Tag: cost of medicine in Italy

Retire to Pontelandolfo!

by midgeguerrera, posted in Practical Matters - Living Abroad

Join the likes of George Clooney, Jonny Depp, Madonna, Sting, and Francis Ford Coppola.  Live the Italian life you’ve thought was impossible. Wait!  Is it possible?  Seriously, can a normal person afford to retire or own a home in Italy?

MIdge Jack Ponte

Jack and I are always being asked How did you do it? How can you afford to live in Italy?  My first response is to remind folks that we do not live in a tourist packed, guidebook referenced city.  We live in a village in the Sannio mountains.  There are lots of small villages like ours, throughout Southern Italy.  Village populations have plummeted.  The lack of jobs has sent the young folks north or to other European cities.  Earlier emigration, during the 20thcentury to the United States, South America and Australia has resulted in lots of empty housing stock.

There are relatively large apartments here that are listed at €40,000.  By large I mean two or three bedrooms, living room, dining room and kitchen.  Yes, of course there are bathrooms too with bidets even. Today, the exchange rate would put that home at $44,458.  Average rents range from €250 to €300.  We pay more than that but not a hell of a lot more for a three-bedroom, three-bathroom, two-kitchen house on a working farm.  We were lucky, when we first rented, it was fully furnished.  Over the years we have personalized our home with our own furniture and art.

Buying a house or renting here in Italy normally means you are getting an empty house, unless someone died and the heirs are selling with all the stuff.   That means no kitchen cabinets, no appliances, bubkas, niente, nothing.  That said, the folks who are leaving a rental unit have paid for a kitchen that probably won’t fit in their new place and might be willing to sell it to the new tenants.  I have seen homes for sale that are being sold full.  Jack cried when I said NO to a house in CentroStoricothat was for sale for a song, had great views and was full of antiques – including art. I love where we live and at this point in my life didn’t want to pack up and move.

Our furniture comes from the ever-popular IKEA!  The price point is almost equal to the USA prices.  More important – they deliver!  Of course, I am delighted that Jack so throughly enjoys putting it all together.  I also found two amazing resale shops in Benevento.  For my Seven Events for Seven Decades festa in May I needed lots of tea pots, teacups and serving pieces.  That is when I discovered the resale shops. Great stuff – housewares, furniture, clothes etc. at Salvation Army store prices.

When we decided to look outside of the United States for quasi retirement options, we sold our house, our cars, our clothes, our housewares, just about everything.  The art I didn’t sell and my favorite kitchen toys have been coming here in our checked luggage.  Jack and I still go back to New Jersey annually for 5 or six months.

According to a February 21, 2019 article in the money section of USNews:

The average Social Security benefit was $1,461 per month in January 2019. The maximum possible Social Security benefit for someone who retires at full retirement age is $2,861 in 2019. However, a worker would need to earn the maximum taxable amount, currently $132,900 for 2019, over a 35-year career to get this Social Security payment.

https://money.usnews.com/money/retirement/social-security/articles/2018-08-20/how-much-you-will-get-from-social-security

Let us arbitrarily and capriciously use $1600 per month as our starting number. Today, that would be worth €1439.55. I am math deficient but will give a monthly budget based on what we pay a whirl. Let’s pretend you bought a €40,000 home.  REMEMBER ALL OF THESE NUMBERS ARE GUESTIMATES AND NOT TO BE TAKEN AS HARD COLD FACTS! Also remember that I am math challenged.

Monthly Fixed Costs

Taxes  €280 a year for our place but I couldn’t get the tax formula.  Some people pay as much as €800 €23.23
Electric This is what we pay for a super huge house.  Bills are for 2 months. We average €63. €31.50
Cell Phone Vodofone cell service – unlimited everything.  I use the data for a hot spot everywhere. €20.00
WiFi   €20.00
Garbage €93 all year €7.75
Car Insurance We have the large Fiat 500 XL and pay €1000 a year. €83.33
Gas –  propane or natural In the winter we heat with propane.  We also use it for hot water. I’m not sure how to figure this out.  Last December we spent €1,000. This summer for most of the summer €400.  Many people heat with pellet or wood-based systems. €400.00
Car Gas Cars are well designed and can be bought that run on gas, metano (natural gas), gpl (propane) and electricity.  We have diesel and fill up once every few weeks unless we are taking road trip.  You buy it by the liter. 65.00
Water 24 Every two months 12.00
Sewer We have septic. 0
MONTHLY FIXED COSTS 662.81

I have never done this before!  Thanks for the budget Midge!  Did I just thank myself?? We average €662 a month for fixed costs.  Actually €10 more – I forgot Jack’s cheap cell phone plan.

Medical care for folks in their second act is really important.  Jack and I are super lucky that I was able to become an Italian citizen and he, as my husband, was too.  That means we have access to the incredible socialized healthcare system here.  I am going to base my thoughts now on your not being of Italian heritage and able to live here and access the system.

Before Jack became a citizen, he was able to purchase in our local Farmaciaall of the medications prescribed in the United States.  That includes meds for diabetes, cholesterol, blood pressure and heart issues.  Every month we saved a bundle.  His purchase price RETAIL was less than or equal to his Medicare part D copay.

We both use a great dental team here – private and not in the system.  Because of dead root issues with the anchor stubs, Jack just replaced a bridge here.  The old bridge with preparation of the anchors cost approximately $8,000.   With two root canals the new bridge cost €1900.

We had an interesting dental experience the first year we were here and subsequently learned from it.  I made an appointment for us to have our teeth cleaned.  The dentist looked in our mouths and said why are you here? You have no plaque or other gross stuff. Your gums look great.  Well, we replied our NJ dental office says you should go every six months and the dental hygienist calls to remind us.    I now go once a year for a check up and a cleaning.  The dentist – not a dental hygienist- does the cleaning and takes what ever time it needs.  I just had it done for €85.  The full panoramic X-ray cost €30.  The dentist doesn’t have the machine. We go down the street to a Diagnostic center.  I am guessing that keeps costs down.

Private doctor visits range from €50 to €150 depending on who you see and for what. Last year I paid a cardiologist €150 for an exam.  He, himself, did an echocardiogram and Doppler for carotid artery stuff.  He also gave me script for blood work.  I returned with the blood results and there was no fee for the second visit.  Since I liked the idea of knowing a cardiologist here, I made an appointment for Jack.  The doctor didn’t charge us for that either.

The town arranges for the Croce Rossaand doctors to bring medi-vans to town for things like free sonograms of your thyroid.  I mention this one because I availed myself of the service and they discovered a few nodes on my thyroid.  I went to my PCP here and got script for a full blood work up that included thyroid tests.  The blood test at a private lab cost €60. (Have you looked at what LabCorp charges medicare?). Then I went to see a fancy endocrinologist who not only looked at the blood work but gave me the same kind of exam an internist would do.  Cost €100.

If you had to go the hospital, I have no idea what they would charge. This is a country with socialized medicine and there isn’t any mechanism for collecting.  This May a friend of mine was visiting from the USA and thought he was having a heart attack.  The rescue squad came – complete with a medical doctor and nurse on board – examined him, gave him an elettro-cardiogram and then took him to the hospital.  The ambulance cost nothing and the hospital didn’t charge. That said, we asked and discovered that if you are from the United States, which does not have health care reciprocity with Italy, you are supposed to buy private insurance. Jack bought it the first year we were here and it cost us about $1000 for a year.  He never used it.

Let’s Eat Out! Why should I cook when we can go to a fabulous restaurant and have great food with good wine and leave with a bill for often less than €40?  At a local tavola caldawe can get lunch for about €10 each.  Why make a cappuccino at home when you can sit in a bar, stare at the piazza, chat with pals and pay barely anything.  Here are some local bar prices.

Croissant          €1

Cappuccino       €.90

Caffè                €.80

Aperal Spritz     €2.50

Tap Beer           €1.20

Tap Wine          €1.50

Cocktails           €3.oo to €5.00

Amaro              1.50

Fast Food – usually only available at night or during one of the many festas

Pork or beef grilled on a hard roll           €3.00

Porcheta on a hard roll                          €3.50

Sausage on a hard roll                           €2.50

I can’t remember the prices of everything – I need to eat out even more. The local bars have specials often.  For example, €5 dinner included a glass of wine, steamed mussels, bruschetta and a fried fish. Every weekend you can get a gyro for €3.50.  The take-away pizza place has whole pizza from €3 to €6.

Our favorite and really exceptional seafood restaurant has fish entrees that range from €8 to €12 -of course  –  fresh not frozen.

Buying Clothes for us is hard here.  We are both too big!  Jack wears a USA men’s XL and I wear a size 18.  I get my dresses made by the seamstress.  The cost of labor is so low that I am embarrassed to tell you what I spend. Jack orders clothes from Lands End UK. If you are thin, you can buy clothes at the market and spend peanuts.

Pets are a dog or three running loose outside or cats.  Most domestic animals are outside, fending for themselves and get fed what the family eats.  I don’t know what pet food costs.  The local shop for farms has all kinds of stuff for cows, pigs, sheep and maybe dogs. It is loose and you buy it by the kilo. Recently we noticed a few families with a dog on a leash.

Yikes, information overload!

Have I convinced you to come?  Let me know what else you would need to know. 

Ci vediamo!

NY Times 10/13/13 – Talks about Drug Prices in USA vs EU

by midgeguerrera, posted in Any Day in Pontelandolfo, Practical Matters - Living Abroad

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html?ref=us

Yesterday, I posted an article about our experiences in Pontelandolfo buying medicines.  It  makes me want to scream at our legislators for allowing big pharma to decide how much to rape  and pillage for profits.  Thinking that maybe I was simply a wacko with a pharma conspiracy theory, I was soooo vindicated to read today’s New York Times.   Since I don’t want you to think I’m a wacko, I had to post this story from the New York Times.

Here are some excerpts from the article:

With its high prescription prices, the United States spends far more per capita on medicines than other developed countries. Drugs account for 10 percent of the country’s $2.7 trillion annual health bill, even though the average American takes fewer prescription medicines than people in France or Canada, said Gerard Anderson, who studies medical pricing at the Bloomberg School of Public Health at Johns Hopkins University.

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Thanks in part to the $250 million last year spent on lobbying for pharmaceutical and health products — more than even the defense industry — the government allows such practices. (pay generic drug makers to stall release and don’t make things over the counter because folks won’t pay more than $20 OTC.) Lawmakers in Washington have forbidden Medicare, the largest government purchaser of health care, to negotiate drug prices. Unlike its counterparts in other countries, the United States Patient-Centered Outcomes Research Institute, which evaluates treatments for coverage by federal programs, is not allowed to consider cost comparisons or cost-effectiveness in its recommendations. And importation of prescription medicines from abroad is illegal, even personal purchases from mail-order pharmacies.

“Our regulatory and approval system seems constructed to achieve high-priced outcomes,” said Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center. “We don’t give any reason for drug makers to charge less.”

And taxpayers and patients bear the consequences.

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In all other developed countries, governments similarly use a variety of tools to make sure that drug manufacturers sell their products at affordable prices. In Germany, regulators set drug wholesale and retail prices. Across Europe, national health authorities refuse to pay more than their neighbors for any drug. In Japan, the price of a drug must go down every two years.

Drug prices in the United States are instead set in hundreds of negotiations by hospitals, insurers and pharmacies with drug manufacturers, with deals often brokered by powerful middlemen called group purchasing organizations and pharmacy benefit managers, who leverage their huge size to demand discounts. The process can get nasty; if mediators offer too little for a given product, manufacturers may decide not to produce it or permanently drop out of the market, reducing competition.

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Welcome to the USA – home to the big pharma lobby.  Read the article – it is part of a series on the cost of medicines in the USA.

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html?ref=us

I apologize for posting a non- Italy specific tale, but hey, its my blog……

La Farmacia – Pontelandolfo’s Family Pharmacy

by midgeguerrera, posted in Any Day in Pontelandolfo, Practical Matters - Living Abroad

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Whoa – all I can think about are drugs!  With the air waves bombarded with the shut down of the American Government and all that debate over the Affordable Health Care Act – who wouldn’t think of drugs.  Medicine to keep us healthy.  Medicine to keep us sane.  Time to look into the meds that keep us sane and send some to the USA Congress.  It makes me crazy to think that  a country still exists where some retired folks stop taking medicine when they find they are in the Medicare Part D donut hole of higher profit for big pharma.  I am hoping that the Affordable Care Act – if allowed to live on and grow – addresses that too.    OK, enough politics – let’s get down to what it is like for an expat to go to the pharmacy here in Pontelandolfo.

There is only one pharmacy in our village – the sign says Farmacia.  It is not Waldgreens or CVS or any big box monolith run by employees who will never remember your name. It is simply La Farmacia – a family owned and operated small space on the Piazza Roma.  No, they do not sell soda, bread, flip flops, books or toys – there is however a condom dispenser on the nearby exterior wall.  How clever – condoms in a machine available 24/7 right out there in public!

FARMACIA PERONE DOTT. NICOLA

Piazza Roma, 1682027 PONTELANDOLFO (BN)

ORARI DI APERTURA 

Martedì  08:30 – 13:30     16:30 – 20:00
Mercoledì   08:30 – 13:30
Giovedì   08:30 – 13:30    16:30 – 20:00
Venerdì   08:30 – 13:30    16:30 – 20:00
Sabato   08:30 – 13:30   16:30 – 20:00
Domenica   chiuso
Lunedì   08:30 – 13:30   16:30 – 20:00

Before we leave for extended Italian stays we always try to stockpile medicines for my husband.  I’m lucky – I just take a blood pressure med and I made sure to get a thousand samples.  Jack takes a suitcase full of heart, cholesterol and who knows what else stuff.  What I do know is that when Jack’s Medicare Part D falls into the donut hole of death for the poor, his monthly tab for meds can be  $2,000.  Damn, my first car cost less than that.   Rats, Jack just edited this and said I am lying about the $2,000.  Ptblahhhh ( that is me sticking my tongue out at him.)  I got the breakdown for what Jack’s co-pays were before we left for Italy in April – $1718.49.  So I exaggerated a little but hey – some people don’t have $1718.49 – and that is still more than my first car.

Jack knew, before we hit the Italian hills, we couldn’t afford to buy multi-month’s worth of pills in the USA .  So, we spoke to Michelle and  Michael our fabulous local  – non corporate  – pharmacists at Raritan Apothecary.  They said – buy them in Italy – they will be a hell of a lot cheaper.

Blatant Plug – Buy Local

Raritan Apothecary

25 West Somerset Street    Raritan, NJ 08869

I will admit, my drama queen worry mamma surfaced.  What if we couldn’t get Jack all the stuff he needed?  Would I have to send him home?  Get in touch with my wild women roots and make drugs from monkwart?  The first time Jack ran out of a medicine, I brought the empty bottle to la farmacia and introduced myself to the Perone family team of Nicola and Tina, the father/daughter pharmacists who keep Pontelandolfo on a healthy path. (Yes, I did remember the Italian courtesy of saying Buon Giorno as soon as I entered the store.)

DSC02108
Tina Perone – who always said “Ciao Midge”. That doesn’t happen at CVS.

Dott. Tina Perone recognized me as Carmella’s cousin – the American who dances two nights a week with her mother.  Small villages create the art and activity they need.  Carmella had organized a bi-weekly line dancing excersize  and get together gab fest at the indoor bocce courts.   I love to dance, need excersize and wanted to meet the village women.  It was a win – win – win since it gave Tina and I an immediate connection.

Even without that connection, Jack and I would have been treated like people not numbers.  Dott. Nicola Perone took the empty bottle and then proceeded to research for an incredibly long time the formula and ingredients.  When he had the Italian perfect match he provided Jack with his meds.  We do not have health insurance for Italy.  We are not part of the Italian health care system.  We paid full retail.  Full retail that was freakin’ less than Jack’s bloody co-pay in the USA!  How the hell can that be?

Over the course of months we visited the pharmacy often.  Jack’s meds were always researched and supplied.  The one thing that cost more in Italy was Advil – ibuprofen  – one euro a pill!  Of course they only sell 400 mg of Ibuprofen – not our 200 mg bottles.   Jack needs to pack his Costco Ibuprofen or start using the Italian Spedifen!  Interesting  that vitamins weren’t pushed – apparently most people only take those vitamins that docs prescribe – like vitamin D.  That made me pause and think about how much I spend a month on supplements.

Poor Jack, he loves to walk in the noon day sun up and down the hills.  Too bad the soft corn between his toes hurt like a son of a bitch.  We went into the pharmacy to get the name of a podiatrist and the first thing Dott. Nicola said was take off your shoe.  Jack took off his shoe and Dott. Nicola looked at the giant thing between his toes.  Damn, I wouldn’t even do that and I love the guy.  He gave Jack some rubber things to put between his toes and some gunk to put on the ugly thing.  Did you catch that, the pharmacist got on his knees and checked out my husband’s toes.  You don’t see that at Walmart.

DSC02107
Dott. Nicola Perone – our fabulous pharmacist!

I am uncomfortable sharing the meds my husband takes so I will only give you one example of price point differentials.  Before we left for Italy Jack got Nexium 40mg – 90 pills – for a $311.95 co-pay or  $3.47 co-pay per pill.  In Italy for the generic exomeprazolo it cost .73 per pill retail – not co-pay. I just checked on line and the exomeprazolo 40 mg for 90 days co-pay at CVS on line comes to .55 per pill.  Retail is less than or a wee bit more than the USA co-pay.  Huh?!!! What?!!!!

Interested in learning more about Italian pharmacies  and brushing up on your Italian –

http://farmacie.tuttosuitalia.com

Le farmacie sono luoghi organizzati dallo stato ma operati da professionisti medici che vendono medicinali solitamente dietro ricetta medica. Con l’istituzione delle parafarmacie è possibile acquistare medicinali equivalenti senza ricetta medica.

Pharmacies are places organized by the state but operated by medical professionals who sell medicines usually with a prescription. With the establishment of drugstores you can buy generic medicines without prescription.  Are big box drugstores coming to Italy?  I hope not.  We did see pharmacy concessions with a separate check out in big grocery stores – kind of a grocery/Walmart store set up.

Just like I won’t shop in a Walmart in the USA and we only get medicine at a local pharmacy – Raritan Apothecary.  When in Italy, I’ll stick with going to see Dott. Nicola and Dott. Tina in our little La Farmacia on the Piazza.  La Farmacia where every “Buon Giorno” is greeted with a smile and you are served by people you can trust.