Can an Australian citizen get Effexor XR in the US without selling a kidney?
March 15, 2009 4:54 PM   Subscribe

My husband, an Australian citizen, is in the US on a tourist visa. We would like him to stay for 3 more months, but he would need a supply of Effexor XR from a local source. Is there a way to do it on the cheap?

I'm uninsured and unemployed. It would be nice to be together while my immigration paperwork to Australia goes through the bureaucratic machine, but we can't really afford to pay $400 per month for his meds here. It would be only slightly less than the cost for him to fly back home and then back here again.

My husband's doctor in Australia can't write another prescription if my husband is not physically present in the doctors office. He is on a fairly epic dosage, and this is why it's so expensive. Oh, and there is no generic version.

Tapering off or discontinuing the drug is not an option. Neither is a liquor store robbery spree; I am far too polite, even when I have a shotgun.

I greatly appreciate any comments and ideas you may have. I see that there have been similar questions asked here about defraying the insane cost of prescription drugs in the US, but his citizenship and this particular drug put a bit of a twist in it.
posted by out of context to Health & Fitness (35 answers total)
 
do you have a lot of friends? Internet friends? a party or a website or both to raise the money
posted by By The Grace of God at 5:02 PM on March 15, 2009


Does his doctor think he can change to a different antidepressant? That's not a terrific option, I know, but WalMart does sell generic antidepressants for $4/refill. Effexor is not on the list, because there is not a generic yet. But maybe his doctor can look at the list and put together a plan to move him from one to the other?
posted by Houstonian at 5:14 PM on March 15, 2009


Best answer: Effexor XR (as in the capsules, not the XR venlafaxine tablets) is available as a generic in Canada...perhaps there might be a way for you to get them via the internet?
posted by thisjax at 5:15 PM on March 15, 2009


Sorry, this isn't answering your medication question exactly, but can your husband even stay another 3 months, since he entered on a tourist visa?
posted by polexa at 5:17 PM on March 15, 2009


XR is a phase two, how-to-extend-the-patent formulation, and it's not covered by some health plans. Can he take the generic venlaflaxine more that once a day, or on a schedule that approximates the XR?
posted by StickyCarpet at 5:33 PM on March 15, 2009


Response by poster: We don't really have friends on that scale. We're both introverts and don't have that kind of huge fan base to call on. Interesting idea though!

Effexor (venlafaxine) is notorious for its horrible discontinuation syndrome. Quitting involves a long, gradual tapering off while being observed closely by your doctor. Because of that, and also just because he has tried many antidepressants and this huge dose of Effexor XR is what works best for him, quitting is just not an option right now.

Taking the extended release form is necessary due to the dosage he is on. He'd have to wake up a couple times at night to take the regular capsules (I've been saying capsules because that's what it says on the box) to avoid any of the effects of withdrawal.

We actually have already extended his visa for three months and moved his flight reservations, before finding out that we couldn't keep getting his meds for cheap from home. Oops. Changing the flights back for him to go home before his supply runs out means we would have just spent about $820 for him to stay a week longer than planned. It's been a great lesson in planning though!
posted by out of context at 5:40 PM on March 15, 2009


Polexa has a valid point. My girlfriend is Australian and we just went through this visa situation at Christmas. She had to leave, to a non-adjacent country (i.e. Canada and Mexico don't count), in order to get a new 3 month tourist visa. She went to London for 10 days to do that, but in this case, he might as well fly home and get more meds while he's at it.
posted by autojack at 5:43 PM on March 15, 2009


Oops, so you've already extended. Sorry I didn't preview.
posted by autojack at 5:44 PM on March 15, 2009


Response by poster: Oh, and I have looked into getting them online. The ~$400 per month that I quoted is from a less expensive but seemingly reputable online pharmacy based in Canada. That is $1.79 per 75 mg capsule. Retail in the US seems to be $3.89 per 75 mg capsule (from drugstore.com) or higher. He takes 7 of these per day to add up to 525mg daily.

I have also looked at some other overseas pharmacies, in particular one that is based in Cyprus and sells drugs manufactured in India. They offered extended release pills using the generic venlafaxine for crazy cheap. About $230 for his 3 month supply. It seemed too good to be true, even if the whole shipment weren't seized by customs.
posted by out of context at 5:54 PM on March 15, 2009


I heard that they just released generics for Effexor-XR that come in tablet form. Some info.

Is there someone you know who's coming from Australia to America that could buy the pills on his behalf and deliver them? I'm on Effexor-XR too and the cost is a bitch! Good luck!
posted by divabat at 5:56 PM on March 15, 2009 [1 favorite]


Best answer: 7 doses of 75mg!! Can he get boxes of the higher doses (I'm on 150mg and I think there's one higher up) so you don't have to buy as many? A box of Effexor-XR 75mg is $40+ but one of 150mg is $60+, so it works out cheaper.

You can get around the customs by post thing if you have a relative or friend come over and deliver them. I've never had a problem transporting stacks of E-XR to and from Australia for myself, but admittedly I've only had to bring a box to the US at a time so I don't know how the customs works there.
posted by divabat at 5:58 PM on March 15, 2009 [1 favorite]


Best answer: http://www.pparx.org. If his/your incomes are low enough, he may be able to get some assistance from the manufacturer. There are programs that include legal residents of the U.S., and maybe even people who aren't. However, I'm not sure if his having some form of insurance in Australia will count against him or not.
posted by fructose at 5:59 PM on March 15, 2009 [1 favorite]


I realize that it takes a lot of time and effort to find a drug that works for one's anxiety and depression, but is it totally out of the question for him to switch drugs? If not, it would be cheaper for you to get a referral from your doctor to a psychiatrist, and maybe find out something that would be comparable and cheaper, hopefully in generic form, and in the US. This may not be an option for him, but I'm just throwing it out there.

Have you guys looked into how far the social care (Medicare) of Australia extends? Some country's socialized health care extends to when one is visiting abroad, too. As in, he could buy the medication, then get money back through Medicare, down the road. This would be worth finding out. (Note: I don't know when an allowance like that expires, if it exists, how long he can be out of the country, etc.)
posted by metalheart at 6:03 PM on March 15, 2009


metalheart: Effexor-XR works very differently from other anti-depressants, so switching to something comparable (if it even exists) would take a long time and possibly be quite as pricey.
posted by divabat at 6:05 PM on March 15, 2009


Just wanted to say that I did see you say tapering or discontinuing was out of the question. (I didn't ignore you!) It's more just that you may not have any other option, and the fact is that either you'll deal with this conundrum now, or it'll keep coming up, rearing its expensive head. If there's a cheaper alternative in the US, it'd be good for him to find it, particularly since I know you guys would be spending absolute tons on flight tickets and visa stuff right now.
posted by metalheart at 6:06 PM on March 15, 2009


NB: Effexor's a hard drug to come off of, and because it's an SRNI as opposed to an SSRI, the only alternative drug is Cymbalta, which is even more expensive.
posted by thisjax at 6:07 PM on March 15, 2009


metalheart: Effexor-XR works very differently from other anti-depressants, so switching to something comparable (if it even exists) would take a long time and possibly be quite as pricey.

It's been around since the early 90s. Surely Wyeth's competitors have worked to create similar products? I've no idea, though, I will readily admit.

According to wiki, many generic versions of it are in the States.
posted by metalheart at 6:09 PM on March 15, 2009


There's a new formulation of Effexor XR called Pristiq. Their website is offering a 50% off voucher for it if you can find someone stateside to prescribe it for you.
posted by asockpuppet at 6:21 PM on March 15, 2009


metalheart: see above. The only similar drugs are Cymbalta and that other drug that Wyeth created to milk their patent for Effexor, and neither are available as generics, so Effexor is the least expensive drug of its kind. Also, the only generic version of Effexor available in the US is the one that the OP's hubby isn't taking (and possibly can't take).
posted by thisjax at 6:24 PM on March 15, 2009


Check out the Wyeth Assistance Program

There's a form you fill out to state your yearly income, etc. and as long as your income level is low, and if you have a Dr.s prescription for Effexor, the drugs will be sent to you, in the mail, in about a week, for free.
posted by Kloryne at 6:45 PM on March 15, 2009


Response by poster: Divabat: Good tip both about the generics and the 150mg capsules being cheaper! I hadn't realized there was as much of a price difference. Our original plan involved having his medication mailed from Australia. There's paperwork involved, but it can be done legally. The problem is that, in order for it to be subsidized by Australian Medicare, the prescription has to be written there with my husband present.

Metalheart: That's a good idea about benefits extending to the period that a citizen is overseas. I hadn't looked at it thoroughly before. From what I can tell, they have reciprocal health care system set up with New Zealand and some countries in the EU. In all other countries, you're on your own. As for your point about looking into a medication switch: If we planned to live in the US long-term, the price would indeed be an issue. We plan to live in Australia full time and only visit the US though.

Fructose: Excellent site! Unfortunately the only assistance it found for us was Wyeth's program, which he doesn't qualify for. He isn't a US citizen and isn't in the process of becoming one. From what I have read so far, being married to me doesn't get him anything except an Individual Taxpayer Identification Number so that the IRS can keep better track of us.

Asockpuppet (and anyone else who advises a switch in medications): Honestly, messing with Effexor is scary, and even switching to the generic makes me a bit nervous. I would send him home first before asking him to risk it without his doctor's supervision and a really really good reason. It would be a totally valid point to bring up in many other situations. I don't like questions here that are basically, "Please help me, my head is stuck in a jar! Caveat: I cannot ever get my head out of this jar and also I don't want to.", either.

Kloryne: He would very likely qualify if he were a US citizen, but alas.
posted by out of context at 7:19 PM on March 15, 2009


I think you best bet is to find a doctor in Australia willing to write the script even without your husband present. It sounds like that is not legal, but I am willing to bet for a few extra dollars, you could find one. Or, if you know anyone else in Australia who is taking it who could send you theirs and claim that they accidentally flushed theirs or lost their so they can get a refill themselves.

Also, if he stays and has no prescription or way to get a refill he will have massive withdrawal symptoms. At that point head to an ER and tell them. They will have to help I think.

Lastly, have you asked the embassy if there is anything they can do? You never know. I am sure this is not the first time this came up. He is here on a tourist visa so it is not like he is living somewhere else and glomming off the AU system.
posted by JohnnyGunn at 7:33 PM on March 15, 2009


Out of context : I sent you a MeFi mail.
posted by Kloryne at 7:37 PM on March 15, 2009


I'm not a US citizen so hopefully someone else will fill in this scenario.

But if you're married, can't he get authorized to work in the US? Even if you're applying for Australian citizenship? Then he could get a shitty job and either a) use that money to pay for the $400 prescription here, or b) work somewhere like Starbucks that has some benefits. I know a green card takes a while (and costs money) -- but what is he considered after-wedding and pre-green card?

Or, if you're totally unemployed, any way that you can pick up a part-time job just to cover those costs, or even part of them? Babysitting, temping, tutoring, dog walking, house painting, deli, working in the back of a bar, etc. - I bet you could make $8-12 an hour for a few months, even in this economy.

Meaning, if it's $400, and there are two of you, and you're both unemployed...maybe the solution isn't a cheap prescription, it's finding a bit more cash. Or maybe it's a combo - getting a prescription from Australia, filling it at a cheaper Canadian pharmacy, and finding a little part-time job.

Sorry if this is impossible given your scenarios though.
posted by barnone at 7:58 PM on March 15, 2009


Response by poster: JohnnyGunn: Your first two ideas go a little beyond my acceptable risk/reward ratio, but calling the embassy is worth a try and I'll do that tomorrow. It's not like he can't go home right now, we just don't want him to.

Barnone: Just being married to me, unfortunately, doesn't authorize him to work. He's still considered a non-resident alien. He would have to be in the later stages of permanent immigration to the US to legally work here, or hold a work visa of some sort. I have been trying to pick up a part-time job, and hopefully will have one soon. It's not that we absolutely don't have the money to do this, it just takes kind of a large chunk out of the savings that we would rather use on expenses in Australia. I was actually quoting $400 as a monthly cost. It was a little above $1200 for three months of non-generics, not including what a psychiatrist would charge for taking him on as a patient here.

So yeah, this is not an absolute must that he stays in the US, just that money is tight and I'd like to spend as little as possible. Thank you everyone for your replies so far!
posted by out of context at 8:34 PM on March 15, 2009


As a last resort...
Maybe he could try to get off Effexor? Withdrawal symptoms can be mediated using Prozac.
posted by spacefire at 8:46 PM on March 15, 2009


What about a low-cost medical clinic for the uninsured? Some of them have pharmacies attached. I'm not quite sure where you are in Washington, but these neighborhood low-cost medical clinics in Seattle are pretty well-used and work according to a sliding-scale.

The one I linked to is at Pike Place and has a pharmacy attached to it. They do chronic illness management. Maybe you could call them and see if your husband would fit their services? Your ability to pay even a little something might help. If Seattle isn't possible, I bet there is one in your town or county.
posted by barnone at 8:52 PM on March 15, 2009


Response by poster: Actually I'll clarify further. He won't agree to spend that much on medication just to stay here for another three months, arguing that it's too much to spend right now and that three months (optimistic estimate of when my visa will be processed) isn't very long to spend apart when you take the long view.

Rather than writing off what we have spent so far on the visa extension, I would like to spend a few hundred more dollars on medication, and of course have the bonus of being together.
posted by out of context at 8:53 PM on March 15, 2009


What about you joining the state's very minimal health care plan? I think since you're married he'd be eligible, even without being a green card holder, no? Here's the plan. You could call and ask.
posted by barnone at 8:57 PM on March 15, 2009


Response by poster: We're about 4 hours away from Seattle in eastern Washington state. There is probably something similar nearby. I'll look into it when I make calls tomorrow.

Basic Health doesn't cover pre-existing conditions for 9 months after you begin payments. Also there is this discouraging notice on their site: "Currently BH is in managed enrollment. Enrollment will be offered to eligible applicants when space is available."
posted by out of context at 10:14 PM on March 15, 2009


This is what I would do:

1/ I'd get your Australian doc to fax the relevant records over to your family's primary care doc in Washington. If you don't have one, you're going to spend time finding someone taking new patients, now, and you may have to try more than one doc.

2/ I'd get a new, US prescription for three months of the dosage required, and bring in the Wyeth paperwork to be completed at the same visit.

3/ I'd fill it in the short term at WalMart while you're waiting, and over the long term from Wyeth.

Through this process, I would avoid being specific with your doctor about visas and such. They shouldn't ask; don't volunteer. They Wyeth programme has a requirement for "residents of the United States or Puerto Rico." The word "resident" is open to interpretation, so interpret it generously and don't put anyone else in a position where they have to think about it.

You will have short-term costs - the doctor's visit and the week or so of prescriptions - but it will be far cheaper than $1200 over three months.
posted by DarlingBri at 2:35 AM on March 16, 2009


Best answer: This idea is possibly a bit left of field, but Australia has reciproical health agreements with the UK and Ireland (and some other European countries - but these are probably the easier ones). This means they he can be dispensed the drug under the PBS by showing his Medicare card and Australian passport at a pharmacy in these countries. You might want to verify this by ringing a pharmacy over there.

If the price of a plane ticket to Ireland/the UK is cheaper than that (I have no idea what it would cost for you....) then maybe this is another option?
posted by ryanbryan at 2:35 AM on March 16, 2009


I used to pay for my own Effexor XR, and the cost was extraordinarily high.

That said, taking 7 75 mg capsules is, as others have said, not a cost-effective way of doing it, so maybe look at the comparative cost of 150 mg capsules--I think they used to cost me about $120 per 30 capsules, though I suppose the price is different now.

And, that said, if he can find a doctor who will write a prescription for 90 days' worth at a time, there are discount prescription vendors whose cost might be more attractive at that price point. Canadian pharmacies also offer less expensive Effexor XR (and the generic venlafaxine in more formulations)--see here, for instance.
posted by Sidhedevil at 7:59 AM on March 16, 2009


Your family doctor would probably be ok with writing him a script if he has proof (pill bottle) showing he's already been prescribed him. DarlingBri's plan to fax his medical records would be best though. A lot of doctors are very helpful about giving you samples of prescriptions they write but it depends on what the pharmaceutical reps have given them. It's usually been a week or two of medication when I've been given it.
posted by stray thoughts at 10:48 AM on March 16, 2009


Response by poster: Thanks to everyone for all the answers!

What we'll end up doing is getting those generics from Canada. For some reason I hadn't spotted them in any online searches until just now.

If I had known about this before I extended his tourist visa, I would have had him just go to the UK for the prescription and solve two problems at once. Airfare is indeed cheap enough right now to make the cost comparable to what we're spending, or maybe less.
posted by out of context at 6:11 PM on March 16, 2009


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