question about health care plans

[lisag43]

Greetings. I am in the US but find reading these blog posts and questions mostly from the UK very interesting. I do have a question comparing the two health care systems. I was diagnosed with RA about 2 years ago. Right now, I'm taking methotrexate, plaquenil, folic acid, vitamin D and calcium. Things are going down hill (I'm flairing and in much more pain than I have been in the past) and my rheumy wants to put me on a biologic (cimzia). With the private insurance plans here in the US, I have a high deductible and have to pay $1200.00 for my prescription to be filled. I've been saving up for a few months to get that money together. Everyone I talk to here about it is amazed that I have to pay that much to get this prescription and all the biologics are the same price. While I'm trying to save, my RA is getting worse and it's hard to work or do anything for that matter. I'm curious how the system works in the UK. Thanks for listening.

[helixhelix]

Hi there. In the UK people pay a national insurance tax that's between 5 and 10% of wages or earnings if self employed. But then everyone whether working or not has access to free healthcare. If you're working then you pay about 12 dollars for a prescription (or about 160 dollars max for whole year) and you have to pay for dentistry. Generally the healthcare is good (although complaining about it is a national sport), but it does mean that some things are rationed. So you can't get the expensive drugs like biologics easily, and in england have to go through a complicated process to show you need them. And you have to wait for ages for appointments, and operations. so there are positives and negatives......

[cathie]

Prescriptions are free for everyone in scotland and wales. There are guidelines about meds. There is some variation about how long you might have to wait for operations etc. The current government is trying to bring a much bigger private element into the health service but thetes a lot of resistance to this. The nhs covers all aspects of health and does research too. The private providers tend to specialise and cherry pick for a quick buck

[Paula-C]

I have my MTX injections delivered now to my door (Healthcare at home) along with all the other bits and bobs that goes with it.......sharp box, spillage kit etc and I don't have to pay for it. Yet when I was taking them in tablet form I had to show my pre payment card or pay for the prescription. Just want to clarify what Helixhelic said, it's not 12 dollars per prescription, it is 12 dollars per item on the prescription, each medication that you are taking is chargeable. We usually get 4 weeks supply of drug each time.

Paula

[Kathyfitz12 in reply to Paula-C]

Paula - buy the annual prescription card. Before I was 60 I did - and you get all items on the scrip included that one price. Also, GPs' are allowed to prescribe up to 8 weeks of each drug, so that halves the outgoings - there should be an easy way of finding out how to work the prescription ystem shouldn't there?

[Paula-C in reply to Kathyfitz12]

Kathy

I normally buy a three month pre payment certificate and with careful planning I manage to get 4 months worth of drugs from it. When one runs out I wait until I get the following months prescription and buy the new card then, I then make sure that my fourth lot of drugs will be collected just before it expires. I save a little bit of money buying three, three monthly cards, opposed to the yearly one. Re-reading what I posted it did sound like I sometimes pay for my meds, sorry if you read it ,that way.

I've always been told that prescriptions should only be for a month, not unless circumstances say other i.e. going away on holiday.

I know that they are not suppose to give you MTX for more than a month, yet Healthcare at Home deliver 8 weeks supply at once. My consultant did give me a prescription last time I saw him. folic acid increased and across the bottom of it printed in bold print it said...One months supply only.

Paula

[Kathyfitz12 in reply to Paula-C]

Pauls - I used to do what you do before I reached magic age of 60 & got free meds - you have to think outside the box don't you? I just phone in now & ask for 8 weeks meds and the GP just writes the Mtx prescription but beware of missing a blood test - "The Computer says no" Dept are on to you in a flash!!

[Kathyfitz12]

I travel between USA/UK often. I visit a friend with RA & we compare treatments. As Helixhelix says we pay a National Insurance contribution whilst working ( I paid in for 42 years)and, in England, at 60, all our treatment is then free including prescription drugs. Like you my friend has a high deductible but is lucky in that both her children can help out. I use both NHS & Private treatment (with insurance which is about the same annual cost as my friend in US but does offer a better deal). The NHS was hopeless when I was being diagnosed - I kept on having to wait 3 months in pain for an apt, so I ended up paying about $500 to a Private Consultant who started off alleviating my pain with a Steroid injection, then ran lots of tests and settled on a drug for me. This was about 12 years ago, and my friend and I seem to be on the same drugs now (Mtx & F/acid only) and the advice offered by our physicians seems pretty similar (except her doc says no alcolhol whilst mine says a glass of wine does me good!) Our NHS service can be wonderful, but it is slowly being taken over by Private companies. Things like dexa scans are handed over to Private hospitals - the NHS pay a fixed fee for an unlimited number of scans - but I'm sure it works out far more expensive than the old system.You might be suprised to know that some RA drugs are more expensive here than in US - my insurance doesn't pay for any drugs unless they are prescribed when I am in a hospital, and then they pay for everything.I hope when you have saved enough for the Cimzia it works well for you.Right now in England it is freezing cold, raining and blowing a 70mph gale - so some things are better in US - like the weather!!

[lisag43]

Thanks everyone for your answers. I didn't mention that while I've been trying to save for this medication, my insurance company kept blocking filling the script. They kept denying it and offering other biologics but the price was still the same to me. I've been trying to get this straightened out for about two months now between my rheumy, the pharmacy and the insurance company. So I laugh when opponents to a national health plan here in the US say they "don't want government between me and my doctor" but I've been living with my insurance company between me and my doctor. Meanwhile I will continue to save up and hopefully should have enough to get the presciption filled in a week or two. I really appreciate your answers because this whole situation has really been bothering me. And, Kathyfitz12, right now it is sunny and in the 70s so yes some things are better in the US!

[Paula-C in reply to lisag43]

Can't believe that your insurance company offers you different biologics, surely that is for your doctor to decide and not them.

Wishing you well.

Paula

[salem974]

I too am in the US and I am having about the same problems. I was on layoff when my symptoms started so I had no insurance. State medicaid would help but they would put a lein on my house for repayment. My medicare starts up in Sept. after 24 mo. on disability. My dr wants to put me on Enbrel but the cost is out of reach for me. After checking into all the different charities(costs still out of reach) he has agreed to wait till medicare starts up. I have read the health care bill and it is not good. There will be rationing and a panel that will decide if you get treatment or not. 2700 pages of nothing more than a form of control. I have suffered through 3 1/2 years of pain and I still do not want this bill. I would love to get in remission and maybe go back to work. My dr already said that I probably will never be back in the work force but I can hope cant I?