Tag: drug prices in Italy

Culture Shock

by midgeguerrera, posted in Any Day in Pontelandolfo

Oh no, has it really been more than a month since I shared my adventures with you? Were you thinking “she must be off doing something magical.” “Maybe she is checking out the new murals in Pompeii.”

Sigh, I am staring blankly out the window clutching my wallet to my chest. We flew back to New Jersey at the end of January and ran smack into the big bad brick wall of culture shock.

cul·ture shock (Definition from Oxford Languages)

  1. the feeling of disorientation experienced by someone who is suddenly subjected to an unfamiliar culture, way of life, or set of attitudes.

WHAT! WHAT! NOOOOO!

How much???? NO! NOT THAT MUCH! HEEEEEEEEEEEEELLLLLLLLP!

HOW LONG? Where am I?????

“Jack,” I queried, “Did I become mean looking or just old and nasty? Unless I say good morning first, everyone passing us is ignoring us.” The ever logical Jack replied, ” No one in Ewing knows your name. Most people are just getting on with their lives. Not everything is about you. We aren’t in Pontelandolfo anymore.”

I really miss the cultural and personal connection that comes from a bunch of people knowing my name and hearing “ciao Midge.” Even if everyone in the pharmacy is a stranger they’ll say Buon giorno to each other. Simple welcoming phrases can put on smile on a lonely person’s face and pull me out of my doldrums.

We love to eat out and don’t need an occasion. Just the joy of – what BS – OK, at this point in my life I’d rather be creating and writing than cooking. So we do eat out a lot. Lunch every day In Pontelandolfo, home cooked with love at Bar Elimar or Ponte Simone cost me about $20 for the two of us. Often less. Out to lunch in NJ my hand trembled when I signed the credit card for a cheap two roll lunch with miso soup at a substandard sushi restaurant that cost $50 for two people. Don’t get me started about the cost of bad coffee in a cookie cutter coffee place.

I miss starting my day with a trip to Cafè Style, chatting with the owner and having him make a perfect super hot, low on foam cappuccino.

“Un euro per favore.” Yup, one euro for a perfect coffee. Since the euro and dollar are almost par you can see why I shudder at the $3.50 to $5.00 almost OK tasting cappuccinos to be found near our condo. Stop, asking If I want whipped cream! Ugggg.

And what is this “there is a 3.5% surcharge if you use a credit card?” Talk about declassè. Dear restaurant and store owner, It is the cost of doing business, raise your prices to cover the cost. Or, as the evil kid in my brain thought, are they just doing the surcharge thing to grow their profit margin and the prices already cover the surcharge. Seriously, is this just a New Jersey thing or is it happening everywhere?

I will admit if the amount I’m spending in Pontelandolfo is less than 40 or 50 euro, I pay in cash. They don’t do the up-charge but I am guessing that a fee must be there.

Don’t get me started on medical issues. Knowing the early bird gets the appointment, I started calling the doctors we wanted to see in early December. My thought was we would be able to see the doctors we have loved for years the first week we were back. Not! Calling in early December meant seeing specialists at the end of February. And all of these frustrating gate-keepers! I had a million questions about Jack’s new Italian pacemaker that obviously wouldn’t get answered until we were in the office. Using WhatsApp, I am able to communicate directly with our Italian specialists. Doctors who actually respond themselves within a day. Sigh… We are only here for a few months so I will suck it up.

“Your co-pay maam for the anticoagulant that your exceptional cardiologists in two countries feel is important to keep you from stroking out is only $500 a month.” You laugh! That is true. Being an inquisitive patient advocate, before we left Italy, I had called my New Jersey pharmacy and my medicare part D insurance provider asking what the anticoagulant pills would cost me a month. After laughing out loud and then cursing out loud, I went to my Italian pharmacy and bought retail the three months worth of pills I needed for my stay in NJ for – drum roll please – 96 euros a month or about 100 dollars a month. Other brands that our USA chums were prescribed would still cost me over $200 a month. In Italy, my universal healthcare system knows not taking the drug could kill me, therefore, like Jack’s diabetes medicine, it has no co-pay.

YES I WILL STOP WHINING! There I feel so much better just getting that last whine out of my system. You all, my delightful readers, are like extended family. And as you know, only our family ever sees us whine. (Ha ha ha.) Thank you. Grazie.

All that bitching out of my system, it is important that you know that we reallydo like being back in New Jersey. I get to see people I adore, eat food from lots of different cultures, ramble through our lovely condo building for instantaneous cocktail hours and easily enjoy lots of urban culture.

Speaking of culture – who is ready to visit Pontelandolfo in 2025?

Click here to find about both our Cooking and WRiting Programs.

Thanks for listening. I promise no more whining. Talk again soon.

Ci Vediamo

Midge

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.)

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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.

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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.