Psoriasis Treatment in Thailand

[Jamman5v1]

Hi,

 

New to here. I am sure this has been discussed in past but wanted to see if anyone had new information.

 

I am a 42 American Nurse looking to move to Thailand for early Retirement with my Girlfriend who is from Bangkok but currently lives in US with me. 

 

I have a question that I am struggling to find answer. I have autoimmune issues (Psoriasis). I am not at the point where I need "biologics" or immune suppressants like Humira but I may in future. Currently I go to clinic to receive Phototherapy (UVB NarrowBand) which works very well.  I do better in warmer climates. I do NOT have Psoriatic Arthritis at this time but could in future. I have recently purchased a home light unit from Manufacturer Daavlin and am testing it out but it may not be as effective as powerful clinic option.

 

While in the states under a prescription drug plan with my employer I COULD receive Humira or Enbrel or first line medication such as Methotrexate at a very affordable price. If I did not have insurance here in USA those biologics are very very expensive due to patent protection. ($30,000/month). 

 

I know that if/when I move to Thailand and start “offshore” or “Thai insurance” I will not be covered for Psoriasis due to (Chronic/Pre Existing Condition) and would have to pay out of pocket. I do not mind paying out of pocket but these drugs are expensive.

 

Since these biologic drugs just recently expired patent in Europe there are “biosimilars” flooding market (Amjevita / Cyltezo for example), but I dont know what options are available in Thailand. 

 

My move and leaving my American insurance are dependent upon this information

 

My questions:

 

1. Do hospitals in Bangkok and Chiang Mai offer out-patient phototherapy (UVB-NB)?

2. Since I go 2-3 times each week is it easy to get into booth and out without long wait times?

3. What would be approximate cost each treatment because I would have to pay out of pocket?

4. Are biologics or "Biosimilars " available and at what costs? Any word on thailand producing them in-country in future to eliminate high import tax?

 

Thanks to anyone who has patience to read all that ???? and knowledge of what I am talking about. I am also going to see  Thai doctor at Bumrungrad hospital when visiting in October.

 

All the best

 

Darren

 

 

[Sheryl]

Despite psoraisis being fairly common here phototherapy is not, though the larger "international" hospitals in Bangkok have it. Will be costly though I csn't give you an amount. You could email places like Bumrungrad Hospital for a quote.

 

Humira is not available here at all. The only biologics here that I know of are Embrel and Remicode/Remsida, the latter requires IV infusion. Both are very costly, all the more so because you can only get them from a hospital and there is a significant hospital mark up on medications.

 

Methotrexate and cyclosporine are available in local generic. And can be gotten from government hospitals whereas I am not sure the biologics can.

 

Not only will the psoriasis be excluded by an insurer but also almost certainly all autoimmune diseases and some companies (especially, but perhaps not only, Thai companies) might refuse to cover you altogether. They'd be concerned re adverse effects of the drugs putting you at increased risk of other problems.

 

There is no such thing as "Thai insurance". Any policy that covers you in Thailand will cover you in other countries too.

 

There are Thai insurance companies and there are international insurers who offer expat policies. I suggest you start now finding out if any of the will cover you. Popular international expat policies include April International, Cigna Glibal (nit Cigna US!) and David Shield.

 

Popular Thai issued policies include Pacific Cross, April Thailand and Aetna Thailand.

 

You can do online applucation to all.

 

Note that insurers are regulated by the laws in the country where they are based and that the regulatory framework for health insurance in Thailand is much looser than in Western countries and allows practices that would not be allowed in Europe or the US.

 

 

 

 

 

 

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

 

 

 

 

[Jamman5v1]

hi,

 

Very kind of you to provide such a thorough response. I will check out those insurance options. I was also looking at GeoBlue Xplorer as a US based insurer with the hopes that I could see specialists when traveling back to US and most offshore insurance companies only covered me for emergencies when back in US.  I have an appointment with Bumrungrad  in October to try to get some details as well. 

 

All the best,

Darren

Edited August 10, 2019 by Jamman5v1
errors

[CMoldie]

Up until three years ago, I was being treated with Remicade for Crohn's disease. Janssen/Johnson+Johnson at that time had an arrangement where individual patients could buy it direct for cash down. I needed 4 x 100 mg vials per infusion, at THB 27,547.15 per vial and so the cost was THB 110,188.60 per infusion. They may sometimes have promotions to make this more affordable - you have to ask them.

Order processing and delivery was actually by a specialist logistics company called DKSH

It is not easy -the Remicade was shipped in ice and had to be delivered at a set date and time. Although Sriphat Medical Centre in Chiang Mai were willing to infuse me with my own Remicade, the Pharmacy would not handle the delivery. I had to make my own arrangements to receive it on the day, and pass it on to the medical staff. The medical costs associated with the infusion were about THB 3500 per time (includes a room for half a day)

I got a quote from Chiang Mai RAM at the time. They wanted 34,000 baht per vial (136,000 per infusion, plus medical costs, no promotions).

I no longer have the contact details for the product manager at Janssen (the one I knew has left). They are at Lad Phrao in Bangkok. You would need to contact them, or have your doctor put you in touch.

You would also need to make sure your chosen hospital was willing to co-operate with this arrangement.

I ended up discontinuing Remicade (because it stopped working for me) and am now on Methotrexate. That costs very little by comparison (around 1500 baht for an injection at Sriphat, including medication or 90 baht total for one 15 mg dose consisting of  6x2,5 mg tablets). Methotrexate injections can only be given at a hospital and I believe that the tablets can only be dispensed at one, as Methotrexate is classed as a cytotoxic chemotherapy agent (at Sriphat, at least).

Edited August 10, 2019 by CMoldie

[Jamman5v1]

Cmoldie,

 

Thanks for your comments. It sounds like biologics are just not a realistic option, at least until they are manufactured in Thailand. 

 

Did you look into these Biosimilars hitting the market now (basically generics of biologics)?

 

Is the Methotrexate working for you? I hope it is. 

 

I will not leave states for another year, so even though biologics are covered, I may try something like Methotrexate here to match what I will have available over there. 

 

All the best

Darren

[CMoldie]

I developed a resistance to Remicade and had a severe relapse, so there seemed no point in trying the biosimilars which are, as you say, basically generics.

Which raises another issue. There was no lab in Thailand that could do blood tests for Remicade and Remicade antibody. Bumrungrad had an arrangement with a major US hospital to send them blood samples and do these assays, but that obviously has implications in time and cost. I don't know if this is still the case for Remicade and have no idea if it is true for other biologics.

Yes, thank you, Methotrexate has worked well for me over the last three years - so much so that if, for any reason, I had to go back to England I would stay on it unless there were serious advice to the contrary - even though biologics are available for "free" on our National Health Service. The only side effect has been a susceptibility to minor skin ailments - warts and the like.

But, as you know already, you cannot take anyone's recommendation for treatment for autoimmune disease. The symptoms, and the response to the various medications, vary so much. As I am sure you will, you must discuss the options with your doctor.

[Jamman5v1]

thank you again

[Chicksaw]

On 8/8/2019 at 8:22 PM, Jamman5v1 said:

1. Do hospitals in Bangkok and Chiang Mai offer out-patient phototherapy (UVB-NB)?

Yes, I suffer from psoriasis too and used to go for 2/week UVB sessions at the Institute of Dermatology in Bkk near Victory Monument. I don't know about other hospitals but Bumrungrud doesn't offer phototherapy, or at least didn't about 4 years ago when I enquired. And in any case if they did it would be pretty expensive being a private hospital.

 

On 8/8/2019 at 8:22 PM, Jamman5v1 said:

2. Since I go 2-3 times each week is it easy to get into booth and out without long wait times?

The registering process takes about half a day, after that easy. Here's what happened for me.  I didn't know about the ID first. I went to see a dermatologist at Bumrungrud, Dr. Bensachee (picked at random but turned out she knows her stuff).

 

After a couple of visits, she suggested I see her at the ID because it's cheaper, a govt. hospital with specialized facilities and, in fact, near where I live. If I remember correctly, because it was at least 4 years ago, the first day to register as a patient at the ID I had to get there around 6am and then one line after another (including a photo session of me in my underwear - to record my skin state - which was awkward).  I was done by lunch time.

 

After that I had to see Dr. Bensachee at the ID once which again was a wait but not long (an hour). She wrote out the prescription for UV-B and after that it was plain sailing: Show up at the appointed time at the therapy room on those 2 days of the week, get a slip to make payment, make payment, take the receipt to the chamber, step in and soak it up. Total time 15-30 mins.

 

On 8/8/2019 at 8:22 PM, Jamman5v1 said:

3. What would be approximate cost each treatment because I would have to pay out of pocket?

Again if I remember correctly (it was 4 years ago that I started and I quit after a few months because it wasn't helping much) about 400b. per session.

 

On 8/8/2019 at 8:22 PM, Jamman5v1 said:

4. Are biologics or "Biosimilars " available and at what costs? Any word on thailand producing them in-country in future to eliminate high import tax?

Methotrexate is cheap here but I never tried it because of the possible side effects.

 

I took Otezla (Apremilast) for a while which I sourced from India. It's easy to get there and the price is trivial (a strip of 10 30mg. tabs for Rs. 250).

 

Cosentyx (secukinumab) is also available in India at a cost lower than the US. I believe Rs. 15,000 for a vial but I haven't checked recently.

 

I am not sure about other systemics/biologics available in India but it might make sense to google up a skin clinic there and talk to a doctor. Almost certainly prices will be dramatically cheaper there than here in Thailand and probably worth a once per year trip to stock up.

 

On 8/8/2019 at 8:22 PM, Jamman5v1 said:

I am a 42 American Nurse looking to move to Thailand for early Retirement with my Girlfriend who is from Bangkok but currently lives in US with me. 

A FIRE success story I take it, congratulations, smart move!

[Thejman]

Hi guys. I'm coming a bit late to this conversation. 

 

Basically, if anyone has some information on the availability of Cosentyx / Scapho it would be most appreciated. 

 

I have been taking the drug for a few years now, and it is by far the best thing I have reacted to in relation to my Psoriatic arthritis. 

 

Up until now I have had access to the drug in my home country. However, this is sadly coming to an end, as I am looking to give up my residency and live full time in Hanoi Vietnam.

 

I'm aware that the drug is manufactured by Novartis in India under the name Scapho for quite a reasonable price. What I'm trying to workout is what steps I need to go through in order to get access to the drug. Can I get access to the drug via hospitals in Thailand, or must I travel to India?

 

Where can I find reputable clinics in India to contact in relation the issue, as google keeps drawing blanks for me?

 

Any information in relation to this issue would be much appreciated. 

 

Regards, John   

 

 

[Sheryl]

Scapho is now available in Thailand but prescription only. Usually that means through a hospital (govt hospital best as private might have only cosentyl). Possible that large pharmacies located near a governmwnt hispital would sell it on proof of prescription.

 

I don't know the cost. It is still an import so won't be cheap but should be less than cosentyl.

 

[andynphuong]

I'm even later to this thread. I was prescribed topicals at Bumrungrad until the end of 2019, when we returned home to the US for a visit. We got stuck here by the covid travel ban, and due to Dr. availability, insurance stipulations on coverage, my psoriasis spread. I've been on Tremfya for a couple months, and it works! Is there any new information concerning Tremfya (guselkumab), or Otezla,  or maybe other biologics in Thailand.

Thanking in advance!

Everyone stay safe

Andyh

[Jamman5v1]

Hi,

 

I am glad you found something that works. I am stuck in US until getting over there. I do not know of any new biologics like you mentioned being approved yet. I might try calling the doctor for a video chat at Bumrungrad to see what they are offering and see advice. I am thinking Biosimilars might gain traction soon

 

Darren

[Sheryl]

Tremfya is avilable in Thailand. So is Cosentyx and Scapho.

 

All in imported name brand only, no local versions.

All are from hospital or clinic only, not over the counter.

 

And all will be very expensive. I can't give an exact price but think in terms of the retail pricei n say Canada or Europe plus costs of import and duty (there is tariff on all imported meds). Still less than ful retain cost in US but not by very much.

[simple1]

I have had psoriasis and psoriasis arthritis for 20 years. Throughout this time I have been taking four 500mg tablets a day of sulfasalazine. The treatment has been very effective. Unless already tried you may wish to review with your GP/specialist. Approx six years ago it cost approx 1000 Thai baht for a months supply.

[andynphuong]

On 4/29/2021 at 11:24 PM, Sheryl said:

Tremfya is avilable in Thailand. So is Cosentyx and Scapho.

 

All in imported name brand only, no local versions.

All are from hospital or clinic only, not over the counter.

 

And all will be very expensive. I can't give an exact price but think in terms of the retail pricei n say Canada or Europe plus costs of import and duty (there is tariff on all imported meds). Still less than ful retain cost in US but not by very much.

Thanks for the reply. I know they are very expensive here in the US, upwards of $30k/year. so, think that will preclude me paying out of pocket there. 

[andynphuong]

On 4/30/2021 at 6:29 AM, simple1 said:

I have had psoriasis and psoriasis arthritis for 20 years. Throughout this time I have been taking four 500mg tablets a day of sulfasalazine. The treatment has been very effective. Unless already tried you may wish to review with your GP/specialist. Approx six years ago it cost approx 1000 Thai baht for a months supply.

Thanks for the input. I've not heard of this, will ask my Doc!

[Patrick Brown]

I.m in Thailand with Pacific Cross work insurance.I have chronic RA and I am currently getting an Infleximab infusion paying 15000 baht excess (340 quid) ,which is just about manageable. 

 

Edited July 3, 2021 by Patrick Brown

[Why Me]

On 4/30/2021 at 10:24 AM, Sheryl said:

Tremfya is avilable in Thailand. So is Cosentyx and Scapho.

Are these currently the only biologics available in Thailand? How about Skyrizi or another? Any idea of the cost?

[Sheryl]

10 hours ago, Why Me said:

Are these currently the only biologics available in Thailand? How about Skyrizi or another? Any idea of the cost?

 

These are what is available here now. Skyrizi is not available in Thailand yet.

 

All of these drugs are extremely expensive as they are imported. I can't give you an amount, but figure slightly more than normal (unsubsidized) retail cost in Europe, Canada or Australia

[Why Me]

In case anyone is interested here are prices (from a visit to the Institute of Dermatology) today:

Scapho   Jab 14,000b.

Tremfya Jab 70,000b.

 

These were quoted by a doc there to me, an obvious foreigner. Are these prices Thais pay or foreigners enrolled in the Thai system? I don't know but seriously doubt it. I can't imagine a Govt. run hospital, which is what the ID is, charging citizens 70k  b. a shot of anything.

[Sheryl]

10 hours ago, Why Me said:

In case anyone is interested here are prices (from a visit to the Institute of Dermatology) today:

Scapho   Jab 14,000b.

Tremfya Jab 70,000b.

 

These were quoted by a doc there to me, an obvious foreigner. Are these prices Thais pay or foreigners enrolled in the Thai system? I don't know but seriously doubt it. I can't imagine a Govt. run hospital, which is what the ID is, charging citizens 70k  b. a shot of anything.

They can and do for imported drugs which cost that much, have no generic equivalent made in Thailand, and are not on the Government's Essential Medicines List.

 

This is a Government Hospital and I have not heard of them charging foreigners more.  And the prices you mention are not high for these drugs. Manufacturer list price for Tremfya in Canada is about $3,000 Canadian dollars   https://www.ncbi.nlm.nih.gov/books/NBK533392/

 

These drugs are still under patent and imported. Government hospitals have to pay the manufacturer to get them.

[DarylH]

Methotrexate worked great for me for more than a decade,  but no alcohol intake and try-annual liver checks.   The checks would catch anything before it wen't bad.  Wish I could still take it today but some negligent oncologist didn't take me off of it when I went on chemo for throat cancer and cause me to develop a allergic reaction that took 9 months to discover what it was. 

Good luck, I came here to find similar info before making the expat plunge. 

[h90]

I have it only very light...my grandfather had it strong and he got rid of it with sun....all the time full sun on it and it disappeared.

[Vermillionline]

Hello all, this is more belated info still, and I'm not sure the OP is still reading this. Times have changed. I'm only familiar with certain hospitals in BKK for psoriasis treatment. Bumrungrad now has phototherapy but it's expensive.

 

Chulalongkorn (sign up for a hospital number in the lobby G floor at the central info booth area and fill out a form and get your photo taken) has it. Phototherapy there costs about 200 baht per session ($6+), there's no one in front of you in line, in and out in about 5 minutes, one person dedicated staff, a quick walk from the Saladaeng BTS station on an overhead roofed walk deck.

 

I know that as recently as last fall - October - Chula offered 2 biologics to treat psoriasis. One was Cosentyx. I can't remember the other but it began with an S - so maybe Scapho but maybe Siliq. One was about $400/mo and the other about $800/mo. Bumrungrad offered biologics but at far, far higher prices. I don't know if biosimilars have arrived since then.

 

The in between steps at Chula are more complicated. You need a doctor to authorize the phototherapy and biologics. You can get a private appointment once you have an HN, but you have to go there to make it since they never answer their phone ever ever ever, and they will try and talk you out of a private appointment and make it months away. That runs about 1600 baht.

 

What they prefer you do is show up for a dermatology clinic. I've avoided this but I believe you have to get in line at 5 am. and wait all day for your number to be called - in Thai. Enormous waiting rooms. No one is remotely helpful.

 

Methotrexate pills are available at most pharmacies near hospitals OTC for pennies. Literally pennies, no Rx needed. Recommended dose for psoriasis tends to be around 15mg 1x weekly followed the next day by 2.5-5 mg folic acid, same drug store, even fewer pennies. I recommend tapering on and tapering off.

[andynphuong]

On 5/9/2023 at 1:04 PM, Vermillionline said:

Hello all, this is more belated info still, and I'm not sure the OP is still reading this. Times have changed. I'm only familiar with certain hospitals in BKK for psoriasis treatment. Bumrungrad now has phototherapy but it's expensive.

 

Chulalongkorn (sign up for a hospital number in the lobby G floor at the central info booth area and fill out a form and get your photo taken) has it. Phototherapy there costs about 200 baht per session ($6+), there's no one in front of you in line, in and out in about 5 minutes, one person dedicated staff, a quick walk from the Saladaeng BTS station on an overhead roofed walk deck.

 

I know that as recently as last fall - October - Chula offered 2 biologics to treat psoriasis. One was Cosentyx. I can't remember the other but it began with an S - so maybe Scapho but maybe Siliq. One was about $400/mo and the other about $800/mo. Bumrungrad offered biologics but at far, far higher prices. I don't know if biosimilars have arrived since then.

 

The in between steps at Chula are more complicated. You need a doctor to authorize the phototherapy and biologics. You can get a private appointment once you have an HN, but you have to go there to make it since they never answer their phone ever ever ever, and they will try and talk you out of a private appointment and make it months away. That runs about 1600 baht.

 

What they prefer you do is show up for a dermatology clinic. I've avoided this but I believe you have to get in line at 5 am. and wait all day for your number to be called - in Thai. Enormous waiting rooms. No one is remotely helpful.

 

Methotrexate pills are available at most pharmacies near hospitals OTC for pennies. Literally pennies, no Rx needed. Recommended dose for psoriasis tends to be around 15mg 1x weekly followed the next day by 2.5-5 mg folic acid, same drug store, even fewer pennies. I recommend tapering on and tapering off.

Thanks for the reply. Since my post, and the pandemic ending, I've been treated at Bumrungrad with Secukinumab.  Cosentyx, brand name in the US. same company mfgs. Costs for the monthly injection is about $650. Seems this falls between your low/high price given. 

[Chicksaw]

On 5/19/2023 at 8:22 PM, andynphuong said:

Thanks for the reply. Since my post, and the pandemic ending, I've been treated at Bumrungrad with Secukinumab.  Cosentyx, brand name in the US. same company mfgs. Costs for the monthly injection is about $650. Seems this falls between your low/high price given. 

The cost of Scapho = Cosentyx = Secukinumab, 2 x 150 ml vials, the monthly recommended dose for psoriasis, at the Institute of Dermatology or Chula (or any Govt. hospital) is 13,882b. = USD 400.

Edited June 14, 2023 by Chicksaw

[AndreasHG]

Last week I went to Bumrungrad Hospital because my psoriasis got much worse and, for the first time in my life, I am having a rush of atopic dermatitis. 

 

To address my symptoms, the dermatologist suggested a therapy with Scapho.
The price charged by the hospital for the two prefilled 300mg pens (2 x 150mg) is 24,000 THB (12,000 THB each). The hospital charges approximately additional 2,200 THB for nursing and hospital charges. These additional charges are avoidable, if the patient self-injects the antibodies.  
The therapy consists of 5 weekly shots (week 0, 1, 2, 3, 4) followed by one shot every month (all shots with 300mg dosage).

As an alternative to monoclonal antibodies, the hospital offers also the phototherapy with UVB-NB, but I did not investigate this option.

[In Full Agreement]

On 3/6/2023 at 11:28 AM, h90 said:

I have it only very light...my grandfather had it strong and he got rid of it with sun....all the time full sun on it and it disappeared.

 

 

What about the skin cancer that followed?

[h90]

13 hours ago, In Full Agreement said:

 

 

What about the skin cancer that followed?

 

We have no cancer in the family as long back as we can remember. We all die as healthy idiots with Alzheimer or bursting blood vessels in the brain. (beside one that died in second worldwar)

[Ronenfe]

I can't help too much. I used to get the Skyrizi injections in Israel using the national health insurance. It cost me maybe 10000 bhats for the injection. But I discovered once or twice a year is enough for me. No need for 4 times a year. Better wait until symptoms show again and are too severe before buying again. Now I'm in Thailand and I got pain in my left wrist joint and right shoulder joint and scalp scaling mostly. The restof symptoms are bearable. I found daivovat and elocom in pharmacy without prescription. But I don't know what to do with the wrist pain.

Edited October 13 by Ronenfe