PPI for cost of medicine??!?!?

[SueDonim]

I just received a PPI due to cost of medicine for blood pressure, allergies, and a couple other minor issues. A few of the medicines are optional, but the MA said the cost was too high. I'm not sure what to do now.

I did my own app. I thought it would be a slam dunk so this hit me like a ton of bricks.

Should I get a consultant or lawyer? Can they really add value on an issue like this? How do I find a good one?

I'm thinking of going to my doc to get different (cheaper) meds prescribed, but not sure if that is worthwhile.

I should (IMHO) be able to get a waiver, but then I thought I would sail through anyway.

I am lost as to what to do (other than pray a lot)

[Arbutus]

How high is too high?

[SueDonim]

In US$, spending $4800 / yr (so about NZ$6850 / yr).

However, most of that is optional therapy. Necessary are about US$1900 / yr (or NZ$ 2700 / yr)

Granted, it is a lot. On the other hand, I am likely to have a very high (at least by NZ standards) salary. They would make far more in taxes off me than I would cost the medical system. And frankly, I would get private insurance anyway, though I don't think they can consider that.

Trying to figure out the strategy, and if a consultant could help. Perhaps re-prescribe cheaper medicine?

Else, given pretty high net worth and salary likelihood, would this get waived?

BTW, is the magic number NZ$25,000 over 4 years or over lifetime (which seems asinine)? I see references to both.

[Jo Jo]

BTW, is the magic number NZ$25,000 over 4 years or over lifetime (which seems asinine)? I see references to both.

Here's what it says in the NZIS operational manual:

A4.10.1 Assessment of whether an applicant for residence is unlikely to impose significant costs on New Zealand's health services

1. The requirement that an applicant for residence must be unlikely to impose significant costs on New Zealand's health services is not met if, in the opinion of an Immigration New Zealand medical assessor, there is a relatively high probability that the applicant's medical condition or group of conditions will require health services costing in excess of $25,000.
   
   Note: Assessment will be in terms of current costs with no inflation adjustment.
   
2. In the case of acute medical conditions, the medical assessor will provide an opinion on whether there is a relatively high probability that the condition or group of conditions will require health services costing in excess of NZ$25,000 within a period of four years from the date the assessment against health requirements policy is made.
   
3. In the case of chronic recurring medical conditions, the medical assessor will provide an opinion on whether, over the predicted course of the condition or group of conditions, there is a relatively high probability that the condition or group of conditions will require health services costing in excess of NZ$25,000.

[SueDonim]

Thanks. I guess that's where I am getting confused.

Still seems odd that the limit on acute condition is same as for chronic. After all, $25,000 for someone with a 25 year life expectancy (for example, mine is longer) is only $1000 / year. Doesn't take much to hit that limit.

But an acute condition has a $6250 / year limit ($25,000 / 4)

[JandM]

Sorry about the wall you've hit. As with all the regulations, this one is what it is, and the next thing is to look for a way round. You've said yourself, you think you can get a different prescription, leaving out some of the medications and in other areas, giving you cheaper ones - that seems like a good first step. If you tell your CO that you're doing that, you could ask at the same time what s/he would recommend as your next step. People on the forum before have had their CO re-present their medical to the MA, or recommend that they seek a medical waiver.

Here's the part of the operations manual talking about medical waivers - the sidebar of the same page has more information about different aspects of medicals which may be of interest. http://www.immigration.govt.nz/opsmanual/i5575.htm

[SueDonim]

Thanks to everyone for their help. On another thread, someone mentioned the problem may be I am using US drug prices. Good idea. I was.

- Does anyone know where I can find prescription drug prices in NZ? Not able to find it on-line.
- Also does anyone know if Telfast (fexofenadine) requires a prescription in NZ? I think it does not, but can't tell

[sophiedb]

There is a pharmacist on this forum someplace, just arrived in NZ from the US. He would probably be able to help... Paging Doc Mike (aka 72andsunny)!

(he'll be about somewhere, but still settling in so I presume not checking here every day or anything)

[Arbutus]

Try this

http://www.pharmac.govt.nz/Schedule/...lePublications

[72andsunny]

There is a pharmacist on this forum someplace, just arrived in NZ from the US. He would probably be able to help... Paging Doc Mike (aka 72andsunny)!

(he'll be about somewhere, but still settling in so I presume not checking here every day or anything)

Sorry all, I've been without the internet for the last week or so.

RE prices: Try this link which goes directly to the current schedule. http://pharmac.govt.nz/2010/03/01/Schedule.pdf (Search for your medication, there will be a price to the right of it and a "per column"; eg: carvedilol 25 mg is $33.75 per 30 tabs.) Consider these the wholesale prices; there's also GST + pharmacy markup...if you multiply by 1.8 you're about at the actual cost.

Must run back to work. Sue, if you want to PM me a med list, I can try to sort through some approximate costs (and let you know what you can't get in NZ).