Utah insurer launches plan to send patients to MEXICO to pick up cheaper prescription drugs

Utah patients may soon be prescribed a free trip to Mexico rather than to their local pharmacy.

The controversial move launched on Tuesday by insurer PEHP Health and Benefits is designed to help patients with MS, arthritis, psoriasis, Crohn’s and other chronic diseases get hold of cheaper prescription drugs.

The company, which provides insurance to 170,000 Utahns, plans to pay for patients to fly to San Diego and drive across the border to get their medications from Tijuana, where manufacturers offer more affordable deals for 13 commonly-prescribed drugs.

On top of the free trip, patients are being offered a $500 cash hand-out as an incentive.

Many of the drugs require four prescriptions a year – which could mean four trips and a $2,000 dollar reward for patients who choose the voluntary offer.

Chet Loftis, managing director of PEHP, says medical tourism is hardly new – the company is simply jumping on a well-oiled bandwagon. 

Pharmacies in Tijuana, Mexico, have been marketing to US customers for years (such as this one pictured in 2006). Now, a Utah insurance company is offering patients a free trip to take them up on those offers

While a one-month supply for the MS drug Avonex costs $6,700 in the US, it is around $2,200 in Tijuana.

‘According to our calculations, the drugs we are looking at cost about $13,500 for a ninety-day supply,’ Loftis said.

‘We can fly a health plan member to San Diego, have them picked up by private transport, receive the same drug as they would in the US from a hospital in Tijuana that meets US standards, give them a cash back incentive of $500, and still save between 40 to 60 percent for the employer.’

The new program, dubbed the Pharmacy Tourism Program, is one option in a broader cash-back incentive scheme launched on Tuesday. 

It comes after a bill passed in the 2018 Legislative Session ordered insurance companies to offer state employees lower cost options and share the savings in the form of cash.

For around a dozen drugs, a trip to Mexico qualifies as a lower cost option. 

Though Loftis expects the list of qualified drugs to ‘evolve’ over time, it is currently limited to these: 

  • Ampyra (for multiple sclerosis)
  • Aubagio 14mg (for multiple sclerosis)
  • Avonex (for multiple sclerosis)
  • Copaxone 40mg (for multiple sclerosis)
  • Enbrel 25mg, 50mg (for arthritis and psoriasis)
  • Forteo (for osteoporosis) 
  • Gilenya (for multiple sclerosis)
  • Humira 40mg maintenance pack (for arthritis, psoriasis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis)
  • Orencia (for rheumatoid arthritis)
  • Otezla (for psoriasis and psoriatic arthritis)
  • Stelara 45mg/0.5ml (for plaque psoriasis and psoriatic arthritis)
  • Tecfidera (for psoriasis and multiple sclerosis)
  • Zytiga 250mg (a hormone based chemotherapy for prostate cancer)

According to Loftis, members who want to make the trip will be screened to make sure that travel is appropriate. 

‘We have seen some interest but no one has gone yet,’ he said. 

‘We look at this as a small way to help reduce costs for members and employer groups that is part of larger effort of sharing savings back with members in concert with HB 19.

‘We have a number of drugs that qualify for Cash Back that are available here in Utah and do not require a trip to Mexico.’ 

PEHP Clinical Services Director Travis Tolley added: ‘The prescription drugs received in Mexico are the same quality and from the same manufacturer as those sold in the US.’    

Read more at DailyMail.co.uk