Enbrel monthly prescription while cruising

[eharapat1]

My friend and I have a dream to join the cruising community and are working towards our 5 year plan. She has Rheumatoid Arthritis and takes a biologic medication shot once a week to manage it. The prescription is filled monthly and the four shots have to be refrigerated. Does anyone have any advice or suggestions on how to manage/traverse a health issue that will most likely require health insurance due to the cost of the medication but also how to acquire this type of medication while cruising? She has discussed with her doctor transitioning to oral medications, but that requires blood work every 3 months and there is not a cost difference. On Enbrel, her symptoms are well controlled and blood work is only required once a year. Insurance companies we have looked into don't approve more than a months supply at a time because of the cost of the medication.

Thanks in advance!

[Shrew]

You could stick around Puerto Rico and USVI.

[SailingHarmonie]

The supply chain is different for each med, and each insurance company handles it differently as well. Not to mention that as you travel different countries will have different systems for drugs and medical care.

Our experience with sourcing meds in the Caribbean has been good--but not perfect. Only one product has been an issue, and that is a new-to-the-market drug that is difficult to get even from major US pharmacies. It has been dramatically effective, and I suspect that manufacturing is trying to catch up. Supplies are so short, even the Canadian pharmacies do not have it in stock. Having been a manufacturing director for a small pharma company, I can empathize!

We use the Navigator policy from Geo-Blue. Designed specifically for extended overseas travel, so they get the issues with drug supply, and the need to sometimes approve more than a month at a time that is official policy. The procedure we have to use is a bit clunky, but it does work. We ask the pharmacy to fill 3 months (or more) at a time. They submit the request, it is denied. We call the insurance company rep we deal with, and they approve an exception to the rule, and the pharmacy can fill it. For some reason, it can't be done without the denial in the system to override.

It might be worth discussing the supply situation overseas with the drug manufacturer. You might have to dig a bit, but I am sure that Amgen has a group of patient advocates on staff that can help with information, and hopefully suggestions.

The cost of medications overseas can vary all over. If there are multiple generic manufacturers and a busy competitive market, surprisingly enough, the USA frequently has the lowest prices. For on-patent drugs, the USA is usually the most expensive. For off-patent drugs with only one or two generic manufacturers, who is cheaper will be a crapshoot. Enbrel is of course not generic, and not likely to be anytime soon.

There is a catch here, however. Most insurance policies that are focused on expats and long term overseas travel are not "Obama-care compliant" because they do not have to be. There will be higher costs and waiting periods associated with pre-existing conditions.