Avastin for Macular Degeneration……pricing

[cheeryble]

Hi there

I speak again on behalf of my 86yo friend and one of his problems is macular bleeding and degeneration.

He has very poor vision in one eye but with the use of the other can read very large text as we have set up for him on the 42inch screen of his PC.

He is in good spirits and highly intelligent and always an avid reader so this is a big deal in his life.

He has been getting injections of Avastin as often as once a month at the Ram….he is very happy with the doctor.

So far the good eye has been doing not too bad and so not injected so often.

that's changed with a recent bleed……though he can still read…..but regular double injections are much more likely.

You may know that the price of Avastin suddenly went up from 400baht to 5500baht per eye as it was stopping people using an extremely expensive new alternative drug.

This means a bill now which can be 11,000 a month. (Not to mention drugs for all his other ailments).

I said why don't I ask on Thiavisa if there is some way round this.

Can we get Avastin injections cheaper?

ps. I mentioned to him tonight as an ex serviceman that he might get in touch with the US base in the Phillipines where i happen to know some vets go for treatment.

I said perhaps if he got in touch and explained his modest financial circumstances and increasing regular drug bills maybe they could do something.

I said that really he cannot travel now so maybe they can do something for him as a semi-invalid. (he could possibly make a one off trip to get things moving.

Any information about this would be welcome too.

Thanks v much!

Edited May 12, 2014 by cheeryble

[Sheryl]

A switch from the Ram to Sripat will remove the hospital mark-up on the drug and also lower the doctor/service charge.

By how much, I can't say but certainly it will be less.

As for care at the VA facility, this link describes eligibility requirements http://www.va.gov/healthbenefits/apply/veterans.asp

Requirements for treatment at the Philippine facility are a little tighter and as I understand it limited to service-related illnesses/disabilities. See http://www.paloalto.va.gov/docs/VA_Manila.pdf

So if relocation is an option for him he would likely do better to think in terms of the US where he will fully qaulify for health care at VA facilities as well as have Medicare.

The manufacturer of Avastin, Roche, has a special program for assistance to indigent patients (as do most US pharm companies). However the request has to come through a US physician's office, and as it is limited to needy people without insurance normally anyone his age, and therefore under Medicare, would not qualify (likewise anyone eligible for care at the VA, for came reason). But you could try contacting them and explaining he is a US citizen residing in Thailand where there are no Medicare approved facilities etc and see if there is anyway to get him under it. https://www.rxhope.com/PAP/info/PAPList.aspx?companyid=124&fieldType=companyid Chance is small but nothing to lose by asking.

As he is in CM, should get in touch with lannacare if not already. http://www.lannacarenet.org/

[lopburi3]

I don't know if he has the military Tricare insurance, or can enroll, but know that there are options to use that in the Philippines (again after a period of fraud control).

[ProThaiExpat]

I have been receiving Avastin injections every ten weeks for two years now both at Ram and at Sripat. Sheryl is right as usual as Sripat is quite a bit cheaper.

I would be interested in his Doctor at Ram since I was referred to a Sripat Doctor that had a clinic at Ram twice a week. Since she is full time at Sripat I moved over to Sripat and know how much price differential there is. I was told that Dr. Paradee is the macular specialist at Ram and she is full time at Sripat.

Your friend should be getting OCT examinations prior to any determination if a shot is required. At the time I moved from RAM they did not have an OCT machine, only Sripat did. If Ram got an OCT machine, they are very expensive and my guess is he is paying alot just for that exam.

Comparing prices, I would say that the operating room fee for the injection is half the cost at Sripat, the Avastin cost two months ago at Sripat was 2200 baht, Doctor fee for injection 2000 baht, Ram it was 3500 last year. Sripat pharmacy costs are much cheaper than Ram.

Total cost for my last Avastin injection at Sripat was about 7000 baht. It has been as low as 5000 baht when I had the procedure on a different day than the office visit with the doctor and the OCT.

My operating room fee at Sripat was as low as 400 baht until my Dr. was clued in and now it runs about 1000 baht. Ram it was 1500 last year.

[NancyL]

Yes, please encourage your friend to contact www.lannacarenet.org or [email protected] 085 709 8801 Sripat can be a little intimidating for someone who has never been there before and coach him thru a visit.

Also, we could advise him about potential veterans assistance.

Edited May 13, 2014 by NancyL

[cheeryble]

Thankyou Nancy for excellent PM...PM sent back will be in touch!

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[cheeryble]

Sheryl thanks so much for taking the trouble to so clearly set out the links.

I have already forwarded them.

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[cheeryble]

I don't know if he has the military Tricare insurance, or can enroll, but know that there are options to use that in the Philippines (again after a period of fraud control).

Hi Lop uri I don't believe he has that.

I looked at the website you were so kind to link to........unfortunately it presents the kind of Chinese jigsaw puzzle Americans have to go through to figure out if they're covered or not.

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[cheeryble]

Thanks for the comments ProThaiExpat.

Bit confused as to the pricing.....I think my friend.....rather a special man.....may be getting treated as a special deal by the female doc at Ram.......however the price of the drug itself certainly went up multifold.

I am meeting my friend at Ram Thursday afternoon ( I often go along as he has bad hearing, well worse than mine! and speaks with a gravelly voice so I'm a sort of communication aide both ways.....the period waiting for the a aesthetic to work gives us chance for a chat). I shall check the doc and pricing details.

Not heard of OCT machine we normally see the retina on a screen as the doc checks it and takes photos for the record.....she does her best to explain any latest developments or hopefully non developments in the retina.

Again thanks for you interest.

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[ProThaiExpat]

Thanks for the comments ProThaiExpat.

Bit confused as to the pricing.....I think my friend.....rather a special man.....may be getting treated as a special deal by the female doc at Ram.......however the price of the drug itself certainly went up multifold.

I am meeting my friend at Ram Thursday afternoon ( I often go along as he has bad hearing, well worse than mine! and speaks with a gravelly voice so I'm a sort of communication aide both ways.....the period waiting for the a aesthetic to work gives us chance for a chat). I shall check the doc and pricing details.

Not heard of OCT machine we normally see the retina on a screen as the doc checks it and takes photos for the record.....she does her best to explain any latest developments or hopefully non developments in the retina.

Again thanks for you interest.

Sent from my iPad using ThaiVisa app

Your friends condition might be such that an OCT evaluation as to the amount of bleed present and if enough to justify an injection may not be applicable in his case. I was required to visit Sripat to get the OCT exam before Dr. Pardee would give me an injection, even while seeing her at RAM. Thus made sense to move to Sripat.

However, the Doctor may feel your friends age and his ability to wait up to two hours to see the doctor might be too much for him so she keeps treating him at RAM. Also, there may be a tacit agreement between RAM and Scripat doctors that patients are not moved to Sripat unless the patient specifically insists on it, as I did. I have also moved to Sripat with my kidney doctor who has a clinic at RAM once a week in the evening but works full time at the University Hospital where Sripat is the private department of that government hospital.

I would certainly bring up your friends financial condition with Dr. Paradee at the next appointment, assuming he is seeing her and ask if it would not save him money by moving to Sripat. I have an appointment with her this evening so will inquire in general terms if she ever does an injection without at OCT before and under what conditions is that done. I, of course, would like to know for my own knowledge and if relevent, I will pass on that information here.