Enbrel in Ireland? ankylosing spondylitis

Christina_AS

Hi, I have some questions about enbrel in Ireland. Maybe the community can help me...



I would like to relocate to Ireland. Here in Switzerland enbrel is paid by my health insurance by law. How is it in Ireland? Is there any chance to get an insurance that will pay my costs for enbrel? I found some informations about the HighTech Scheme, but to be honest, I don't understand it.



How much do I have to pay by myself? Here in Switzerland I only have to pay the first 850 Euro per year by myself.
Thanks for your help!
Christine

locum-motion

Usually, in Ireland, a person either has a GMS Medical Card (General Medical Services) or they don't. People on lower incomes get a GMS Card, and their meds are paid for except for a contribution (currently €2.50 per item, up to a max of €25 per family per month) from the patient.

People who don't qualify for the GMS pay for their medicines privately, and the price is whatever the pharmacy thinks the local market will bear.

However: there is a system that puts a cap in the amount that a family has to pay. That cap is currently €144 per family per month. This is called the DPS (Drugs Payments Scheme). Every Irish resident who doesn't have a medical card can apply for the DPS.

Enbrel, though, is different. It is one of a number of medicines that are treated differently, because of their complex, 'High Technology' nature and extremely high cost. Instead of the pharmacy purchasing the medicine and selling it for a profit, these 'High Tech' meds are delivered to pharmacies for them to dispense to their patients, but the government pays the distributor for them directly. The pharmacy is paid a 'Patient Care Fee' for taking care of the often complex requirements of these patients.

As far as the patient is concerned, the High Tech med is free if they have a GMS Card, and if they don't, they need to apply for the DPS. In that case, the patient's contribution to the cost of the meds is the same as it is for all other meds under the DPS, namely €144 per family per month.

echo beach

If you are a Swiss citizen, or a citizen of an EU country, you would be entitled to use the hi-tech scheme. You could ask to be referred to a consultant in Ireland to prescribe Enbrel for you and to monitor your condition and response to treatment every 6 months. You would pay €144 per month for your medication, including the enbrel and any other prescribed medicines for you and for your partner and/or children. While it is a good bit more than you pay in Switzerland it is still very little compared to the cost of the drug.

Private health insurance in Ireland doesn't cover the cost of any medicines used in the community. Usually there is a 'waiting period' before you are covered for a pre-existing condition but it is worth checking with your own insurer if it is possible to transfer your cover to a company here.

Christina_AS

Thanks a lot for your help, locum-motion and echo beach. Your answers are very very helpful.

It's a bit more expensive, but as you mentioned it, compared to the high price of enbrel it's still affordable. I was for two years on Celebrex and had still pain. So as long as it is possible to be painfree with enbrel, I will pay for it.

Here in Switzerland I have to visit my rheumatologist four times a year for monitoring my blood and my condition. For me it sounds a bit easier to handle ankylosing spondylitis in Ireland.

Thank you again for your help and your time.

Best wishes to you from Switzerland!
Christina

locum-motion

echo beach wrote: »

If you are a Swiss citizen, or a citizen of an EU country, you would be entitled to use the hi-tech scheme. You could ask to be referred to a consultant in Ireland to prescribe Enbrel for you and to monitor your condition and response to treatment every 6 months. You would pay €144 per month for your medication, including the enbrel and any other prescribed medicines for you and for your partner and/or children. While it is a good bit more than you pay in Switzerland it is still very little compared to the cost of the drug.

Private health insurance in Ireland doesn't cover the cost of any medicines used in the community. Usually there is a 'waiting period' before you are covered for a pre-existing condition but it is worth checking with your own insurer if it is possible to transfer your cover to a company here.

The arrangements for a Swiss citizen visiting Ireland are slightly different to those of one resident here. Christina spoke of relocating, so the arrangements are as I described - as a resident, Christina would be treated in exactly the same way as any other resident, and would be able to apply for a GMS card and would be eligible for a DPS card if earning too much for a GMS card.

Visitors, on the other hand, are covered under the EHIC arrangements (also called the EEA Scheme), which treats a person as I they have a GMS card. This is only temporary, is not intended for long term stays, and specifically excludes anyone who deliberately travels with the express purpose of obtaining medicines. It is intended to cover the emergency needs a visitor might have if the fall ill or have an accident in Ireland. Therefore, it does not include any provision, as far as I know, for a visitor to obtain supplies of any High Tech drug. A patient using Enbrel, coming on holidays to Ireland, would be expected to bring their own supplies with them, sufficient for the expected length of their stay. I've never seen nor heard of it happening, but I imagine that if some form of emergency occurred and a visitor needed supplies of Enbrel, then the HSE would probably cover it, but I'm fairly sure there's no routine way of getting it.

This point is moot, however, as Christina is intending to reside here.

Christina_AS

That's right, i want to work and live in Ireland.

echo beach

I'm glad to hear you have had a good result from Enbrel. Often we focus on the very high COST of drugs like this and forget about their VALUE. Not only do you have a much better quality of life but you can work and travel. Without this drug some patients might well be unable to work and need expensive care.
I hope your plans work out and you are happy in Ireland.

huskerdu

Christina_AS wrote: »

That's right, i want to work and live in Ireland.

As soon as you arrive, register with a GP, explain your situation and get a referal to a consultant.

You can see a consultant privately at a cost of approx 150 per visit.
You can ask for a referral to see a consultant in the public health system, but there is a long waiting list for a first visit for a ruematology consultant.

Private health insurance in Ireland does not cover medication, but the DPs has already been explained to you. There are many different private health isnurance policies and some pay €60 per consultant visit


The €144 that you have to pay every month for drugs ( and all other medical expenses) is a tax deductible expense, at the 20% rate. This means that you can get €28*12 back at the end of the year.

Here is a very useful irish government werbsiter which explains various laws ans government policies inn plain language. If you are moving to Ireland, there is lots of useful info here.

www.citizensinformation.ie