a_grz_vr

Hello,

I’ve already been busy in the forum finding out about applying for residency at the town hall/comune.

I am a 29-year-old male moving to Italy again this year. I was diagnosed more or less at the age of 22 with a congenital condition, similar to Klinefelter’s syndrome. My condition has a different name and isn’t actually caused by an extra x chromosome (men typically only have one, just like me); yet the symptoms are more or less the same. I’ve been on testosterone replacement therapy since my diagnosis, and it will be a life long treatment.

I’ve been in contact with the Agenzia del Farmaco (suggested to me by the Ministero della Salute).

1. First of all, they’ve told me that my medicine (Tostran) is unauthorised in Italy (but they can get hold of it, though the procedure seems long from how they explained it). I could switch to Tostrex.

2. Second thing they told me was that the charge is about 60 euros. (I pay £9 in the UK).

3. The third thing they told me is that it is “a carico del paziente”.



I want to be sure of a few things.

In the UK I use the NHS for my Tostran and the prescription charge isn’t actually the price of the medicine, it’s a contribution to the NHS. I think this is correct…So that means I don’t actually pay for my medicine…the NHS does. I THINK…

In Italy on the other hand, I think they mean that IT’S ME who pays for it, not the public health service, and that when I’ll pay for my prescription, I’ll be paying the full price. The 60 euros isn’t a contribution, it’s the actual price of the medicine.

I do remember an Italian medicine student several years ago saying to me that the state doesn’t pay for hormones…perhaps he meant exactly what I’m attempting to explain now.

Does anyone know if this explanation I’m trying to give myself is correct or I’ve just got it all wrong?



Another thing. If I need this medicine that’s “a carico del paziente”, does it mean that me enrolling on state healthcare won’t get me my Tostrex? Of course, I’ll still apply for state healthcare for every other health problem, but I’m wondering whether I have to enrol somewhere else (where, I don’t know), to get medicines that the state doesn’t provide.



I’m going to contact the AGENZIA DEL FARMACO again, and also some Italian Klinefelter’s Syndrome associations, but the more information I can get, the better. So, share anything if you can!

philat98

You have to get your Tessera Sanitaria first. Then go to your Italian doctor and explain the situation and they can probably tell you the bureacratic process to follow for obtaining free treatment. There are no prescription charges for chronic illnesses in Italy.

modicasa

Serrano

Hi - I've had a severe dose of RL the last few days, so haven't been able to follow this up. First a bit of general background. In the UK, as you indicate the prescription charge doesn't cover the cost of the medicine but - the clue is in the name - it is a charge per prescription (actually per item on the prescription). This is usually less than the real cost of the medicine, but may sometimes be more. In Italy, the system is very different - medicines authorised by the SSN fall into one of a number of categories or 'fasce'. Fascia C, for example, is 'a carico del paziente' - which means the patient pays the full amount - and covers both prescribed medications (fascia C) and and over-the-counter medications (fascia C-bis). Fascia A, by comparison, is for essential medicines, and is nominally free to the patient, though there is often a small amount to pay - the 'ticket' - which will vary by region.

But for this to be applicable I would imagine you have to be enrolled in the SSN. Probably private health insurance would leave you (or the insurers) liable for the entire cost. Most likely you, because insurers do not usually cover pre-existing conditions. So this really should be your first priority

Tostran is but one brand name of testerone gel (and is also known by the name Fortesta in some other countries). Other, allegedly similar, testorone treatments are available - in Italy for example Tostrex (as you mentioned ) and Testim, among others. My view would be that, unless you tried a number of different pharmaceuticals before finding one that suits you, you should be guided by the urologist/endocrinologist that you consult here.. Incidentally virtually all of these pharmaceuticals were reclassified into Fascia A in 2017 - see this document. I can find no trace of any further change of classification.

a_grz_vr

Hello, thanks to everyone for their help.
I needed some time to think about what I wanted to ask. I've also been back at work (Italian style take-away shop ), so I've been a bit slower with finding out about moving.
I have several questions:

The first is about something mentioned in the post about residency (which was also about healthcare):
GOV WEBSITE “living in Italy” section SAYS:

“If you’re staying more than 3 months, you need to register with the SSN through your local ASL.

You can register for free if you have a work contract.

If you can’t register for free, you can pay an annual fee to receive state healthcare”.

The annual fee = assicurazione volontaria / “buying into the system”/

Is that what you mean by buying into the system? (the annual fee that is mentioned on the GOV website).

You said that sometimes it’s possible, sometimes it isn’t. Depends on the region. What kind of regions is it usually not possible to do this in? Do you think it would be available in Milan?/Northern cities in general. Is it illegal to buy into the system? The way you say it, “buying into the system”, makes me think of corruption.

a_grz_vr

medicines authorised by the SSN fall into one of a number of categories or 'fasce'. Fascia C, for example, is 'a carico del paziente' - which means the patient pays the full amount - and covers both prescribed medications (fascia C) and and over-the-counter medications (fascia C-bis).

So, my medicine is available through the SSN. If I can access the SSN (with a work contract/annual fee, if that option is available), then I’ll be able to have my medication through the SSN.

Just because a medication is “a carico del paziente”, doesn’t mean you don’t go through the SSN.

Have I understood the point?

I was thinking that “a carico del paziente” meant that, other than paying the full fee, the SSN doesn’t have anything to do with it at all. So, you would have to go through a different system (such as a private one) in order to get hold of those types of medication.

a_grz_vr

Fascia A, by comparison, is for essential medicines, and is nominally free to the patient, though there is often a small amount to pay - the 'ticket' - which will vary by region.

But for this to be applicable I would imagine you have to be enrolled in the SSN.

In other words, in order to get FASCIA A medicines for free/at “ticket” price, you would need to be enrolled in the SSN. If you got your health care privately, you wouldn’t get FASCIA A medicines for free/at low price?

a_grz_vr

Probably private health insurance would leave you (or the insurers) liable for the entire cost. Most likely you, because insurers do not usually cover pre-existing conditions.

I have no idea how private health care works, not even in England.

When you say “private health insurance”, does that actually mean you have access to a doctor? An actual doctor’s surgery to go to (the difference being that you pay to go to this private doctor’s surgery and you don’t pay to go to the SSN one).

I need a doctor to prescribe my medication, I then take the prescription to the pharmacist, the pharmacist orders it, and the medication arrives the next day. This is what I do in England.

Without an actual doctor, I can’t get prescriptions.

I’ve been imagining private health insurance as this fee you pay to an agency, and then…I’m not sure what happens when you need healthcare.

Wouldn’t the private healthcare system need a work contract as well? (Just like the SSN?)

a_grz_vr

all of these pharmaceuticals were reclassified into Fascia A in 2017 - see this document.

In other words, TOSTREX is no longer a carico del paziente. Which of course is good news if I can get access to the SSN.

How did you find this document? Where does it actually say in the document that the medication has been reclassified? I did open it, but reading that kind of Italian is like reading the chemical ingredients on the back of a bottle (it’s nothing like written or spoken Italian, at all).

The agenzia del farmaco told me that TOSTREX was a carico del paziente in February 2017:

From: Farmaciline <[email protected]>
Sent: Tuesday, February 14, 2017 11:05:30 AM
Il medicinale Tostrex è invece autorizzato e disponibile in Italia; il costo del farmaco (attualmente €59,61è a carico del paziente) e necessita di una prescrizione specialistica(endocrinologo, urologo, andrologo)

a_grz_vr

Hello, thanks for the answer.
One of the main problems is actually getting the Tessera Sanitaria From what I've understood, you need a work contract (see the LIVING IN ITALY section of the BRITISH GOV website), and getting a work contract is like...how can I say..."chiedere la luna" I've never had one in Italy, and many Italians don't have one. I mean the actual contract, not the job itself. I've worked many times in Italy, but they always gave me the cash in my hand, either at the end of the week or the day.

37100

A GP can prescribe anything. Whether the product is ''free', partially free or privately doesn't matter.

37100

You need to be enrolled in the SSN to access free medicines.

37100

Once you are signed up for the ssn and you have a gp, the gpto wi send you to a specialist. There is a prescription charge. The specialist will certify you pathology. With that piece of paper, at the same office that you signed up for, you can obtain an exemption for your pathology for any future specialist visits, tests etc. A specialist will have to authorise your hormone treatment, he will give you a plain prescription, you gp will the be able to prescribe it on the ssn.

Serrano

Yes

Yes, you have understood. Indeed the entire discourse about 'a carica del paziente' relates only to pharmaceuticals through the SSN.

As you have understood the point, you will have realised that this is not the case.

Correct

The normal process is that you are effectively on your own, the insurance will refund expenditure incurred (within the limits and conditions of the policy). The normal idea of insurance is to cover you for unpredicted eventualities, which explains why pre-existing conditions tend to be excluded. Think about it, if you have a condition which will cost, say, €100 per month, the insurance knows it will have to reimburse you that money, so will logically charge it to you in the premium - plus their administration costs, profits etc.

Absolutely not - it is a simple commercial contract between you and the insurer, uyour employment status doesn't affect their risk in any material way.. Indeed if you had a work contract you would have access to the SSN, which removes much of the point of the insurance.

I honestly can't rermember how I found the document - if it's important to know I can try to find it again and record the process for you. And the document doesn't state that it has been reclassified (I found that somewhere else as well), but it does say, toward the bottom of page 2, "classe di rimborsabilita': A"

Which does appear to be an error on their part. But bearing in mind that the reclassification was less than a month before their reply, maybe an understandable one. Maybe you could follow it up with them, including the link.

If you are working cash in hand then almost certainly the 'employer' isn't paying contributiions, which means that you won't be admitted into the SSN - because you aren't paying your dues. I agree, getting a legit job is much harder than finding black work, but black working comes with these (and many other) disadvantages to you.

This is not at all my undedrstanding. The pharmaceutical under discussion can only be prescribed by a hospital department or by an endicronologist, urogolist or andrologist - see Article 3 of the document linked to previously. As such I believe the power to prescribe can not be delegated to a GP.

See previous answer.

37100

I did say that it has to be authorised by a specialist before it can be prescribed. Of course, they actual procedure can vary for region to region and even from ASL to ASL While our gp loads prescriptions directly into the system without handing you a red prescription, our hospital doesn't do it yet, or at least, they didn't a few months ago. The poster will also need to go through the whole rigamarole of getting an exemption for pathology.

For the poster. I don't know which regions allow you to buy into the system. Veneto doesn't.