An extended stay abroad with ongoing medical treatment requires careful planning. How will you get your medication if you're abroad for more than six months? What if there is a shortage of medicines in your host country? How do you adapt your treatment to the medications available in the foreign country?
General rules for expats
The following rules are general and may vary from country to country. Theoretically, a pharmacy can only dispense your medication for one month, even if you present them with a 6-month prescription (except for certain medicines that come in boxes for 3-month treatments). However, you can obtain an exception by contacting your family doctor and your health insurance company.
1 to 3 months stays
For a stay of 1 to 3 months, you'll need an affidavit and a prescription to receive your medication. Your prescription must state "Outbound Trip" and the expected number of months' supply. Opt for a prescription with the International Non-proprietary Name (INN): The INN is the scientific name of the medication. It will make it easier for foreign doctors to find your products.
Your doctor should write the duration of your stay on your prescription. They will also authorize the pharmacy to dispense your entire course of treatment at one time. You are responsible for filling out the certificate on your honor. It should include the length of your stay and the pharmacy's name that dispensed the medication. This certificate can be used if you have difficulty obtaining or renewing your treatment in your host country. Stays of 1 to 3 months are considered short stays, so in theory, you don't need to get a waiver from your health insurance company. However, it depends on your country. You may need to get permission from your health insurance company.
3 to 6 months stays
For stays of 3 to 6 months, you must first submit a request to your health insurance company, which will notify you of its approval or denial. If your request is approved, you can go to your pharmacy with your prescription (indicating the length of your stay). Contact your insurance company in advance to avoid any unpleasant surprises and ensure a timely response. In any case, the exceptional supply of medication cannot exceed 6 months.
Longer stays abroad
It's not technically possible to take all of your treatment with you if you're planning a long-term stay abroad. For stays longer than 6 months, you will need to find a doctor in your host country. Inform your current doctor of your plans. They may know colleagues in your host country. Your embassy may also have a list of doctors. Ask your general practitioner for a list of alternative medications in case your medications are unavailable in the host country (this will depend on the country you are moving to). Ask for a letter explaining your medical history and any allergies to certain medications. Don't forget to have the letter translated into your host country's language and discuss with your doctor the list of medicines and emergency supplies you will need.
However, there are some medications you cannot take with you, even if you are staying abroad for an extended period. In fact, some of them cannot be dispensed for more than a month. Examples include hypnotics or narcotics, as their prescription period is determined by local law; direct-acting antivirals (hepatitis C); medications that require special monitoring or special testing. Customs authorities in the host country may also require a medical prescription. Inspections will be more stringent if you are carrying medications that are classified as psychotropic or narcotic in the host country.
What are your options in the event of a medication shortage?
In countries like Greece, France, Germany, Spain, and Switzerland, pharmacies regularly run out of medicines. In fact, drug shortages are on the rise in Europe. Other countries such as the United States, Canada and Australia are also experiencing shortages. Some medications are chronically out of stock, forcing patients to interrupt their treatment for several days, which is a considerable risk to their health. In France, for example, there are chronic shortages of cardiovascular medicines. The same goes for anti-infectives and even paracetamol. In response to the crisis, President Macron has pledged 200 million euros of investment to produce around 50 drugs in France. But in the meantime, locals and expats in France have no choice but to make do with what's available.
If one or more of your medications are out of stock, you first need to find out where the shortage is coming from. Is it an out-of-stock situation at the drug manufacturer or at your pharmacy? Is the shortage temporary, chronic, or permanent? The latter seems easier to deal with, as you can simply go to another pharmacy. The former may cause more problems, especially if the manufacturer indicates that the shortage is chronic or long-term.
Finding an alternative drug
The first solution may be to look for an equivalent. In the first instance, pharmacists in your host country can suggest an equivalent drug. But they will need your doctor's permission to do this, as they will need to make sure that the change in medication is possible. What's more, the change may involve a change in dosage.
Have your medication delivered in your host country
Consider having your medication delivered. There are strict rules about shipping pharmaceuticals in a viable way. Transport must be done by a company that specializes in this area. A prescription is required. Some medications can be shipped without restriction, while others have restrictions or may be prohibited. Restrictions may depend on the type of medicine, the quantity transported, etc. Transport conditions must also be taken into account (some medicines must be transported at a certain temperature).
All these regulations make drug delivery a tricky business. Check that the company you use delivers to your host country. You should also check with the customs authorities in your host country to find out whether such transport is possible. If you have relatives in your home country, see whether they can handle these formalities for you.
The other option is to return to your home country to renew your stock of medicines.
Adapting your medical treatment in your host country
So, how do you adapt when the medicines you usually take are unavailable in your host country?
First of all, check with your doctor before you travel. What is the situation in your host country? Are any medicines in short supply? Is it chronic? Are your medicines threatened by shortages? Is it easy to obtain medicines? Are pharmacies accessible? These questions are all the more important for the medications that are essential to you.
Some medicines are difficult to replace. Molecule issues, dosage adjustment, allergy, efficacy, etc., are some of the factors you should consider. The question arises differently if, for example, you're being faced with an international transfer or you're a trailing spouse. In such cases, you haven't necessarily chosen your host country and will have to come to terms with these new realities. So you need to be sure that your pathology is compatible with travel, that your treatment can be adapted, or that you can receive your medication abroad.
Before you travel, ask your doctor about alternatives in case your medication runs out in the host country. Have your prescription translated into your host country's language and into English if necessary. Once you have settled abroad, look for a doctor you can trust to monitor your progress. They will also be able to adapt your treatment to the products available in the country. Check whether pharmacies are easily accessible.
In all cases, proper planning is essential, especially in terms of affiliation to the foreign health insurance fund, reimbursements, etc.). Moving abroad is possible, even with a long course of medical treatment.
Useful links:
UK: NHS – take medecine abroad
US: Centers for Disease Control and Prevention – traveling abroad with medicine
Japan: Ministry of Health, Labour and Welfare of Japan – bringing medicine for personal use
Netherlands: take medicine abroad
France: Traveling with medication
European Union: prescriptions abroad – expenses and reimbursements
Medication shortage lists
European Medicines Agency: public information on the medicine shortage
