457 Visa on Humira for Crohn's

[Heatherhb]

Hi, 

I am a US citizen and my company has asked me to transfer to Sydney on a 457 visa in the couple months (yes, they plan to meet the March 2018 deadlin). I have Crohn's and have been in remission with no flair-ups since 2008 - thanks to Humira. Based on some of the info I've been reading on here, it seems like it may be difficult for me to get the 457 visa based solely on the fact that I take Humira. My company will be paying for me to work with an immigration lawyer to work through the visa process, so assuming I pass the medical and get the 457 visa - I'm trying to understand a few things about the health care system in Australia for someone on private health insurance on a 457 visa. And I'm hoping this forum can help me out. Thanks in advance!

1. I've read on here that it can be difficult to get a prescription in Australia for Humira - would that be the case for me since I've been on it for so long already? I'll have my medical notes from my US specialist for the past five years with me. 
2. I'm also trying to understand the physical cost of Humira/month in Australia. According to the PBS website Humria (2 40mg syringe = 1 month supply)  is listed as having a DPMQ of $1,401/month....but is that really what I would pay? Or since I'd be on private insurance, would it be even more? 
3. I've looked into private health insurance and even the most comprehensive plan I've found will only cover up to $600 of prescription costs for prescriptions given by a specialist or non-hospital related prescription. Are there any health insurance plans that help cover more of the costs for these types of drugs? Or is $600 typically the max?
4. In the US, AbbVie (teh maker of Humria) has a patient assistance program that helps cover the cost of Humira (even for people with moderately good health insurance), does anyone know if there is a similar program in Australia? And if people on a 457 Visa are eligible? 

Thanks again! 

[ali]

PBS price is about $35 per item - so you'll pay that for the 2 injections 

I'd recommend bringing something from your specialist/Dr so that your GP has sufficient information about your condition.

AbbVie do have an Australian website - they would probably be able to give you more information.

[Kevin Ring]

Hello, I recently went through a similar situation, so I think I can help clarify a few things for you...

As a condition of your 457 visa, you'll be required to have "overseas visitors cover", which is private health insurance but is much different from what most Australians think of as private health cover.  Private health cover in Australia is usually a supplement to the government-provided Medicare system.  But a person on a 457 is not eligible for Medicare at all, so your health cover will be entirely private.  There's a decent chance your employer will provide overseas visitors cover, but, if not, it's not as expensive as what you're used to in the US.  I used Bupa and was happy with them, so check out https://www.bupa.com.au/health-insurance/cover/overseas-visitors (though there are other companies as well).

The first problem you'll face is there there's a 12 month waiting period for pre-existing conditions, meaning they won't cover your Crohn's for the first 12 months.  You can get around this, though, by getting a "clearance certificate" from your current (US) insurance company proving that you've had continuous coverage for the year before moving to Australia, and then sending that to your new (Australian) insurance company.

Next, you'll probably find that many doctors in Sydney have little to no experience with overseas visitors cover.  That means you'll be paying out of pocket then moving a claim yourself directly with your insurance company. It's a hassle, but not too bad once you get the hang of it.

Your doctor will probably need to go through a pretty substantial process to get approval for a biologic drug like Humira, though. It won't hurt to call / email around before you arrive to find one who is willing to take you on. It will be a fair bit of work for them.

One thing I'm not sure of is how a self-administered injectable like Humira will work, because, as you said, there's usually a $600/yr limit on pharmaceuticals.  One thing I do know is that this does not present a problem (other than the process of getting it approved) for medications given by infusion (e.g. rituximab, infliximab) because these are given in a hospital and so the limit does not apply.  You might try calling up your insurance company and asking them; I found them to be surprisingly helpful over the phone.  Or this might be a good question for the sympathetic doctor above.

I don't think you'll have trouble getting approved for the 457 since the government will not be covering your healthcare costs anyway.  You probably will have trouble applying for permanent residency in the future, though, as the health requirements there are much more strict.

Hope this helps,

Kevin

[Heatherhb]

Thank you, Kevin. That was very helpful! I really appreciate the note about the "clearance certificate" and looking for a doctor ahead of time. This makes me feel better about the process at least. 

[Tryingtomovetoboo]

Heather,

I am in a similar situation to you, could you please give an update if you were able to get humira reimbursed by the private insurer?

 

 

[Marisawright]

2 hours ago, Tryingtomovetoboo said:

Heather,

I am in a similar situation to you, could you please give an update if you were able to get humira reimbursed by the private insurer?

 

 

Unlike the US, Australian private insurers do not decide whether to reimburse for medications on a case-by-case basis.  If your private insurance includes cover for prescriptions, they will have fixed rules which automatically apply to everyone who is insured with them.

So all you need to do is ring the private insurance company and ask them.