and treatments.
  

Foreign nationals can state they are in need and that they are consequently unable to pay health treatment provided by the S.S.N. by means of a written self-certification to be submitted to the health structure giving medical assistance.

 

[gorillamark]

Thanks, I should have specified that I'm actually self employed, so I don't have a company plan unfortunately. I'll reach out to Nordisk if I can't get a hold of a local pharmacy in Rome.

Reach out to them before you leave the USA as stated below prices in Italian pharmacies can vary quite a bit - if you already know roughly what your insulin should cost you'll be able to work out if a particular pharmacy is charging over the odds or not..