Mabthera/Rituxan/Rituximab in Australia

Hi,

I was diagnosed with ITP in 2000, had a splenectomy in 2000, and was on high dose cortisone for years.

Approximate 5 years I ago I tried Mabthera which was successful and I went into remission for approximately 2 years. I then tried Mabthera second time and have been in remission ever since. I had a lot of trouble getting my medical aid in South Africa to authorise and pay for this treatment.

I am now considering moving to Australia. Does anyone know which private medical insurance (if any) would cover Mabthera/Rituximab/Rituxan in Australia? I can only consider the option of immigrating if I know. I have tried phoning a couple of medical aids, but I get to speak to some sales consultant and I don't feel comfortable with their knowledge.

Are there any Australians on this board that can help me find out this information or tell me their experience and difficulties with getting Mabthera treatment for ITP in Australia? Is there a preferred Medical Aid I should be considering?

Hi, first of all Welcome, sorry u have had to find this site, but you will find lots of information and support here. Instead of responding to your email, i'll just answer you here, Yes I am from Australia and i think the best place for you to start out is the Medicare Australia website. It is www.medicareaustralia.gov.au . It gives some very good information on the medicare system and the Pharmaceutical Benefits Scheme.

I believe Mabthera is on the PBS, but not for ITP. I believe at the moment it is only on the PBS for Rheumatoid arthritis and for certain types of cancer. If it is not on the PBS then you do have to pay more for the prescription.

I have not had mabthera, so i can't really comment if it is difficult to to get, but i was treated with Nplate earlier in the year and it is also not on the PBS and my doctor got me into this program where the drug company paid for the treatment. I still had to pay about $30 Australian dollars every week though for the presciption. There was a strict guideline that you had to meet before they allowed me to go on it though. I think there maybe something similar to that with Mabthera, but i obviously couldn't guarantee you would qualify for it as it is a case by case thing.

Regarding Private insurance companies, i don't know if they would cover the cost of it, i didn't really have to look into that as like i said it was organised and paid for by the drug company. You would really have to reseach the insurance companies here on the net and maybe contact them and speak to them about it. I don't have a lot of experience with what they will or won't cover in regards to medications and treatments as apart from the nplate, i have never really had to deal with that before.

I hope I have been able to help you a little and don't hesitate to ask me anything else. I may not always know the answer, but i maybe able to point u in the right direction.

Hi. Mabthera is not on the PBS for ITP. Its there for lymphoma and Rheumatoid arthritis.

I do not mind paying a little more, but its quite expensive and so could not afford the whole thing.

I have phoned two medical aids (Medibank and Australian Unity), where the Sales Consultants said they thought it was covered, but I certainly did not get any warm and fuzzy feeling they really had a clue about what they were talking about.

There might a be strict guideline, but I had to get past a strict guideline to get it here too. I have had a splenectomy and cortisone does not work on low doses and my count can drop to 2. Also I now have evidence that it works for me; which should get me past any strict guideline. If I could find that guideline for the different medical aids that would be great; but just phoning the medical aids is not working for me.

I have also contacted a family friend who is a doctor in Australia and asked him if he could try and find out for me, and am awaiting his reply.

Are you on medicare? Or a private medical insurance?

Thanks for reply! I appreciate any input from Australians.

I do have Medicare, but I also have my own private health insurance.

Have u heard back from your doctor friend or made any more headway on what you are going to do. I don't want to pry, but I am interested seeing as how u have made you intentions known that u would like to move to Oz.

Sadly I have not heard back.

(Assuming I come on a permanent visa)

My current understanding is that I would have medicare by default to cover my ITP and a year's long wait for a private medical insurance to cover my ITP. I do not have much worry that one of the private medical insurances will provide Mabthera based on my medical history. It is proven to be effective with me; whilst the splenectomy and cortisone did not help. I don't have proof of this assumption; but Australia is first world isn't it?

But I am very concerned about the first year. I am thinking about investigating how much it would cost me for my current South African medical aid to cover me for that first year.

I am very frustrated with the difficulty in finding information on this.

Hi There,

I am also in Australia and have been living with ITP for close to 5 years now.
About a year after I was diagnosed, I was given Mabthera as part of a clinical trial.
I'm not sure if it was on the PBS then but the costs were covered by the drug company.
I had a nasty reaction to it but it did put me in remission for over a year.
After the effects wore off, the doctors were hesistant to give me another dose due to my reaction, but from general discussions, it did seem possible for me to get some more if I had no other options.
I was on and off pred for another year or so before starting on Nplate just a couple of weeks ago.

So I guess it depends on your doctor and your individual condition. I think you will need to talk to a haematologist here before you can get a more definite response, they will know about the system and who can qualify for what.

In terms of private health insurance. I doubt they would be able to cover any costs (especially in the first year or two) because they have a pre-existing illness exclusion clause. Also from what I understand, it's not just the cost of the drug (which is quite expensive) but also the cost of adminstering it, you will need to be monitored and given a hospital bed which could end up costing more than the drug it self in private hospitals.

Are you planning on visiting Australia before coming to live here permanently? I think the best thing would be for you to discuss this with a doctor here first to find out your options, the rules change all the time even for those of us living here so I think you will struggle to find a lot of information from where you are.