# Medical - prescriptions question



## hopers7

Hi all,

Just a quick question re: the medicals. We have ours booked in July. My husband is prescribed medication for acid reflux...will he definitely be referred and would taking a letter from his Doctor explaining why he is prescribed the medication help?

Thanks!


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## bdl123

Hi,
This may not cause a problem at all. It all depends on the cost of the drugs in NZ and the nature of the illness. I have ulcerative colitis & take one kind of medication per day...I was referred due to future prognosis of the disease ie. it's possible I may need surgery etc etc. my hubby has hypertension & takes 1 kind of medication a day & he wasn't referred. I think with something mild like acid reflux (although I'm sure it doesn't seem mild when an attack strikes..in terms of illness/disease it is relatively complication free) I'm sure things will be fine, and even if you are referred I wouldn't imagine it causing too much of an issue. If you are using a migration agent ask them their opinion! Hope all goes well.

Sent from my iPhone using ExpatForum


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## hopers7

bdl123 said:


> Hi,
> This may not cause a problem at all. It all depends on the cost of the drugs in NZ and the nature of the illness. I have ulcerative colitis & take one kind of medication per day...I was referred due to future prognosis of the disease ie. it's possible I may need surgery etc etc. my hubby has hypertension & takes 1 kind of medication a day & he wasn't referred. I think with something mild like acid reflux (although I'm sure it doesn't seem mild when an attack strikes..in terms of illness/disease it is relatively complication free) I'm sure things will be fine, and even if you are referred I wouldn't imagine it causing too much of an issue. If you are using a migration agent ask them their opinion! Hope all goes well.
> 
> Sent from my iPhone using ExpatForum


Thanks for that, it's reassuring. Hopefully since it's only one medication and apparently the most prescribed in uk if he is referred then it shouldn't take too long. We're time restricted by a job offer! We haven't got a migration agent, thought we'd save the money as application seems straight forward as applying for the talent accredited employer work visa and for my hubby a partnership work visa. Fingers crossed!


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## G-Mo

Acid reflux will likely be referred to the MA. Contrary to the poster above, acid reflux is not mild and can lead to significant additional gastrointestinal issues including surgery and Barrett's esophagus (a form of cancer). Depending on the information provided, they may request an endoscopy or a colonospy or both. What medicine is he on?


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## hopers7

G-Mo said:


> Acid reflux will likely be referred to the MA. Contrary to the poster above, acid reflux is not mild and can lead to significant additional gastrointestinal issues including surgery and Barrett's esophagus (a form of cancer). Depending on the information provided, they may request an endoscopy or a colonospy or both. What medicine is he on?


Hi, 

He's on 40g of esomeprazole.


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## G-Mo

hopers7 said:


> Hi,
> 
> He's on 40g of esomeprazole.


I assume you mean 40mg, not 40g. Esomeprazole, also known by the brand name Nexium, is a second generation proton pump inhibitor. You should be concerned if he's regularly taking 40mg, as this is a healing dose, not a maintenance (20mg) dose. Regardless, it's a very expensive drug ($100/month) and last time I checked wasn't available in NZ; they will have an alternate, I don't know what the pricing on the NZ approved alternative will be. How old is your husband, it's foreseeable that this perscription over the cost of his lifetime could easily break the $25,000 threshold.


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## hopers7

G-Mo said:


> I assume you mean 40mg, not 40g. Esomeprazole, also known by the brand name Nexium, is a second generation proton pump inhibitor. You should be concerned if he's regularly taking 40mg, as this is a healing dose, not a maintenance (20mg) dose. Regardless, it's a very expensive drug ($100/month) and last time I checked wasn't available in NZ; they will have an alternate, I don't know what the pricing on the NZ approved alternative will be. How old is your husband, it's foreseeable that this perscription over the cost of his lifetime could easily break the $25,000 threshold.


Yes sorry, missed a key. He's 33. In 2003 he was on 30mg of lanzoprazole after the 10mg wasn't suffient. Was later prescribed omeprazole and has been on esomeprazole 40mg for about 4 years. Is funding it ourselves not an option?

The visa we're applying for is 2 years then after we'd be looking at applying for residency...


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## G-Mo

hopers7 said:


> Yes sorry, missed a key. He's 33. In 2003 he was on 30mg of lanzoprazole after the 10mg wasn't suffient. Was later prescribed omeprazole and has been on esomeprazole 40mg for about 4 years. Is funding it ourselves not an option?
> 
> The visa we're applying for is 2 years then after we'd be looking at applying for residency...


No, you cannot fund it yourself, it's not even an option.

At 33, even with a projected life expectancy of 73, if the NZ equivalent is similar in cost to esomeprazole you are looking at well over $25,000.


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## hopers7

G-Mo said:


> No, you cannot fund it yourself, it's not even an option.
> 
> At 33, even with a projected life expectancy of 73, if the NZ equivalent is similar in cost to esomeprazole you are looking at well over $


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## G-Mo

You should for sure apply, but, someone who has been taking a healing dose for 4 years plus has a long history of gastrointestinal issues -- your husband has G.E.R.D., not just acid reflux -- is going to be referred to the MA for sure.


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## hopers7

G-Mo said:


> You should for sure apply, but, someone who has been taking a healing dose for 4 years plus has a long history of gastrointestinal issues -- your husband has G.E.R.D., not just acid reflux -- is going to be referred to the MA for sure.


Yeah, I'm sure we will still. Just a lot of money if from what you say it seems the likely answer would be no. you seem to know a lot about the issue, have you had experience of similar problems with nz visa application? If so what was the outcome?


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## G-Mo

hopers7 said:


> Yeah, I'm sure we will still. Just a lot of money if from what you say it seems the likely answer would be no. you seem to know a lot about the issue, have you had experience of similar problems with nz visa application? If so what was the outcome?


I had to take Nexium once for a few weeks, I have a family member who takes it regularly. I was slightly overweight at the time I took it and lost the extra pounds and modified my lifestyle and haven't needed it since. My father-in-law is an executive for PHARMAC in NZ. I'm married to a Kiwi, I had no problems with my application, all my health stuff was normal, and the one time use of Nexium they didn't blink at (no referral), although it had been a number of years previous, as a result my application only took 3 weeks.


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## topcat83

G-Mo said:


> I assume you mean 40mg, not 40g. Esomeprazole, also known by the brand name Nexium, is a second generation proton pump inhibitor. You should be concerned if he's regularly taking 40mg, as this is a healing dose, not a maintenance (20mg) dose. Regardless, it's a very expensive drug ($100/month) and last time I checked wasn't available in NZ; they will have an alternate, I don't know what the pricing on the NZ approved alternative will be. How old is your husband, it's foreseeable that this perscription over the cost of his lifetime could easily break the $25,000 threshold.


Hm... To me 40mg is a maintenance dose. Hubby is on 40mg a day of Omeprazole (which I assume is the same drug) just to make sure that if he has a heart attack he knows it's not indigestion!

BTW, a 3 months prescription is costing him $3 NZD, which has been subsidised from the 'normal' cost of $10.63. I'm reading that directly off his prescription - so I'm not sure where the hundreds of dollars is coming from!. 
(PS Shock-horror the prescription charge is going up to $5 NZD soon - wonder if we'll be able to afford it? )


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## hopers7

topcat83 said:


> Hm... To me 40mg is a maintenance dose. Hubby is on 40mg a day of Omeprazole (which I assume is the same drug) just to make sure that if he has a heart attack he knows it's not indigestion!
> 
> BTW, a 3 months prescription is costing him $3 NZD. Shock-horror it's going up to $5 NZD soon!


Hi Topcat,

You have revived my optimism, thank you. Yes it is the same. Reason he changed to esomeprazole was because he needed 40mg of omeprazole but in uk - mayb not now as been 4years - but at time they only did 20mg tabs so cost would have been double for NHS compare to to switching him to esomeprazole. So at 5dollars a go, unless he lives an excessively long time it's not going to pass the 25k number is it?

He's actually looking at reducing it anyway as has made a lot of life style changes, cutting out foods, losing weight and going to gym....the change would be to omeprazole again.

Think we he see's the doctor, we'll ask for a letter explaining is medication etc.

Thanks again Topcat!


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## hopers7

hopers7 said:


> Hi Topcat,
> 
> You have revived my optimism, thank you. Yes it is the same. Reason he changed to esomeprazole was because he needed 40mg of omeprazole but in uk - mayb not now as been 4years - but at time they only did 20mg tabs so cost would have been double for NHS compare to to switching him to esomeprazole. So at 5dollars a go, unless he lives an excessively long time it's not going to pass the 25k number is it?
> 
> He's actually looking at reducing it anyway as has made a lot of life style changes, cutting out foods, losing weight and going to gym....the change would be to omeprazole again.
> 
> Think we he see's the doctor, we'll ask for a letter explaining is medication etc.
> 
> Thanks again Topcat!


Sorry, been corrected by hubby, it's not same but sim!


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## bdl123

Hi again,
I apologise for assuming that your husbands condition was mild. I took it as he was managed by his GP & not a GI Specialist. I still believe that it may not cause as much of an issue that you are being led to believe. 
TopCat is correct in that Omeprazole & Esomeprazole are similar..virtually the same actually, both proton pump inhibitors and used for similar symptoms. The main difference are more of the prescribed dose is absorbed with Esomeprazole than Omeprazole but there are more side effects too.
I too have a parent who takes 40mg a day prescribed by her GP for a complaint of 'burning sensation in her throat'! She too started on other forms but with no success. She has never had an endoscopy, and has never seen a GI specialist. I work in an Intensive Care Unit & Esomeprazole is given as a prophylaxis treatment when patients are expected to be NBM for any length of time...to basically protect the lining of their stomach & oesophagus from excess acid...which is most patients everyday!
As stated earlier I suffer from Inflammatory Bowel Disease & I was referred to a medical assessor who initially stated I didn't have a 'satisfactory level of health' to be granted a visa as the cost of my meds, specialist input, regular colonoscopys & hospital check ups would be far greater than the $25k...we disputed this (with numerous letters from my GI Specialist in the UK) until immigration asked for a GI guy in NZ to look at my case who, not surprisingly agreed with my GI guy!!! I was then granted a residency visa! My drug apparently costs $50 per month on maintenance dose in NZ that can double during flare ups! My disease is pre-disposing to bowel cancer & quite often requires major abdominal surgery to relieve symptoms. Hopefully i will never need to follow this path but I was never once asked to have a colonoscopy done. I can't quite see how a colonoscopy would be of any use to your husband as it looks purely in the colon (large intestine)!!!
My husband has hypertension which is a massive contributory factor in heart disease..the biggest cause of deaths in NZ every year, he was not referred to a medical assessor.
Please don't shelve your application...every individual is different but I am proof that you can always 'argue your side'! Our immigration agent told us she had a previous client accepted who was actually suffering from cancer at the time...so there's always a chance it won't become a problem, even if it's an issue. Good luck and keep us posted x

Sent from my iPhone using ExpatForum


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## G-Mo

Omeprazole is a first generation proton pump inhibitor, commonly known as Losec, which is now generically produced at a significantly reduced cost. Esomeprazole is a second generation proton pump inhibitor that only recently had it's patent expire and is just now starting to be produced generically; both the original (Nexium) and generic version are still very expensive. Along with that, is the underlying medical condition and future associated costs...

BTW, $5 a go is the dispensing fee, not the cost to the NZ government to buy and supply the drugs.


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## hopers7

bdl123 said:


> Hi again,
> I apologise for assuming that your husbands condition was mild. I took it as he was managed by his GP & not a GI Specialist. I still believe that it may not cause as much of an issue that you are being led to believe.
> TopCat is correct in that Omeprazole & Esomeprazole are similar..virtually the same actually, both proton pump inhibitors and used for similar symptoms. The main difference are more of the prescribed dose is absorbed with Esomeprazole than Omeprazole but there are more side effects too.
> I too have a parent who takes 40mg a day prescribed by her GP for a complaint of 'burning sensation in her throat'! She too started on other forms but with no success. She has never had an endoscopy, and has never seen a GI specialist. I work in an Intensive Care Unit & Esomeprazole is given as a prophylaxis treatment when patients are expected to be NBM for any length of time...to basically protect the lining of their stomach & oesophagus from excess acid...which is most patients everyday!
> As stated earlier I suffer from Inflammatory Bowel Disease & I was referred to a medical assessor who initially stated I didn't have a 'satisfactory level of health' to be granted a visa as the cost of my meds, specialist input, regular colonoscopys & hospital check ups would be far greater than the $25k...we disputed this (with numerous letters from my GI Specialist in the UK) until immigration asked for a GI guy in NZ to look at my case who, not surprisingly agreed with my GI guy!!! I was then granted a residency visa! My drug apparently costs $50 per month on maintenance dose in NZ that can double during flare ups! My disease is pre-disposing to bowel cancer & quite often requires major abdominal surgery to relieve symptoms. Hopefully i will never need to follow this path but I was never once asked to have a colonoscopy done. I can't quite see how a colonoscopy would be of any use to your husband as it looks purely in the colon (large intestine)!!!
> My husband has hypertension which is a massive contributory factor in heart disease..the biggest cause of deaths in NZ every year, he was not referred to a medical assessor.
> Please don't shelve your application...every individual is different but I am proof that you can always 'argue your side'! Our immigration agent told us she had a previous client accepted who was actually suffering from cancer at the time...so there's always a chance it won't become a problem, even if it's an issue. Good luck and keep us posted x
> 
> Sent from my iPhone using ExpatForum


Hi,

No apologies required! He is under the care of his GP and not a GI. He saw a GI about 4 or 5 years ago and was referred back to his GP with no follow ups etc required. 

Thank you for the reassurance! We will definiately apply and see what happens...hopefully we'll be posting on here in a few months with a success story!


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## topcat83

G-Mo said:


> Omeprazole is a first generation proton pump inhibitor, commonly known as Losec, which is now generically produced at a significantly reduced cost. Esomeprazole is a second generation proton pump inhibitor that only recently had it's patent expire and is just now starting to be produced generically; both the original (Nexium) and generic version are still very expensive. Along with that, is the underlying medical condition and future associated costs...
> 
> BTW, $5 a go is the dispensing fee, not the cost to the NZ government to buy and supply the drugs.


No - the other figure I quoted of $10.63 was the 'unsubsidised cost' - according to the prescription which shows both costs, including an unsubsidised cost of over $100 for one of his other drugs. 

And I think it's up to a health professional who is actually seeing the patient to comment on the seriousness of the underlying medical condition - not us, based on one drug that is being taken.


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## G-Mo

topcat83 said:


> No - the other figure I quoted of $10.63 was the 'unsubsidised cost' - according to the prescription which shows both costs, including an unsubsidised cost of over $100 for one of his other drugs.


Unless you are buying your pills in 12 packs, $10.63 is not the cost for the NZ government. As I said, my father-in-law is an executive with PHARMAC so I probably have a little more insight into the costs and methodogies of drug purchasing for NZ than someone who didn't know 4 posts ago that esomeprazole and omeprazole were different drugs.


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## topcat83

G-Mo said:


> Unless you are buying your pills in 12 packs, $10.63 is not the cost for the NZ government. As I said, my father-in-law is an executive with PHARMAC so I probably have a little more insight into the costs and methodogies of drug purchasing for NZ than someone who didn't know 4 posts ago that esomeprazole and omeprazole were different drugs.


I can only go by what the prescription said. It was for 90 capsules (3 months). And regardless of the cost, my comment about it's up to a health professional who is actually seeing the patient to comment on the seriousness of the underlying medical condition - not us - doesn't change.


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