#88

I got a years supply(312 1mg tablets) of sirolimus for $180 at CVS Pharmacy with Good RX. Go to GoodRX.com. Select CVS Pharmacy. They have a list of quantity options. the last option is custom. That is where I put in the 312 amount. Finding a doctor for a prescription is pretty easy. Good luck.

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#89

Bobo, how did the DR write the script? 6mg/wk and a years script? TIA

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#90

My PCP is a goddess of coding both for prescriptions and labs. 90x 2 mg rapamycin cost me $4 at my local pharmacy. I do not ask how she does it. Some unusual lab tests such as TTGF-b1 (TRANSFORMING GROWTH FACTOR BETA cost between $100 and $200 or more when ordered by my previous doc. I rarely have to pay anything when my current PCP orders it. Note that she has an awesome medical assistant who will call her friend at the lab to find out what codes insurance companies like.

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#91

While these are great prices, you should be aware that this goes on your lifetime record and may be accessed by health and life insurance companies. As sirolimus is commonly used by organ transplant patients, it could affect your ability to get insurance at all or increase the cost.

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#92

For health insurance, It would only affect insurance if you’re currently enrolled in a private supplemental Medicare plan and then try to change providers, in which case they’re allowed to discriminate based on medical history. Otherwise, per Obamacare, they aren’t allowed to turn you down or increase rates based on past medical history or pre-existing conditions.

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#93

Yes - see these threads:

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#94

If anyone is looking for someone to be a guinea pig for their supplier, I volunteer. I’m in the USA and I have some urgency here as I need to order drugs for Long COVID. Send me a DM.

#95

True as long as nothing changes in medical insurance regulation for the next few decades.

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#96

Post offices around the world are suspending shipping to the U.S. after President Trump ended a rule that meant tariffs did not apply to packages worth less than $800. Darian Woods and Wailin Wong from The Indicator explained why the end of the de minimis exemption is causing mayhem.

DARIAN WOODS, BYLINE: De minimis for China ended in May. The rest of the world, last Friday. The executive order said that goods from most countries would need to have a minimum duty of at least $80 paid at the border for the next six months.

WAILIN WONG, BYLINE: It’s worth pausing here to talk about who actually pays the tariff. We’ve talked about how importing businesses pay tariffs. A big shipment on a freight container, say, has a customs broker. They work with the American recipient to pay the tariff on the border. Well, if you, an everyday American, ordered something directly from a seller overseas, you are the importer. So you are on the hook. The goods only get released from the border once that money is paid.

WOODS: That’s how it works in a lot of countries. But Derek Lossing, a logistics expert at Cirrus Global Advisors, says getting every recipient of every small parcel arriving into this country to pay up is going to be a nightmare, especially after the $80 minimum duty ends and it changes to whatever the import country’s tariff is.

DEREK LOSSING: Trying to get, you know, hundreds of recipients like yourself to pay $2.60 to a customs broker for the duty that they owe would be extremely difficult. In practicality, it’s going to be paid by kind of the shipping company.

WONG: By the overseas postal service, in other words. So rather than be stung by thousands or millions of those owed duties and tariffs, postal services for a lot of shipments to the U.S. decided to just pause them.

WOODS: Derek says a lot of this comes down to IT systems and training.

LOSSING: Each post office around the world, whether that’s Australia or Germany or U.K., just does not have the systems in place to collect all the right information.

WONG: It’s been quite a mess. And we asked Customs and Border Protection whether it could’ve done anything more to avoid this.

WOODS: A CBP spokesperson said the agency is coordinating with carriers and trade partners to minimize disruption while securing revenue, strengthening border integrity and delivering long-term benefits to our national and economic security.

WONG: That brings us to the question of who exactly does benefit or lose out from the end of de minimis.

WOODS: A couple of economists tried to quantify exactly how much money households save by buying things online through de minimis shippers like those online stores. Pablo Fajgelbaum at UCLA is one of them. He says he found a strong connection between buying de minimis goods and how wealthy your neighborhood is.

PABLO FAJGELBAUM: Those that spend the most as a share of total income are the poorest.

WOODS: That means low-income ZIP codes will lose out on more, relatively speaking, from the end of de minimis.

FAJGELBAUM: For the poorest ZIP codes, in the order of $40 per person per year.

WONG: There will also be winners from de minimis ending. Derek Lossing says that increase in prices will be good for American retailers.

Source: Why the end of the de minimus tariff exemption is causing shipping chaos worldwide : NPR

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#97

One could hope that a question “Make America Healthy Again” and RFK J’s willingness to embrace “alternative” therapies, he might relax restrictions on OTC drugs.

Yep, this seems to be the case. Things are in disarray in general because somebody keeps changing their mind, making deadlines, then ignoring them. The US government purportedly wants foreign investment in the US, but how is anybody supposed to make long-term investment decisions when the rules keep getting changed (by executive order, social media shitpost, or court order) almost every week?

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#98

I don’t think it’s that comprehensive yet. My health care providers are wired into local pharmacies, but not into the DEA.

#99

It has nothing to do with the DEA, but rather your medical records. There was a discussion about this very issue a while back in a different thread. Someone was denied insurance because the company flagged their past use of rapamycin/sirolimus. They wouldn’t even overturn their decision after an appeal and explanation.

#100

There’s not a whisper of rapamycin in my medical records. How would insurance companies learn that I’ve ordered it from India? Given your status as a clinician, you probably document every thing you prescribe or take yourself.

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#101

They wouldn’t. The discussion about this was related to someone who is getting it prescribed by their PCP.

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#102

Got a message from one India-based reseller suggesting the India PO will begin shipments in the next week again.

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#103

Isn’t that what they said last week? :wink:

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#104

We are planning a trip to Texas this fall to visit family so I might have to cross the border into Mexico and visit a farmacia. It’s crazy. I’ve been ordering from various other countries for 11 years and never truly appreciated how easy and convenient it was until now.

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#105

I see a lot of mis-understanding of shipping logistics in that conversation.

DDP (Delivery Duty Paid) is how small parcels with a relatively low value will be handled. It goes like this,

  1. Customer initiates a purchase with a Vendor
  2. Vendor adds the broker fee and tariff/tax at the “checkout”
  3. Customer pays those up front to the vendor
  4. Vendor ships the parcel
  5. Vendor pays the broker fee AND the tariff/tax to the Broker
  6. Broker pays the government that applied the tariff/tax
  7. Customer receives their goods.

This is not new, this is how it’s been done on all commercial shipments I’ve been involved in (in the 90’s I shipped millions of dollars worth of med equipment from Canada to the US). One of the key components of the system is the HS codes required to import/export any item in international trade.

This means the vendor much have HS codes for their products. Without a code for each product they will not be able to export anything. Brokers will not handle a shipment without a HS code.

This means there must be a customs broker in the chain, either the vendors or the shippers broker will work. It’s easier for small vendors to let the shipper deal with the fees. FedEx, DHL, UPS, etc all have this system in place and have had for decades.

The only “new” thing is the cancelling of de minimus that brings this complication to the average consumer who never dealt with tariff/tax before.

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#106

This is one reason you need a broker that understands your product and market. Shipping companies with their own brokerage system will help small vendors with this.

Here is what a company exporting pharmaceuticals has to come to grips with.

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#107

Sure - all of what you say may be true.

But the Indian pharma resellers don’t typically follow the rules that closely. What if they just put in some supplement HS code (for example HS code for glycine 2922.49.43.00), and call it a day. Ultimately it sounds like the personal exemption for medicine import might be gone now (I’ve not dug deeply into the rule changes), but I also suspect that the Indian pharma resellers may just keep shipping and see what happens.

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