receiving HIV meds from abroad

[alex007]

Hi,
My husband and I have justmoved to the US from Israel; he is HIV+ and could receive his meds from home, which would be cheaper than getting them in the US. Does anyone know if this is possible (they would, of course, be prescribed by a doctor) and how to go about it?
Thanks a lot!
Alex

[mecch]

If you are israeli citizens why would the US care where or how you got your drugs?
Isn't it key to figure out what you must do in Israel to keep getting them, while living abroad?
Also, if you are going to be living in he USA, aren't you going to need to go to doctors, etc.  What insurance is going to cover that?  Your israeli insurance?  or do you need to buy American policies. 
If you need to buy american policies, then the policy is going to cover HIV medicine minus a deductible, or copay, which might be high or low, but which also might be covered by copay cards directly to the American HIV drug consumer in the USA. 

[Since1993]

Hi,
My husband and I have justmoved to the US from Israel; he is HIV+ and could receive his meds from home, which would be cheaper than getting them in the US. Does anyone know if this is possible (they would, of course, be prescribed by a doctor) and how to go about it?
Thanks a lot!
Alex

Hi, Alex:

As a "lawfully present" immigrant in the US (work visa to green card included), you are eligible to purchase an Affordable Care Act (ACA) Medical Insurance Plan, regardless of HIV-status:

https://www.healthcare.gov/

http://www.nilc.org/immigrantshcr.html

When applying for an ACA plan, if your income falls within 400% of the Federal Poverty Level (FPL) (<$62,920 for a household of 2) and you are "lawfully present", you would be eligible for Advance Premium Tax Credits (APTC) which would help pay for a portion of your insurance premiums.  If your income falls within 250% of the FPL (<39,325 household of 2), you would also be eligible for Cost Sharing Reduction (CSR) which provides reduced insurance co-pay, annual deductible and maximum annual out-of-pocket associated with your insurance health plan.

All assistance is means-tested so the amount of assistance is based upon your income. 

1.  Advanced Premium Tax Credits (APTC)  if your household income falls between 100-400% of the Federal Poverty Level (FPL), you are eligible for assistance helping to pay monthly Affordable Care Act (ACA) insurance premiums.  For a household of two, your income would have to fall between $15,730 - $62,920 USD to receive this credit.  The more you make, the less assistance you receive as a rule.

2.  Cost-Sharing Reductions (CSR)  if your household income doesn't exceed 250% of the FPL, you are eligible for assistance for your ACA health plan which reduces the amount of co-pays, annual deductible and maximum out-of-pocket expenses you might incur.  For a household of two, your income couldn't exceed $39,325 USD to receive this assistance.

3.  Ryan White Care Act Part B/AIDS Drug Assistance Program (ADAP):  Ryan White Care funds are distributed to each state to assist those with HIV/AIDS in the areas of medication assistance, medical care, mental health, dental, vision, housing, etc.   Every individual state administers their own programs.   Each state has varied levels of income eligibility requirements, ranging anywhere from 100% to 400% of FPL.  In order to receive Ryan White Part B assistance which would pay the remainder of your insurance premiums and pay any outstanding HIV medication co-pays, you would have to qualify financially.  Each state typically has asset limits by which you can't exceed in order to get this assistance.  This can range anywhere between $2000 - $4000 USD.

4.  There are also patient co-pay assistance programs offered by the individual drug manufacturers which help those who fall outside of Ryan White/ADAP income requirements.

Since you are now living in the US, you need to get linked into medical care ASAP.  You need to schedule an appointment with a medical case manager at your local AIDS Service Organization (ASO) who can assist you through this process and get you any financial assistance you might need and refer you to a physician who can prescribe your medication.

It is not legal to receive medications from outside of the United States because the Food and Drug Administration heavily regulates all prescribed medications within the United States.

[alex007]

Thank you both for your replies; we have very good health insurance in the US and the medication is affordable. I guess this might be a case of avarice (!) In Israel we pay nothing for expenses linked to HIV treatment (we have socialized medicine) and this will always be better than the best US plan. I realize that Israelis, together with many Europeans, are very lucky in this respect. As long as we pay a small contribution to our health care organization ($35), which we do, all treatments are free. Of course, we will see a doctor over here and have regular blood tests, but it would be cheaper to have the actual medication sent by courrier from home. From my research this is allowed by the FDA as long as the medication is approved by them, and prescribed by a doctor. For what regards US Customs, it should also not be a problem as we are not US citizens nor permanent residents.

[Since1993]

Thank you both for your replies; we have very good health insurance in the US and the medication is affordable. I guess this might be a case of avarice (!) In Israel we pay nothing for expenses linked to HIV treatment (we have socialized medicine) and this will always be better than the best US plan. I realize that Israelis, together with many Europeans, are very lucky in this respect. As long as we pay a small contribution to our health care organization ($35), which we do, all treatments are free. Of course, we will see a doctor over here and have regular blood tests, but it would be cheaper to have the actual medication sent by courrier from home. From my research this is allowed by the FDA as long as the medication is approved by them, and prescribed by a doctor. For what regards US Customs, it should also not be a problem as we are not US citizens nor permanent residents.

If your income falls within specified FPL of your states Ryan White Part B guidelines, there isn't any reason you should have to pay anything for any of your HIV medications.

If your income is too high for Ryan White Assistance, there is also patient copay assistance programs available that can greatly minimize, if not totally eliminate any costs associated with HIV medications.

I guess my concern would be, what would you do if your medication during shipment from Israel became delayed, or lost in transit, and you didn't have much medication left.  You should definitely have a contingency plan.

I would still urge you to contact a local AIDS Service Organization who would gladly assist you with any needs in the US related to HIV treatment and care.

 

[JR Gabbard]

Of course, we will see a doctor over here and have regular blood tests, but it would be cheaper to have the actual medication sent by courrier from home. From my research this is allowed by the FDA as long as the medication is approved by them, and prescribed by a doctor. For what regards US Customs, it should also not be a problem as we are not US citizens nor permanent residents.

Alex,
You'll need to make sure your Israeli pharmacy can fill a prescription written by an American physician.  They may need one from an Israeli physician in order for the meds to be covered by national health care.
I'm not sure that is the case between the US and Israel, but that's how it normally works with cross-border prescription refills.