Any health bureaucrats from the EU on the list? Need to deal with a bureaucratic issue to stay 6-8 months in Spain

[Former member 91017]

Hi all;

I am aiming to spend my coming sabbatical in Spain, walking various camino routes, and having a home-base in Galicia.
When I last had extended sabbatical time in the EU I was not yet taking a monthly biological injection.

I have an EU passport, am an Irish citizen.

I work and live in Canada and have private health insurance BUT:

My private insurance company will not provide me with the doses I need to leave Canada with. The drug is very expensive here and they won’t pay several thousand dollars of coverage up front for me to take several months’ worth with me to Spain.

My drug is certified in the EU to be self-administered (Xolair) so if I can find a way to receive the doses in Spain, I can do that and then resume treatment under my current coverage when I return to Canada.

Does anyone know if EHIC covers Xolair/Omalizumab costs in Spain?

Does anyone know if I apply to Spain for EHIC in order to have my medical care there as a resident while I am based there? Or do I apply to Ireland even though I will reside in Galicia somewhere?

My ultimate goal is to purchase a home and to move to Spain in July of 2023. My current plan is to arrive January 1, 2022 and I can stay for as long as I want (up to when I have to resume regular work on September 10th back in Canada).

I just don’t really know where to start (I’ve started with the obvious with my private insurance provider). But becoming a sabbaticant resident in Spain as an EU citizen would be a whole new thing.

If I can’t find a way to do this, I will either have to fly to Canada every 6 weeks to have my shot (annoying and expensive, but maybe not as expensive as trying to obtain the drug in Spain), or lose my coverage and return to having really awful hives and asthma that limit my daily life in significant ways. I am willing to consider flying every 6 weeks because the EU passport means I can purchase 1-way tickets (which is way cheaper). Still… it could get to a point of being unaffordable for me to do it that way… so I’d rather not have to, obviously.

If there are any health system bureaucrats out there in the EU, I’d really appreciate some direction here.

 

[Kathor1]

@Faye Walker, you need to sort this out with the health authorities in Spain.

Forget about EHIC. This card is only of interest if you are already covered by/a member of a health insurance system in the EU country where you live and WHILE you are on a trip in a different EU country. You never need your EHIC card while you are in the EU country where you live.

In order to be covered by the health insurance system in Ireland you need to be a resident in Ireland.

There are no EU wide rules about whether a medication is totally or partially reimbursed. This is entirely up to each individual EU country and their health insurance system(s).

 

[henrythedog]

Whilst it wouldn’t be my first choice route for obtaining prescription-only-medication the drug you’re wanting is available online in the uk at a ‘bargain’ £280 per dose. There may well be Spanish options also

Buy Xolair online in UK - Pharmacy Ordering | Xolair Price

Visit us to order or buy Xolair online in UK. View the price of Xolair offered by our UK based pharmacy and order without prescription. Find out more about Xolair.

www.onlinemedix.net

 

[Former member 91017]

@Faye Walker, you need to sort this out with the health authorities in Spain.

Forget about EHIC. This card is only of interest if you are already covered by/a member of a health insurance system in the EU country where you live and WHILE you are on a trip in a different EU country. You never need your EHIC card while you are in the EU country where you live.

In order to be covered by the health insurance system in Ireland you need to be a resident in Ireland.

There are no EU wide rules about whether a medication is totally or partially reimbursed. This is entirely up to each individual EU country and their health insurance system(s).

Yeah, I won’t be living in Ireland. Living in Spain. But the rest of your answer is super helpful. Thanks. I will write to the Spanish embassy to see what I need to do about having health coverage while I am in resident in Spain, I guess.
I cannot see myself trying to take the time required to find a permanent home in Spain if I can’t take my medications regularly while there for 6-8 months doing the search.…

 

[Former member 91017]

Whilst it wouldn’t be my first choice route for obtaining prescription-only-medication the drug you’re wanting is available online in the uk at a ‘bargain’ £280 per dose. There may well be Spanish options also

Buy Xolair online in UK - Pharmacy Ordering | Xolair Price

Visit us to order or buy Xolair online in UK. View the price of Xolair offered by our UK based pharmacy and order without prescription. Find out more about Xolair.

www.onlinemedix.net

Thank you. I went immediately to the site: no stock available.

 

[SioCamino]

Would you investigate the cost (and possibility) of purchasing the drug in Spain? It does look like a fairly expensive drug but i would imagine that regular flights back to Canada would cost a fair bit in terms of money, time, energy, environmental costs etc etc. I have purchased prescription drugs in Spain with a script from my domestic doctor. Hope this is of help.

 

[Former member 91017]

Would you investigate the cost (and possibility) of purchasing the drug in Spain? It does look like a fairly expensive drug but i would imagine that regular flights back to Canada would cost a fair bit in terms of money, time, energy, environmental costs etc etc. I have purchased prescription drugs in Spain with a script from my domestic doctor. Hope this is of help.

Yes; I will try to figure that out. What I need is the purchase cost in order to find out. The price to beat in terms of my current coverage is $1500 a month in Canadian currency. I can fly home and back for half that… But if I can purchase in Spain for something on par with £280 GBP, then that would be better Still.

 

[MinaKamina]

Private insurance will probably not cover pre-existencias, pre-exisitng conditions like yours.

Seguridad Social (Centro de Salud) is the place to go for prescriptions, but as a resident, you need to pay taxes to qualify for Seguridad Social.

https://www.immigrationspain.es/en/...ou_NOT_need_private_health_insurance_in_Spain

 

[Former member 91017]

Pivate insurance will probably not cover pre-existencias, pre-exisitng conditions like yours.

Seguridad Social (Centro de Salud) is the place to go for prescriptions, but as a resident, you need to pay taxes to qualify for Seguridad Social.

https://www.immigrationspain.es/en/...ou_NOT_need_private_health_insurance_in_Spain

Ugh… I’m in a Catch-22. My private insurance will not cover what I do out of the country unless it’s an emergency (I am appealing because they are effectively telling me I cannot exercise my employment right to the sabbatical — which actually as a proper research agenda attached to all the private things I want to pursue in Spain. I work with an international group with scholars in Spain, Portugal, Malta and the UK.)

If I have no income in Spain for the 6-8months I plan to be there (because I have my sabbatical income from Canada), then I pay no taxes in Spain…

Have my specialist writing the appeal letter to my insurance company to allow me to cart 6 doses overseas, but fully expect them to refuse… Just because that’s mostly what insurance companies do…

So trying to solve this before I’m half way across the Atlantic.

I *could* try going off the drug (but there are risks)… and if I go off the drug, my home-base insurance company is likely to refuse to allow me to resume.

so so so stupid. QALY studies on this medication show significant cost-effectiveness over non-Xolair managed asthma and chronic hives.

 

[MinaKamina]

Ugh… I’m in a Catch-22. My private insurance will not cover what I do out of the country unless it’s an emergency (I am appealing because they are effectively telling me I cannot exercise my employment right to the sabbatical — which actually as a proper research agenda attached to all the private things I want to pursue in Spain. I work with an international group with scholars in Spain, Portugal, Malta and the UK.)

If I have no income in Spain for the 6-8months I plan to be there (because I have my sabbatical income from Canada), then I pay no taxes in Spain…

Have my specialist writing the appeal letter to my insurance company to allow me to cart 6 doses overseas, but fully expect them to refuse… Just because that’s mostly what insurance companies do…

So trying to solve this before I’m half way across the Atlantic.

I *could* try going off the drug (but there are risks)… and if I go off the drug, my home-base insurance company is likely to refuse to allow me to resume.

so so so stupid. QALY studies on this medication show significant cost-effectiveness over non-Xolair managed asthma and chronic hives.

IMO what you need is the price of the drug in Spain and confront your insurance company with this.
Offer to pay the difference if Spain is more expensive, or tell them they are getting a bargain if it is cheaper.
You might even ask them to do the comparison. I've tried to find prices in Spain and I cannot find them, but prices in the Netherlands are easily found, namely € 157 for 0.5 ml injectable and € 314 for 1 ml injectable.

 

[Deleted member 73526]

Does anyone know if EHIC covers Xolair/Omalizumab costs in Spain?

Does anyone know if I apply to Spain for EHIC in order to have my medical care there as a resident while I am based there? Or do I apply to Ireland even though I will reside in Galicia somewhere?

I am not an expert but I think that the European Health Insurance Card (EHIC) is for people who reside in one signatory country when they are temporarily visiting another signatory country, for purposes other than getting health treatment. Therefore, I think that:

• An EHIC card issued to a resident of Spain serves no purpose in Spain.
• An EHIC card for a resident of Ireland can be used when they are a temporary visitor to Spain.

Prescriptions abroad: expenses and reimbursements - Your Europe

Find out about paying for prescription medicine in the EU and how to get reimbursed when you buy prescription medicine in another EU country

europa.eu

If you are going to become resident in Spain, I think you might need to look into the national health insurance program or a private policy:

Health insurance in Spain

Learn how you can cover your bases with health insurance in Spain.

www.expatica.com

If you're going to be a temporary visitor rather than a resident in Spain ... it might be worth getting residency in Ireland first. But as I said, I am not an expert.

BTW - If you're going to become resident in Galicia, consider becoming resident in A Coruña so that you can qualify for the 72.4km "underachiever Compostela." ;-)

 

[Kathor1]

If you are going to become resident in Spain, I think you might need to look into the national health insurance program or a private policy:

Health insurance in Spain

Learn how you can cover your bases with health insurance in Spain.

www.expatica.com

This looks like a very useful overview.

Just to clarify again: Coverage by a general / public / national health insurance system is not tied to nationality, it is tied to residency. In general, residency alone does not give you automatic access to public health insurance systems or social security systems. For someone who moves to an EU country, it is easiest when you will be an employee in your new country of residence, or a pensioner or a student with previous coverage from another EU country, or, possibly, when you register as self-employed. Apparently, when none of these conditions apply, in Spain you can join by paying into the system but this is not a universal option in all EU countries.

 

[Kathor1]

@Faye Walker, you can find the price of medication in the Vademecum database, in this case Vademecum.es; you need to register. For example: XOLAIR 150 mg Sol. iny; Env. con 1 jeringa precargada de 1 ml; Precio de Venta del Laboratorio: 369.27€; Precio de Venta al Público IVA: 436.99€

 

[Deleted member 73526]

I just checked with a friend who is a US national, resident in Spain. He is currently using a private insurance policy from DKV. I think it's specially geared toward expats. I think this is their website:

DKV Seguros

Descubre nuestros seguros médicos para particulares. Queremos que cuides tu salud y la de tu familia, y por eso te ofrecemos seguros de salud para acceder al mejor servicio de la medicina privada.

dkv.es

It might be worth looking into, although you may have better options available to you as an Irish citizen, or because of your existing Canadian policies.

 

[ivar]

When I moved to Spain (I am a Norwegian citizen), all I had to do was to go to town hall and get the "Certificado de Empadronamiento". This is a document that says that your officila reccidence is in Santiago (or whatever concello you decide to live in). I think (you need to check) you can get this with your Irish passport.

Once you have this, I am pretty sure (you need to check this as well) you will get the SERGAS (public health service in Galicia) card and can then use the public health services in Galicia... and get (I should think) your medication here.

Here is a link to this for Santiago:

Concello de Santiago de Compostela

Páxina web oficial do Concello de Santiago de Compostela

www.santiagodecompostela.gal

Procedures might be different in different municipalities. I see there is an email address listed on the link above. Why not try to craft an email in Spanish and ask.

Good luck!
Ivar

 

[Kathor1]

When I moved to Spain (I am a Norwegian citizen), all I had to do

And were you also the spouse of a Spanish national at the time ... ? That can help to make procedures smoother.

 

[ivar]

And were you also the spouse of a Spanish national at the time ... ? That can help to make procedures smoother.

I was... but I don't think that made a difference. Freedom of movement within the EU (Norway is part of that even if not in the EU).

 

[Kathor1]

Freedom of movement within the EU (Norway is part of that even if not in the EU).

I know. My only (very slight) concern is the fact that @Faye Walker wants to stay as a sabbatical resident (i.e. not employed, not paying social security, not a student, not an EU pensioner, not a spouse or a dependent child of an insured person).

 

[ivar]

I know. My only (very slight) concern is the fact that @Faye Walker wants to stay as a sabbatical resident (i.e. not employed, not paying social security, not a student, not an EU pensioner, not a spouse or a dependent child of an insured person).

Yes, what I mentioned above is for more permanent residents...

 

[peregrina2000]

Just to clarify again: Coverage by a general / public / national health insurance system is not tied to nationality, it is tied to residency. In general, residency alone does not give you automatic access to public health insurance systems or social security systems.

@Rebekah Scott (US citizen expat in Spain) has told a very long saga on this issue, either on her blog (moratinoslife@blogspot.com or here on the forum). In the end I am virtually certain she was able to get into the Spanish health care system only because of her husband’s British nationality. Her experience was very different from @Ivar’s.

I (US citizen) very briefly toyed with this idea years back after getting my own Irish passport. The details are now very fuzzy, but I came away with the clear undertanding that it would be a lot more complicated for me, never having paid into any EU health care system with my taxes, to qualify for Spanish health care.

 

[DoughnutANZ]

Is your sabbatical associated with a Spanish University? Of course my situation is different because I live in a different country from Canada but.... If when I worked at a ANZ university and took a sabbatical and it was associated with an overseas university then my ANZ university negotiated on my behalf with the hosting university over a number of things that included access to accommodation and local healthcare insurance. Would your Canadian university assist in this manner?

 

[Former member 91017]

Is your sabbatical associated with a Spanish University? Of course my situation is different because I live in a different country from Canada but.... If when I worked at a ANZ university and took a sabbatical and it was associated with an overseas university then my ANZ university negotiated on my behalf with the hosting university over a number of things that included access to accommodation and local healthcare insurance. Would your Canadian university assist in this manner?

Thanks Doughnut;
Right now it is not associated with one, but I can try to work it out as an option, to have a visiting research fellowship, perhaps in Ourense or Vigo….
On this particular trip, I do not actually *require* a host institution because my work is all field-work oriented, but you’ve raised a very good point.
If this were my permanent move over, it would be a different thing. I think the difficulty is the temporary nature of my intentions this go-round. When I make the eventual permanent jump, I will have the option to either a) get a small job for a few years just for the purposes of paying into the Spanish system, or b) to buy into one of the private systems suggested up-thread.

 

[Former member 91017]

Yes, what I mentioned above is for more permanent residents...

But thank you, @ivar — may be very handy in 2023 when I aim to make the leap permanent.

 

[Former member 91017]

I just checked with a friend who is a US national, resident in Spain. He is currently using a private insurance policy from DKV. I think it's specially geared toward expats. I think this is their website:

DKV Seguros

Descubre nuestros seguros médicos para particulares. Queremos que cuides tu salud y la de tu familia, y por eso te ofrecemos seguros de salud para acceder al mejor servicio de la medicina privada.

dkv.es

It might be worth looking into, although you may have better options available to you as an Irish citizen, or because of your existing Canadian policies.

Thank you, Raggy! I will look. The combination of my public and private health insurance in Canada is very good (although there are things I am insured for that my public system simply cannot provide, like the private hospital room; even a semi-private is out of the question in most locations now). The limitation when I am travelling is the non-emergency care, like my monthly drug.
I will check this company (and others suggested in the thread) to see if they will take my “pre-existing” status.

 

[Former member 91017]

@Faye Walker, you can find the price of medication in the Vademecum database, in this case Vademecum.es; you need to register. For example: XOLAIR 150 mg Sol. iny; Env. con 1 jeringa precargada de 1 ml; Precio de Venta del Laboratorio: 369.27€; Precio de Venta al Público IVA: 436.99€

Thank you!
…that is cheaper than flying home every 6 weeks.

 

[Former member 91017]

This looks like a very useful overview.

Just to clarify again: Coverage by a general / public / national health insurance system is not tied to nationality, it is tied to residency. In general, residency alone does not give you automatic access to public health insurance systems or social security systems. For someone who moves to an EU country, it is easiest when you will be an employee in your new country of residence, or a pensioner or a student with previous coverage from another EU country, or, possibly, when you register as self-employed. Apparently, when none of these conditions apply, in Spain you can join by paying into the system but this is not a universal option in all EU countries.

Thank you! When I make the permanent move I will look into this. I would imagine there is still this problem of my being temporarily in Spain on a long haul 6-8 months and not holding a job *in Spain*. But I will contact the Spanish embassy here to find out. You’ve helped me to know what I am asking for! (And when I move to Spain, maybe I will take up some form of simple work so that I will be paying into the system…).

 

[David Tallan]

Hi all;

I am aiming to spend my coming sabbatical in Spain, walking various camino routes, and having a home-base in Galicia.
When I last had extended sabbatical time in the EU I was not yet taking a monthly biological injection.

I have an EU passport, am an Irish citizen.

I work and live in Canada and have private health insurance BUT:

My private insurance company will not provide me with the doses I need to leave Canada with. The drug is very expensive here and they won’t pay several thousand dollars of coverage up front for me to take several months’ worth with me to Spain.

My drug is certified in the EU to be self-administered (Xolair) so if I can find a way to receive the doses in Spain, I can do that and then resume treatment under my current coverage when I return to Canada.

Does anyone know if EHIC covers Xolair/Omalizumab costs in Spain?

Does anyone know if I apply to Spain for EHIC in order to have my medical care there as a resident while I am based there? Or do I apply to Ireland even though I will reside in Galicia somewhere?

My ultimate goal is to purchase a home and to move to Spain in July of 2023. My current plan is to arrive January 1, 2022 and I can stay for as long as I want (up to when I have to resume regular work on September 10th back in Canada).

I just don’t really know where to start (I’ve started with the obvious with my private insurance provider). But becoming a sabbaticant resident in Spain as an EU citizen would be a whole new thing.

If I can’t find a way to do this, I will either have to fly to Canada every 6 weeks to have my shot (annoying and expensive, but maybe not as expensive as trying to obtain the drug in Spain), or lose my coverage and return to having really awful hives and asthma that limit my daily life in significant ways. I am willing to consider flying every 6 weeks because the EU passport means I can purchase 1-way tickets (which is way cheaper). Still… it could get to a point of being unaffordable for me to do it that way… so I’d rather not have to, obviously.

If there are any health system bureaucrats out there in the EU, I’d really appreciate some direction here.

I have to admit this is something of interest to me. I acquired CIU while on Camino 5 years ago and have been on Xolair myself for about the last 4.5 years. My last Camino in 2018 was shorter and scheduled between shots. We are starting to increase the time between shots and my hope is that by the time I do my next long one, I will also be able to do it between shots. But this would be really good to know if I ever want a longer stay abroad.

 

[Former member 91017]

I have to admit this is something of interest to me. I acquired CIU while on Camino 5 years ago and have been on Xolair myself for about the last 4.5 years. My last Camino in 2018 was shorter and scheduled between shots. We are starting to increase the time between shots and my hope is that by the time I do my next long one, I will also be able to do it between shots. But this would be really good to know if I ever want a longer stay abroad.

I will keep you posted on how it sorts out in the end. And yes, I’ve done shorter caminos of three weeks instead of six since going on my regimen.
Much as I love the Xolair and found it life-changing… I am not loving these bureaucratic hurdles. Fighting with my own insurance company to have them not stand in the way of standard overseas fieldwork for sabbaticants...

 

[David Tallan]

I will keep you posted on how it sorts out in the end. And yes, I’ve done shorter caminos of three weeks instead of six since going on my regimen.
Much as I love the Xolair and found it life-changing… I am not loving these bureaucratic hurdles. Fighting with my own insurance company to have them not stand in the way of standard overseas fieldwork for sabbaticants...

I also found it life-changing. My shots are 7 weeks apart right now (up from 4 weeks at the beginning), so I could in theory manage a 6 week camino between them if I timed it right. But I couldn't manage a sabbatical!

 

[Colette Z]

I worked at the senior medical level of pharmaceutical industry in Basel Switzerland home to Novartis & Roche. Contact Novartis in Basel (they co-produce Xolair with Genentech) and ask for their help in procuring your treatment. They may sort out the best route for you. OR perhaps your prescribing physician in Ontario could already move you to another product.

 

[Kathor1]

I will keep you posted on how it sorts out in the end.

Thanks, it may be helpful for others who are also considering moving to Spain.

My doubts about how easy it is to become an insured person under the Spanish healthcare insurance system these days if you move there as a holder of an EU passport and are neither employed, self-employed, a student enrolled in a Spanish education establishment or an EU pensioner is based not only on what I read on the internet but on frustrating personal experience in our family (in a different EU country, not in Spain, but the EU rules and basic principles of freedom of movement and of settlement are the same - although there may be a difference between countries as to how broadly or narrowly these rules are applied and enforced). And my emphasis is on: these days.

It appears that the option of voluntarily paying into the Spanish healthcare insurance system is only available after having lived in Spain for 12 months.

Xolair seems to be widely used in Spain, there shouldn't be a problem with supply.

The website of the Galician public healthcare system is here: https://www.sergas.es. It has information on the Spanish targeta sanitaria and on the convenio especial.

My totally unqualified non-expert opinion: During your limited stay in Spain, pay for the medication out of pocket or find a private healthcare insurance plan that will cover part or all of the cost. Do try to find out all you can about access to public healthcare insurance in Galicia in your specific situation.

​

 

[geraldkelly]

I've looked into the whole healthcare situation here in Spain for residents and non-residents. I think you're wasting your time trying to go through the public system and private insurers will have conditions around pre-existing conditions and possibly a run-in period during which you cannot make a claim (sometimes 6 months).

My advice would be, get documentation about your prescription from your Canadian doctor, go to a private doctor in Spain, show them the documentation and ask them to write you a Spanish prescription and put them in touch with your Canadian doctor if necessary. Pay for everything up front (drugs in Spain are often a lot cheaper than other countries), and try to claim it back in Canada.

There are also several Facebook groups for expats where these issues get discussed in detail, maybe ask there.

 

[Former member 91017]

I've looked into the whole healthcare situation here in Spain for residents and non-residents. I think you're wasting your time trying to go through the public system and private insurers will have conditions around pre-existing conditions and possibly a run-in period during which you cannot make a claim (sometimes 6 months).

My advice would be, get documentation about your prescription from your Canadian doctor, go to a private doctor in Spain, show them the documentation and ask them to write you a Spanish prescription and put them in touch with your Canadian doctor if necessary. Pay for everything up front (drugs in Spain are often a lot cheaper than other countries), and try to claim it back in Canada.

There are also several Facebook groups for expats where these issues get discussed in detail, maybe ask there.

I will probably end up doing something like this… but I have to be super careful that my insurance company at home does not decide that it will quit my coverage when I return based on my not having claimed the drug through them for 6-8 months.

Turning into a real nightmare just to want to do what every other member of my profession does: travel far away to combine fieldwork or other research with rest and re-energization for the next “deep dive”.

My insurance company rep here agrees that “It doesn’t seem right for a person with private health coverage to be unable to complete a sabbatical when all they need is a monthly shot to be perfectly healthy”.

OTOH…. My brain is churning away about making my exit from Canada *earlier* — definitely at age 55 and not at age 60 — so that I can work in Spain, pay into public healthcare there for *all the reasons one needs health care* , and buy my medication privately if needed (because yes, it’s only about 1/3 the cost in the EU that it is in Canada).

 

[geraldkelly]

"it’s only about 1/3 the cost in the EU"

Just to point out, the EU has no role in healthcare provision in its member states (apart from the EHIC which is just for emergencies when people are travelling) and the situation with costs and services varies greatly from country to country.

 

[Deleted member 73526]

EHIC which is just for emergencies when people are travelling

I expect that it's used a lot for emergencies, but it is not limited to emergency care. For example, EHIC entitles the traveler to get a regular prescription for a chronic condition at a pharmacy in the country where they are a temporary visitor, at the same price as locals.

Prescriptions abroad: expenses and reimbursements - Your Europe

Find out about paying for prescription medicine in the EU and how to get reimbursed when you buy prescription medicine in another EU country

europa.eu

 

[Kathor1]

I expect that it's used a lot for emergencies, but it is not limited to emergency care.

The word is not "emergency treatment" but "necessary treatment" . I noticed that the page that you linked is a general EU information page for citizens. It has a section about Residence formalities with the familiar five categories. Under "Economically inactive EU citizens" it states the two basic pre-conditions of having sufficient financial means and of proof of an established health insurance cover in order to be entitled to register as a resident and not become an unreasonable burden on the social assistance system of the host Member State during an initial period of residence, as the official lingo puts it. Quote:

If you want to settle in another EU country but you have no intention to take up any work or education there, you need to prove that you:​

• have sufficient resources for you and your family during the time you want to stay in your new country
• have comprehensive health insurance

​

 

[Former member 91017]

"it’s only about 1/3 the cost in the EU"

Just to point out, the EU has no role in healthcare provision in its member states (apart from the EHIC which is just for emergencies when people are travelling) and the situation with costs and services varies greatly from country to country.

Yes, I just meant that the cost of my drug, privately purchased at my own expense, runs roughly 1/3 the cost of at home — whether I look to NL, EI, SP, Fr or PT (being countries to which I travel frequently enough). I did not look at costs in places to which I less frequently travel.