affordable care and meds close to Europe (anywhere) without insurance

[31ontheway]

Hi,
I am abroad for work and will be for 6 months and have lost insurance coverage. On treatment and will be out of meds soon. I am wondering if anyone here can recommend the best (and ideally cheapest) place to visit both a Dr. for labs and get meds in Europe? This would be without any insurance. Does anyone have any experience here, and an approximation of average cost of meds (isentress/norvir, prezista in particular)? From reading here it seems that Asia (especially Thailand) is the place to go for affordable care and meds but it is quite a hike. Is there anywhere closer to Europe or in Europe that is significantly cheaper than the US for care and meds? As the Americans here know its prohibitively expensive to visit a Dr. and buy HIV meds in the US without insurance.
Thank you very very much in advance for your help!

[mecch]

There is no generic Isentress.

Maybe there is an eastern European country that does have Isentress that might sell it a bit less than the first world price, I dunno.

Many people in a so called rich country with top retail pricing, who need generic drugs, buy them in Asia or buy them in India. 
 
If you want to stay on Isentress my guess is you have to contact HIV+ people and HIV organisations in THE COUNTRY where you are now, and ask what people do in your situation...  Maybe some countries have loopholes or lax rules on who can get access inside the country to subsidised drugs...   Go to any and all HIV/AIDS service organisations you can find and start asking questions.
 
Isentress has fallen in retail price, but its about the same price in each rich country.

Merck sells it in so-called "low-income" countries at a huge discount...

[alberche]

I can tell you about Spain, which is the case I know the better.

You can access medication and healthcare with no cost getting covered by the Social Security System, Public Healthcare.

To do so, you need to be hired with a formal contract, by a Spanish company. and settle your domicile in Spain. Being an employee of a company based in Spain and being your contract signed and registered in Spain, your employer will pay your social security on your behalf to the Government (it is mandatory for the employer), and then the government will give you full healthcare coverage.

It means, you will not have to pay neither for HIV meds, neither for labs, densitometries, appointments with your HIV specialist or your General Practitioner, etc.

Another way to obtain this coverage is to be what we call here an autonomous worker or entrepreneur. You can register as one in Spain and you can invoice your clients (even your employer, acting as their supplier). In this case, even being your employer in an European country other than Spain, you can invoice them from Spain. Of course you will need to register your domicile in Spain and pay taxes in Spain. In this case, you will pay yourself your own Social Security fee. The amount is of about 300 EUR (450 USD) per month.

In both cases there is no need to advance any payment, neither for treatments, nor for labs or appointments with your doctor.

You only will pay for OTC medications, and only a percentage, a maximum of 50% of the cost.

HIV meds are dispensed only in hospitals, and are 100% free of charge so far.

Spanish healthcare system works reasonably well, but since all specialties are centralized in hospitals, and hospitals are huge, you may find it a bit massified. But it works OK and patients with HIV are given the latest medications. Generic formulations usage is not very extended to treat HIV. (though it is on OTC medications, those you may purchase at a pharmacy).

In both cases you will have to apply for a residence permit, You may get more information at Spanish Embassy or consultate.

If you have an European ancestor (parents, grandparents), you may have the option to apply for the nationality of some European countries, prior to come to Europe. It works in the case of Spain, Portugal and Italy, as far as I know, Maybe also for Germany and other countries, but I am not so sure. These arrangements are due to these countries have had in the past lots of emigrants gone to the Americas who settled and created new families there. This is an easier way, since you will get an European passport and you do not have to renounce to your American citizenship.


Other alternatives, that work more or less in a similar way are France and the UK. In France, however, you may have to pay in advance and then the Public Healthcare System will reimburse you the 70% to 80% of costs. They have an special norm for people with HIV and in most cases you do not to pay in advance, but, to obtain this status, you must follow a bureaucratic procedure which is different in each region of the country.


In any case, do not come to Europe without a job contract or being previously hired. And if you are able to become an "entrepreneur" then get information on all the steps you may have to do. In Spain it may take from one week up to 2 months to get a company (incorporated or limited) constituted. If you remain just as an autonomous worker, such an independent consultant, a lawyer, a broker, etc., the procedure can be done in one day at the Chambers of Commerce.

If you come without the above mentioned, as a tourist, let's say, you will not be covered by the Social Security in none of the EU countries. Just in case of an emergency, accident or similar, you will receive healthcare, otherwise, you wont and you will be asked to pay for the cost of your healthcare.

Private insurances in Spain and most of European countries will not cover you due to the preexisting condition.

I hope this information is helpful.

Regards,