MS Medications in Mexico: Insurer Encourages Patients to Go South

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by Ed Tobias |

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MS medications are expensive in the United States. We all know that. We also know that some of those expensive meds are a lot less expensive in places like Canada and Mexico.

Now comes a novel idea from the nonprofit health insurance provider PEHP, which covers state workers and their families in Utah: Pay those patients to buy their expensive meds south of the border.

As Erin Alberty reports in The Salt Lake Tribune, the insurer is “offering plane tickets to San Diego, transportation to Tijuana, and a $500 cash payout to patients who need certain expensive drugs for multiple sclerosis, cancer and autoimmune disorders.” The MS medications that are covered are Ampyra, Aubagio, Avonex, Copaxone, Gilenya, and Tecfidera.

The story uses Avonex as an example. It can cost about $6,700 for a 28-day supply in the U.S., according to Alberty’s reporting. But if obtained from a Tijuana clinic that’s under contract with the PEHP, the medication’s cost is only $2,200. That’s a $4,500 monthly savings. Travis Tolley, PEHP’s clinical operations director, told the Tribune that the money for the Tijuana travel “is pretty small in comparison to the difference between U.S. prices and Mexico prices.”

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PEHP started sending people to Mexico for high-cost medications after the Utah state legislature passed a measure requiring health insurance plans covering state workers to offer incentives to people to choose less expensive healthcare providers. State Rep. Norman Thurston sponsored that legislation. He told the Tribune, “Why wouldn’t we pay $300 to go to San Diego, drive across to Mexico and save the system tens of thousands of dollars? If it can be done safely, we should be all over that.”

Treatments can also be part of the deal

Medications aren’t the only thing for which PEHP is encouraging patients to be cost-conscious. Its website also contains a cost-comparison tool. Enter a common medical service and you can see the total costs at different providers. Sometimes you’ll see multiple services bundled together. The costs are based on actual medical claims the insurer has processed. The PEHP website says patients can “compare providers and costs to seek quality care and great value.”

If they build it will they come?

A few months ago, I wrote about a study of patients who were given the opportunity to use a tool that compared the cost of a nonemergency MRI from several providers. Fewer than 1 percent of the patients used it. Had they done so, according to the study, they could have reduced their out-of-pocket costs by about 30 percent and saved their insurance company about 40 percent.

That probably wouldn’t come as a surprise to the people at PEHP. When they first offered to cover medications and medical care that was less expensive in Mexico, there wasn’t a rush of patients who wanted to head south. It was only after the insurer offered a cash incentive that patients became interested. Money, it seems, does talk.

So, why don’t some major health insurers try showing us the money and do something similar to what PEHP is doing in Utah? Why don’t other state legislatures pass laws like Utah’s, requiring incentives to be offered for healthcare cost-saving? Spending a few hundred dollars and buying a plane ticket to save thousands sounds like a no-brainer to me.

You’re invited to follow my personal blog at www.themswire.com.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

Comments

Jason avatar

Jason

The insurer could pay for HSCT. That would be a thought.

Reply
Terry avatar

Terry

PEHP vetted the clinic which is great. Wish I knew the name, as I would head to Mexico for Tec in a heartbeat. Stopped taking it 4 months ago as cost with Medicare Part D is too high for my budget. When I had regular insurance, I qualified for co-pay assistance...but no more. Mexico works for me.

Reply
Ed Tobias avatar

Ed Tobias

Hi Terry,

Maybe PEHP would tell you if you called them. If they do, please share what you learn.

Ed

Reply
Joy laker avatar

Joy laker

Hi, I am on Medicare also, the cost for Aubagio is ridiculous, where did you go in Mexico for your MS meds, do you need a prescription from a Dr.? I really appreciate your help.
Thanks much,
Joy

Reply
Jason avatar

Jason

Gilenya cost 62,000 in 2013. It costs 98,000 now. That seems strange.

Reply
Laura avatar

Laura

This is not a tenable solution to the high cost of critical care medications. How many people with MS, cancer, or autoimmune diseases really have the energy and/or mobility to fly to another state, get transferred to a foreign countrym and then do the trip in reverse?

Reply
Cindy avatar

Cindy

Question?? Why are the drug companies here in the United States selling these drugs to Mexico for so much cheaper? Something seems terribly wrong when the drugs are being manufactured here in the US, but we have to go to another country to buy the drugs at hugely discounted prices.

Reply
Ed Tobias avatar

Ed Tobias

Hi Cindy,

One significant reason is that the U.S. government, which because of Medicare is the largest drug purchaser in the nation, is prohibited by law from negotiating prices directly with drug companies.

Here's a very interesting article about drug prices. It's long, but worth the read:

https://www.mmm-online.com/home/channel/corporate/how-to-lower-drug-prices-in-the-u-s-lots-of-suggestions-few-viable-solutions/

Ed

Reply
Glenda avatar

Glenda

It's no wonder that elected officials end up being millionaires once they've been in D.C. for a short while.

Reply

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