Importing Transplant Meds From America?

[transplanttraveler]

Hi Everyone,

(I apologize for the length of the post, I just want to make sure that everything is clearly described.)

I came to Thailand about 5 months ago with a six month supply of my two transplant medications, myfortic (Celcept) and cyclosporine (Neoral - 100 MG capsules).

I'm in Cambodia now, but have plans to return to Bangkok in a week or so. About two months ago, when I was in BKK, I made some inquiries about buying my two medications in Thailand. A pharmacist at Boots told me that both of my medications were "only available in hospitals."

I visited Bangkok Christian Hospital in Silom and spoke with a pharmacist. For a month of pills, I can expect to pay around $235 USD buying from BCH. I then visited the government hospital up the road (Chulalongkorn), and a pharmacist there told me that a month's worth of pills will cost around $257 USD.

I'm a recent university graduate trying to live in Asia on a shoestring budget. Paying around $250 a month for pills isn't the end of the world, but it'll eat up a significant chunk of my budget.

However, I'm still under my mom's insurance back in the USA, where I get my pills basically for free. I've searched the forum and read all of the threads about importing prescription medication into Thailand. I haven't seen a transplant scenario discussed, though, and figured it wouldn't hurt to ask.

Questions:

-Are generic versions of myfortic (mycophenalate) and cyclosporine available over the counter in Thailand?

-Or, does the "only available in hospitals" designation mean that my two pills are controlled substances in the Kingdom?

-In terms of shipping from the US, if I have my family send a three month pill supply to me (which amounts to one 7-inch cylindrical pill bottle of myfortic and three small cardboard boxes of cyclo -- the shipment would fit in a small shoebox), via registered or express airmail, is it likely that I'll have issues with customs holding/delaying/returning the shipment?

-For those that have imported prescription meds from America, which mail carrier and shipment method have you had the most success with?

-Will contacting the US Embassy and asking for their help make this process easier or less complicated?

Thanks!

[Sheryl]

The Embassy will tell you there is nothing they can do, and that is true.

It is not technically legal to import medication into Thailand unless you have an import license which you cannot get unless you are an authorized pharmaceutical importer. An exception to this rule is bringing in medication with you when you travel, for personal use. The legal framework is essentially silent on the subject of importing medication by mail for personal use. In practice, many people do it and it is often, but not always, successful if done through regular air mail --- never try a courtier, guaranteed customs problems. Also be sure that any medication so sent is in a clearly labelled prescription bottle given that these are prescription only meds, and if you do nto already, be sure you have avaulable a medical summary or doctor's letter that attests to the fact that a doctor has prescribed these for you. That way the worst you risk is having it confiscated as opposed to legal problems for yourself. Also suggest keeping the quantities modest so that they do not create suspicion that you intend to resell it.

Cyclsporine is available in several locally made brands, including Cipol-N and Kasporin.

The exact law regarding OTC sale is:

"S = Special Controlled Drug
A first grade pharmacist shall be on duty at the premises selling modern drugs. Sale to public is on prescription only. Daily purchase and sale record required."

As you will note, this does not preclude buying it yourself at a pharmacy, but in practice most pharmacies do not bother with Category S drugs because the paperwork is too much trouble, plus most do not meet the first requirement. Some of the larger pharmacies, though, do. Fascinos would be one; Southeast Pharmacy on Sukhumvit road just west of Soi 15 is another (and probably the less expensive of the two). Many years ago I bough cyclosporine at a pharmacy near Victory Monument, opposite Ratchawithi Hospital.

However, buying these drugs yourself is not going to be much cheaper -- if cheaper at all -- than getting it at a government hospital pharmacy since mark-ups at the latter are nil.

Cyclosporine is in any event very inexpensive.Your problem is the mycophenalate. It is available in Thailand (likewise Category S) but only as an import, brand names CellCept (Roche) and Myfortic (Novartis). So it is very expensive and this will be true whether you manage to buy it yourself or get it through a government hospital or non-profit hospital. (Will cost significantly more if at a for-profit hospital, of course).

[transplanttraveler]

Sheryl: Wow, thanks so much for the detailed response! Can't thank you enough. I owe you one.

Interesting that the legal code doesn't necessarily restrict the importation of certain medications, but, from reading your other posts, the authorities don't exactly encourage it, either.

Thanks for tipping me off to the fact that generic forms of cyclosporine are available here. I'll definitely be buying those in BKK. I'll ask around at Fascino, SE Pharmacy, and some of the general hospitals for the best price. There was a Fascino in my neighborhood the last time I was in Thailand, I'm kicking myself for never making inquires there. Appreciate the pointers on the pharmacies.

Yeah, the mycophenalate isn't cheap. I might explore having that one shipped from overseas. I'll be sure to have a doctor's note and prescription script sent along with the pills if i do.

Thanks, too, for clarifying the law for OTC-related purchases. The pharmacist at Boots made it seem like cyclosporine and myfortic were dangerous to the public (I can't remember what she said exactly). I was too flustered and didn't want to seem impolite by pressing her further on the issue.

---

An interesting note regarding pricing: For the Celcept, Bangkok Christian was charging 58 Baht per pill, while Chulalongkorn wanted 72 baht per pill. Any reason for this inconsistency? Especially because, as you note, the government hospitals aren't usually marking their medications up. Is this just a special case where the opposite is true and they boosted the price a bit?

Thanks again!

Edited February 24, 2014 by transplanttraveler

[transplanttraveler]

Someone sent me this very helpful post. It doesn't appear to be in the thread, and I don't see it in my Thai Visa inbox, but it showed up in my regular e-mail account. Thanks for the tips!

Glad to hear you're doing well! I'm doing well, too, just celebrated 8 years with my "new" liver. It's always nice to hear from other transplant recipients. Interesting that you've experienced trouble with doctors failing to recognize your condition, though. People in Thailand have expressed immediate concern (and sometimes genuine fear) when I show 'em my incision scar.

I figure I'd post the message to the thread because it has some of the best info I've seen about what exact shipping method to choose when having medication sent from overseas.

Like you, I've never had any issue with customs agents wanting to see my medicine. In fact, when I was checking back into Thailand from Poipet a few months ago, I started removing my pill bottles from my bag and the customs agent waved his hand at them dismissively and didn't even bother to look at them.

Hello i have a kidney transplant and i live in Phuket, the best way is to have your family send you your meds every month by USPS unregistered ,mail, no insurance. If they pack it in a very small box, it could go under the radar of customs. Last box i received they charged me 7 baths. I have done this only a few times as i flew in with 8 months treatment and my family brought more when they came to visit.The first and last time they send my meds through a courier DHL customs took 30,000 baths from me, never use a courier this people have no shame and don't care. If you don't want to mail your meds, do the math, it could be cheaper to buy a ticket for a friend or family member, they can visit you and bring you your meds. I took my 8 months treatment on a carry on on my 4 months honeymoon all around South East asia, usa and france without any problem. No body asked not even once but i still had my recipes and doctors letter with me.

I would always send a medical report and prescriptions in case they open the box so that they now is for your own consumption.

I had terrible experience with couriers and doctors here that would not give me a medical report about my condition and my description about my meds.

Hope you are doing good, i have my transplant now for over 5 years and i am very happy living in Thailand and enjoying life after 3 years of dialysis. I hope you are doing fine and please let me know if there is anything i could do for you.

Regards

Edited February 24, 2014 by transplanttraveler

[Sheryl]

I have n idea why the difference in cost for Celcept between Bkk Christian and Chula but govt hosp pharmacies don't mark up. Most likely they obtained the drug at different prices either because of which country they used or the date on which obtained.

Staff behind the pharmacy counters at Boots and places like that are seldom first grade pharmacists. (And in some places staff behind pharmacy counters have no formal training at all!) . Have to go to large pharmacies to find "real" pharmacists.

The main Fascinos and one other large pharmacy right next (forget the name) are opposite Siriraj Hospital in Bkk (opposite side of the river) and have just about everything and if they don't, they can order it. I hear SE Pharmacy also has a very wide range and wholesale prices. You can certainly try for the mycophenalate there, but as mentioned it will still be expensive.

Note that you are supposed to have a prescription. The system for writing/filling prescriptions isn't well developed in Thailand so they might -- might -- accept seeing a prescription bottle from the US or even not ask for it, but be prepared that you might have to see a local doc to get a script.

[transplanttraveler]

Thanks again for the great info, Sheryl!

Staff behind the pharmacy counters at Boots and places like that are seldom first grade pharmacists. (And in some places staff behind pharmacy counters have no formal training at all!) . Have to go to large pharmacies to find "real" pharmacists.

Wow, interesting. I thought the tier of pharmacies below Boots and Watson's staffed the second rate pharmacists.

The main Fascinos and one other large pharmacy right next (forget the name) are opposite Siriraj Hospital in Bkk (opposite side of the river) and have just about everything and if they don't, they can order it. I hear SE Pharmacy also has a very wide range and wholesale prices. You can certainly try for the mycophenalate there, but as mentioned it will still be expensive.

Great, I'll head to both of these locations the day after I arrive back in BKK to compare prices.

It's unfortunate, though . . . Paying the import prices for Neoral (Which it looks like I'll have to stick with, even with cheaper generics available) and Celcept is virtually the exact same price as flying back home every six months to re-up my supply, haha! Funny how it managed to work out like that.

Thanks again, Sheryl! Appreciate the advice and tips.

Edited February 25, 2014 by transplanttraveler