Monday, December 31, 2012

Rx in Cuenca, Ecuador

Written by Karen.
One of the biggest challenges that we faced before we left on our trip was how to ensure that Adam could continue to take his required medications.  These aren't unusual or high-risk medications, rather they are the everyday, preventative and ongoing maintenance medications that are required as a commitment to better health.   

First, I went to our medical insurance provider and asked how I could go about getting and paying for a year's supply of these required medications in advance.  To my surprise, even with the specific one-year prescriptions written by a doctor, actually getting a year's supply of prescribed medication in advance wasn't allowed by the medical insurance provider. They very nicely offered us a three-month travel supply with a certain amount of red tape, but could not extend their offer beyond a one time three-month advance.    

After I explained that we were going to be traveling for at least one year, the medical insurance provider suggested that we could have the medications mailed to us on a monthly basis.  We did explore their suggestion, but have held off on actually implementing that option for the time being.  It's complicated and expensive to ship and receive medications overseas, and we aren't always sure of where we will be to receive the package.  So that option stays as a last resort.  

The question of who was more powerful and relevant in advocating preventative medicine - the doctor or the medical insurance provider - did cross my mind on more than one occasion. It was time to explore all of our options.

I began to research other stores with pharmacies, including Wal-Mart and Target, to see what types of prescription drug plans they offered and how much it would be to purchase the required medications at retail costs.  While both of these stores offer discounted prescription drugs, several of the key medications that we needed weren't offered.  However, both of these stores offer a variety of prescription drugs at a cost of $10 for a three-month supply.  This was a good option to learn about.  

Next, I went back to our pharmacy, Walgreens, and asked if there were any discounts available when purchasing a year's supply of prescribed medication at the retail costs.  We received significant discounts using our CSAA (California State Automotive Association) card with Walgreens when we were getting our travel shots. They did have several options and we ran the numbers.  However, even with the discounts, we were looking at paying more than $2,700 for a year's supply of basic medication.  Yikes!

The pharmacist must have noticed that we turned a bit pale at this news because he leaned towards us and said, "You might want to try Costco down the street.  They usually charge about 20% less than we do."  

We weren't members of Costco yet, but went anyway and had the pharmacy run the numbers for a year's supply of prescribed medications.  Sure enough, the numbers dropped by a couple of hundred dollars, but were still too high for our budget.  We decided to go with a six-month supply on all of the medications, except for one - the most expensive - which we instead opted to purchase a three-month supply. This dropped our retail medication costs down to $722.94.  A steep price to be sure, but we felt it was a necessary cost.  We figured we would re-visit the prescription medication issue again once we were in Cuenca, Ecuador.  We had read that Cuenca had been placed on the best places to retire list for the past several years and that the level of medical care was very good there as well as affordable and accessible.

A few days ago, we started researching doctors in Cuenca with the specialty background that Adam needed.  We found several doctors in the specific area of expertise that we were looking for and went to the medical offices yesterday - Sunday - to find out what the procedure was to make an appointment.  We were told that we could either call the doctor directly on his cell phone and make an appointment, or we could drop in tomorrow morning - New Year's Eve - and make an appointment at the reception area.  

First, call a doctor directly?  On their cell phone?  We considered that option, but knew that with our limited Spanish skills we would quickly be in trouble explaining medical circumstances, and opted for the other choice. So, we set the alarm - for the first time in three months! - and walked into the medical offices at 7:59 a.m.  The receptionist called the doctor and let us know that he would be here in 15 minutes.  We had all of Adam's medical records available online for the doctor to review and Adam answered all of his questions.  The doctor wrote a prescription for the medication that Adam needed, and thirty minutes later we were out the door.  

In California, this prescribed medication cost us $496.82 for a 3-month supply, or $5.52 per pill.  In Cuenca, the same medication cost us $8.42 for a 4-month supply, or .07 cents per pill. There's something wrong here.  

The cost to visit this specialist physician was $30.00, which we paid in cash this morning. And, if Adam has any further questions on this particular topic, he can go back to the doctor at no additional charge.  It was a very professional visit - no different than any other doctor's office that I've been to - and what I especially liked....no additional tracking and accounting of co-pays or billing statements.  My other observation was that we saw a specialist physician - equal in expertise to Adam's current specialist at Stanford - and we saw him the same morning that we came in to make an appointment!  There were no lengthy waits or mountains of paperwork to complete.  

We did the responsible thing by trying to get all of Adam's prescriptions in advance, but after my experience today and now knowing what the costs are for professional medical, optical, and dental care here in Cuenca, I might do things differently in the future. 

Today we saw accessible, affordable, user-friendly and highly-professional medical care in action.  I can absolutely understand why Cuenca, Ecuador is on the short list for retirees.  In addition to its many other attributes, the idea of having reasonable options for health care is a serious and worthy consideration - for the traveler or resident alike.


Kelly said...

Karen, that cost difference is shocking! I'm glad to hear that Adam found a good doctor in Cuenca. Safe travels!

Observers of Life said...

Hi Kelly!

Great to hear from you! :) The cost difference between California and Cuenca - for both the doctor's visit and the prescription medications - was pretty surprising! In a very good way! :)


Anonymous said...

Karen- we've been pleasantly surprised at how professional and simple medical issues can be while traveling in the Americas. So far, 18 countries visited and i can say with some level of certainty that ALL of them are better than the good 'ole USA when it comes to cost & access, and typically equal in quality.

Also, next time, if you know what you are looking for from the farmacia - just go ask for it. The pharmacists are knowledgeable (and sometimes act as surrogate doctors) and often don't require a prescription.

Observers of Life said...

Hi Jason!

Thanks for the great tip on the pharmacists. I was a little surprised at how affordable, accessible and professional our interaction was with the medical profession in Cuenca. It was all about what the patient needed. We walked away pretty amazed that the overall experience and outcome was better than the process that we would have undergone in the States. It's good to know that we can expect similar experiences throughout the rest of South America.