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I have a house in Escazu and spend most of the year in CR. I do not yet have residency status. I do have good health insurance coverage in the U.S. which includes a mail order prescription drug service (Medco) which offers substantial discounts. I require maintenance medications for blood pressure and cholesterol.
When I discovered that plain old aspirin here costs 20 times what I pay in the U.S., I am trying to arrange local medical primary care and still use the Medco source for prescription drugs. THE PROBLEM is that Medco can only fill prescriptions written by physicians who have a U.S. DEA (Drug Enforcement Administration)registration number.
I do not believe that the DEA registration is the same thing as a license to practice medicine in the U.S. Here is my question(finally): Does anyone know of a local physician who has a U.S. DEA registration number? The simplest way to know this is if you are able to order prescription drugs from the U.S. based upon a prescription written here.
I am currently using a prescription written by a doctor in the U.S., but I cannot continue that arrangement unless I make frequent and costly trips back to the States for the physician to monitor my health in person (at least every 3 months).
I have an email into Dr. Loyola to address this, but have not yet heard back. I would appreciate any information readers could offer. Thanks.
DC Bob trying to do reverse medical tourism….
There is, in fact, a U.S.-licensed physician living in the San Jose area who has reviewed my medication regimen and written prescriptions for me which Medco has honored. I’ll contact her to see if she wants me to make her name known.
If she agrees to be identified, I’ll forward her name and contact information to you if you e-mail me at: daveandmarcia@gmail.com.
That said, I tend to agree with maravila that buying locally is much less complicated and maybe less expensive. The combination of Medco’s co-pays and Aerocasillas’ charges have convinced me to buy everything but my glucometer test strips here in Grecia. The test strips I use are not available in Costa Rica.
Thanks, Marvilla and David. I could buy the medications here, but the cost to me could be 3 to 10 times higher even if I use generics. The Medco supplier in the U.S. is in effect subsidized by my medical insurer which in turn is supported by my medical insurance premiums in the U.S. I have not yet investigated the cost differential to buy in CR, but my roughly $50 per month out of pocket cost for 4 prescription medications could rise to several hundred dollars a month here. Not necessarily a budget buster, but I already pay for my insurance coverage in the U.S. and my personal purchase here would be the open market price. I would be interested in being able to contact your physician David if she agrees. DC Bob
[quote=”DavidCMurray”]There is, in fact, a U.S.-licensed physician living in the San Jose area who has reviewed my medication regimen and written prescriptions for me which Medco has honored. I’ll contact her to see if she wants me to make her name known.
If she agrees to be identified, I’ll forward her name and contact information to you if you e-mail me at: daveandmarcia@gmail.com.
That said, I tend to agree with maravila that buying locally is much less complicated and maybe less expensive. The combination of Medco’s co-pays and Aerocasillas’ charges have convinced me to buy everything but my glucometer test strips here in Grecia. The test strips I use are not available in Costa Rica.[/quote]
if you haven’t investigated the cost of generic drugs, how do you know they will be 3 to 10 times higher? typically, most drugs are cheaper than in the US. are you not a legal resident? because if you were, you could use the caja system and get the drugs for FREE!! also typically, i know a lot of people who came here, changed their lifestyle, and no longer needed to take the handful of meds some US doctor rx’d for them. every time i buy something in the farmacia, i am amazed at the prices — a creme i use on my face costs $135 a tube in the US, not counting what it costs to see the doc to get the rx. here i buy it over the counter for $21. another creme i had to buy to lighten some pigmentation costs $50 in the states and $5.00 here. the DEA registation number is so a doc can rx a particular class of drugs.
As is so often the case, I find my self agreeing with maravilla and also disagreeing.
It’s certainly true that many generic medications are as effective as the brand name ones and can be had here, over-the-counter, much cheaper than in the U.S. But that’s not universally true. Some are not cheaper, and despite the claims, some generics are not bioequivalent to the brand name preparations, and generics are not available for all medications.
Likewise, the CAJA does provide medications for virtually all conditions, but whether they are the meds that are effective for your particular needs are another matter altogether. The medication that controls my diabetes is simply not available through the CAJA and my endocrinologist says that the one blood pressure med they provide is not worth taking.
It is true, of course, that lifestyle changes can make a real difference in one’s need for medication, but those changes are not always easy to make, nor are they always effective.
In the matter of obtaining one’s medications from a U.S. mail-in pharmacy (assuming you can get the scripts written), you must consider both the physician’s charge, the co-pay imposed by the mail-in pharmacy, and the costs and delays associated with actually getting those meds into Costa Rica. Despite using a few physician-prescribed meds, I’ve determined that the saving in importing them isn’t worth the headaches, so I buy everything here.
and then. . . if they get snagged in customs, which they occasionally do, you have a real nightmare on your hands, regardless of whether they were sent through a shipping service or not. it’s the luck of the draw, and i know several people who lost a lot of sleep and had a lot of stress after they thought they had figured out the system to get their meds shipped in, only to find out that they saved nothing in dollars, and spent a lot of time and energy trying to solve the problem.
Thanks again Marvilla for your assistance. My situation is a little complicated but I will try to summarize. My real need as a mostly permanent resident of CR is to find a local primary care doctor who will attend to my health including prescribing of medications as necessary. I am not looking for a mere prescription writer, but I am trying to make maximum use of my U.S. health insurance coverage. I am retired from the U.S. government and the benefits include a generous health insurance coverage which includes federal contributions. I would be foolish to ignore that benefit. With respect to my residency status, I am cautiously waiting to see how the CR immigration regulations play out regarding the CAJA 13% of income contribution. It all depends on what the 13% is calculated from (gross, net or some other portion of my monthly income) and as far as I can tell that is not yet clearly defined. I now pay about $200 per month as my share of a very comprehensive medical insurance plan in the U.S. that I would be foolish to discontinue. That plan actually will pay a fairly generous reimbursement to me for medical care here according to a cost schedule for services. On the final point about drug cost comparisons, I ran out of one of my medications here and bought a small supply here as a stopgap until my Medco package arrived. After visiting the Walmart and a private pharmacy (Fischel), I discovered that they did not have a generic version of what I needed and I ended up paying $4 per pill.
I do not know how to say “sticker shock” in Spanish.
Regards, DC Bob
P.S. Medco will only fill prescriptions from doctors who have a DEA registration number regardless of the type of drug.[quote=”maravilla”]if you haven’t investigated the cost of generic drugs, how do you know they will be 3 to 10 times higher? typically, most drugs are cheaper than in the US. are you not a legal resident? because if you were, you could use the caja system and get the drugs for FREE!! also typically, i know a lot of people who came here, changed their lifestyle, and no longer needed to take the handful of meds some US doctor rx’d for them. every time i buy something in the farmacia, i am amazed at the prices — a creme i use on my face costs $135 a tube in the US, not counting what it costs to see the doc to get the rx. here i buy it over the counter for $21. another creme i had to buy to lighten some pigmentation costs $50 in the states and $5.00 here. the DEA registation number is so a doc can rx a particular class of drugs.[/quote]
Thanks David for the thoughtful ideas. This dialogue has helped me reshape my thinking about what is most important for my next steps when it comes to my health care. My top priority really should be obtaining a permanent primary care doctor here in CR to assess and hopefully redefine my medical regimen which may include a different medication protocol altogether. I am hoping for the CR health/well being dividend of my new life and lifestyle here. Figuring out the most cost effective strategy for paying for everything can come later. As I think of all the snake pit lifestyle environments I found myself in while I lived in the U.S., it is a wonder I wasn´t taking maintenance medication for snake bites!. Regards, DC Bob
[quote=”DavidCMurray”]As is so often the case, I find my self agreeing with maravilla and also disagreeing.
It’s certainly true that many generic medications are as effective as the brand name ones and can be had here, over-the-counter, much cheaper than in the U.S. But that’s not universally true. Some are not cheaper, and despite the claims, some generics are not bioequivalent to the brand name preparations, and generics are not available for all medications.
Likewise, the CAJA does provide medications for virtually all conditions, but whether they are the meds that are effective for your particular needs are another matter altogether. The medication that controls my diabetes is simply not available through the CAJA and my endocrinologist says that the one blood pressure med they provide is not worth taking.
It is true, of course, that lifestyle changes can make a real difference in one’s need for medication, but those changes are not always easy to make, nor are they always effective.
In the matter of obtaining one’s medications from a U.S. mail-in pharmacy (assuming you can get the scripts written), you must consider both the physician’s charge, the co-pay imposed by the mail-in pharmacy, and the costs and delays associated with actually getting those meds into Costa Rica. Despite using a few physician-prescribed meds, I’ve determined that the saving in importing them isn’t worth the headaches, so I buy everything here.[/quote]
getting the primary care doc here would be a good first step. i know lots of people whose docs here had vastly different ideas on how to treat their “condition” — and several people i know were given rx’s to go to a nutrition class to help with their diabetes and cholesterol problems. but in many ways, the docs here are locked stepped with Big Pharma the same as they are in the States. their usual first reaction to my cholesterol levels is to tell me i need lipitor. but when i point out that my HDL is 3x’s what the minimum is and is a number they can’t even achieve with drugs, they back off. i love my cholesterol!!! but then all they know about cholesterol is what the drug rep told them and now it’s coming out that the drugs may actually be more dangerous than the numbers they are trying to lower. and a change of lifestyle can really do wonders and that may have a really good influence on what you are being treated for. if you were in the snake pit, it’s time to extricate yourself.
Thanks again Maravilla for the most cogent advice. I hear you about the differences between BIG MEDICINE and more humane paths to total health sans the medicine cabinet. I know reducing body weight, more exercise and dietary sanity can help get the cholesterol bogeyman under control. In fact you are right, cholesterol can be your friend in the right quantities in terms of healthy body tissue. I take 3 grams of fish oil capsules daily (Omega 3 fatty acids) which seem to have a good effect on cholesterol levels and health generally. Anyway, can you offer advice about how to find a good primary care physician here? From what I have read on this forum, some affiliation with CIMA or Clinica Biblica seems prudent. As for the snakes in Washington DC, my only extrication was to head south to pura vida. I much prefer the snakes here in CR. At least they are honest and professional….and I think they enjoy their work. DC Bob
[quote=”maravilla”]getting the primary care doc here would be a good first step. i know lots of people whose docs here had vastly different ideas on how to treat their “condition” — and several people i know were given rx’s to go to a nutrition class to help with their diabetes and cholesterol problems. but in many ways, the docs here are locked stepped with Big Pharma the same as they are in the States. their usual first reaction to my cholesterol levels is to tell me i need lipitor. but when i point out that my HDL is 3x’s what the minimum is and is a number they can’t even achieve with drugs, they back off. i love my cholesterol!!! but then all they know about cholesterol is what the drug rep told them and now it’s coming out that the drugs may actually be more dangerous than the numbers they are trying to lower. and a change of lifestyle can really do wonders and that may have a really good influence on what you are being treated for. if you were in the snake pit, it’s time to extricate yourself.[/quote]
i can’t help you with doctors in the Escazoo area who are affiliated with Cima or Biblica because i live way up in the campo where our main concern is having a p.c.p. who is also affiliated with the CAJA. but surely Scott could recommend someone as he lives in that area and knows everyone worth knowing!! jejeje
Escazoo indeed! I fear I am a mutt among purebreds! Maybe I should consider a veterinarian…I am following Scott´s threads on the forum and starting with Dr. Loyola as a point of departure. I hope I don´t get trampled on by the hordes of medical tourists….I guess there is always the risk I could go into CIMA for a hernia repair and come out with a nose job!
[quote=”maravilla”]i can’t help you with doctors in the Escazoo area who are affiliated with Cima or Biblica because i live way up in the campo where our main concern is having a p.c.p. who is also affiliated with the CAJA. but surely Scott could recommend someone as he lives in that area and knows everyone worth knowing!! jejeje[/quote]
Find a Cuban trained doctor.
Also before you take medications prescribed by a Tico “doctor”, go to drugs dot com and check for any interactions unknown around here.If I hadn’t done that, on two separate occasions, I might not be typing this.drug interactions should always be checked no matter WHO rx’s the meds. since a doctor’s primary medication info comes from a perky drug pusher in a tight skirt and stilettos heels, most doctors haven’t a clue what drugs can be combined. drug interaction account for approximately 100,000 deaths IN THE STATES. Caveat emptor!!
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