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Taking Humira on the Camino Frances. Is it doable?

psychoticparrot

psychoticparrot
Time of past OR future Camino
April, May (2017)
As I mentioned in some previous threads, my husband and I are making plans to walk the Camino starting in April 2017. His health has been a concern, as he has been suffering from an autoimmune condition that would prevent him from going if it remains uncontrolled.

His doctor has recommended that he start taking Humira for his condition and is very confident that it will control the problem. Humira is a medicine that has live biologics. It can't be frozen, nor can it be kept at temperatures higher than 77 degrees F (25C). It's given via injection every two weeks. It's recommended that Humira be kept refrigerated, but it can be kept at room temperature at no higher than 77 degrees F (25C) for no longer than 14 days.

So, given the conditions of the Camino from early April to mid-May (our Camino time frame), is there any way for my husband to be able to walk the Camino and carry/store Humira along the way?

I don't think it's possible to carry it along in a chilled cooler, as that would be cumbersome and the outdoor temperatures too unreliable. Carrying it unprotected in his pack is even more chancy. From everything I've read, there is often snow or freezing temperatures in the Pyrenees in early April. If the Humira gets frozen, it's no good for use. By mid-to-late May, it could be getting pretty warm in Galicia, so temps over 77 degrees (25C) may be a problem. Even on days with the ideal temperature range, the medicine may get too hot inside his pack.

He would prefer to buy the Humira in the U.S. and bring it along, as it's very expensive (full cost is about $2,000 per injection; he will need 5 injections during our 2-month stay in Spain), but our insurance will cover most of the cost. If he were to buy it in Spain, it would be prohibitively expensive and probably not available except in cities (Humira is not a common medicine). So the biggest problems are storage and transportation. I hesitate to use a transport service, as we could not be certain the medicine would be stored properly.

Any suggestions/solutions/advice would be very welcome.
 
The one from Galicia (the round) and the one from Castilla & Leon. Individually numbered and made by the same people that make the ones you see on your walk.
I do not know how large and bulky the medicines would be but the thought which crosses my mind is that using a stainless steel vacuum flask might be a solution - possibly one of the wide-mouthed versions meant for food storage. Should be no great difficulty in finding chilled water to fill it and the inside temperature is unlikely to rise above 25C even on a hot day. Also very unlikely to freeze in the relatively short periods at any great height in April or May.
 
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In April on Camino Frances temperatures most possibly won't get higher than 25C. Or at least maybe for an hour or two but you never know. If you store the medicine in refrigerator over night it might "survive" to your next stop well wrapped up somewhere by the back (also your husbands back) of the rucksack. You can also put it by 0,5l plastic bottle with frozen water or anything similar. Last year I walked Camino de Levante in temps as high as 48C and for most of the day frozen water stashed deep in my backpack as I mentioned above wouldn't completely melted.

Otherwise if your husband has isolated container for the 5 Humira injections he could also leave it in the home of a taxi driver which would bring you the injections after 2 weeks. You can repeat that with another driver and so on... But that would cost and probably you won't feel really confident in that taxi driver.

Hope you will find a good solution and enjoy your Camino!
 
A selection of Camino Jewellery
He would prefer to buy the Humira in the U.S. and bring it along, as it's very expensive (full cost is about $2,000 per injection; he will need 5 injections during our 2-month stay in Spain), but our insurance will cover most of the cost. If he were to buy it in Spain, it would be prohibitively expensive and probably not available except in cities (Humira is not a common medicine).

Not neccessary:
http://www.statista.com/statistics/312014/average-price-of-humira-by-country/

Maybe also this could of some help:
https://healthunlocked.com/nras/pos...a-available-through-the-spanish-health-system
 
Links above not accessible without membership. Can you pass on info contained within?
 
@psychoticparrot. The suggestion of a small stainless thermos above is a good one. I presume you are considering transporting 5 - 6 pre-loaded 40mg syringes that could b easily packed into a 500ml - 750ml Thermos. Particularly if buried in the heart of a pack there is likely to be little temperature variation. You can test this by carrying a small Max / Min Thermometer buried in a pack on your practice hikes. Which method would also provide assurance en-route. I think you will be pleasantly surprised by the insulating qualities of clean (or dirty :p) laundry or a rolled sleeping bag. It is likely that Humira is available in Spain and your insurer will advise and confirm whether they would support purchase from a Spanish pharmacy should the need arise. There is a thread, as I recall, on carrying Insulin within similar constraints. A search of the forum on Insulin / Diabetes may assist.
 
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Our Atmospheric H30 poncho offers lightness and waterproofness. Easily compressible and made with our Waterproof fabric, its heat-sealed interior seams guarantee its waterproofness. Includes carrying bag.

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I do not know how large and bulky the medicines would be but the thought which crosses my mind is that using a stainless steel vacuum flask might be a solution - possibly one of the wide-mouthed versions meant for food storage. Should be no great difficulty in finding chilled water to fill it and the inside temperature is unlikely to rise above 25C even on a hot day. Also very unlikely to freeze in the relatively short periods at any great height in April or May.

This may work, but only if we can get access to cold/ice water at least 3 times a day. I checked images of the Humira pen and hypodermic versions. The pen appears to be about 3/4 inch diameter by 9-10 inches long (2x24cm). The needles are sealed in a plastic/cardboard box that appears to be about 3x6x1/2 inches (7.5x15x1cm). I don't know which one my husband's doctor will want him to use.

****I forgot to add in my original post that once Humira is warmed to room or ambient temperature, it cannot then be rechilled and used. It must be kept at a constant 35-45 degrees F (1.6-7C) for storage longer than 14 days.****

So we can't chill it overnight, then carry it forward without reliable insulation to the next night's refrigerator.

Looks like I'll be doing some experimenting with insulated vacuum flasks, water, ice and thermometers. :confused:
 
In April on Camino Frances temperatures most possibly won't get higher than 25C. Or at least maybe for an hour or two but you never know. If you store the medicine in refrigerator over night it might "survive" to your next stop well wrapped up somewhere by the back (also your husbands back) of the rucksack. You can also put it by 0,5l plastic bottle with frozen water or anything similar. Last year I walked Camino de Levante in temps as high as 48C and for most of the day frozen water stashed deep in my backpack as I mentioned above wouldn't completely melted.

Otherwise if your husband has isolated container for the 5 Humira injections he could also leave it in the home of a taxi driver which would bring you the injections after 2 weeks. You can repeat that with another driver and so on... But that would cost and probably you won't feel really confident in that taxi driver.

Hope you will find a good solution and enjoy your Camino!

Yes, most taxi drivers are not EMTs (Emergency Medical Technicians), and I would not trust them with my husband's health. No offense to taxi drivers (I was one myself many years ago), but they may not fully understand the stringent requirements to keep the Humira stable and viable.
 

The first site requires a $49 membership fee, so I won't be using that, but thanks for mentioning it as a resource. I already registered with the second site and posted my question about availability and cost of Humira in Spain. Hope to hear from them soon.

Thanks.
 
Ideal sleeping bag liner whether we want to add a thermal plus to our bag, or if we want to use it alone to sleep in shelters or hostels. Thanks to its mummy shape, it adapts perfectly to our body.

€46,-
@psychoticparrot. The suggestion of a small stainless thermos above is a good one. I presume you are considering transporting 5 - 6 pre-loaded 40mg syringes that could b easily packed into a 500ml - 750ml Thermos. Particularly if buried in the heart of a pack there is likely to be little temperature variation. You can test this by carrying a small Max / Min Thermometer buried in a pack on your practice hikes. Which method would also provide assurance en-route. I think you will be pleasantly surprised by the insulating qualities of clean (or dirty :p) laundry or a rolled sleeping bag. It is likely that Humira is available in Spain and your insurer will advise and confirm whether they would support purchase from a Spanish pharmacy should the need arise. There is a thread, as I recall, on carrying Insulin within similar constraints. A search of the forum on Insulin / Diabetes may assist.

Thanks for your suggestions. I will be buying my pack in the next week or two; then the experiments will begin.

I'm sure Humira is available in Spain, but where and at what cost? I registered at a site recommended above by Kinkyone, posted my questions and am currently waiting for answers.

My husband and I will both be 65 years old and on the U.S. Medicare plan by next year. Medicare will not cover any medical expense incurred outside of the U.S. However, he does have a continuing prescription plan from Penn State University, which may cover most of the cost. If we could be sure we could buy Humira in the larger cities along the way, and if Penn State will pay for most of it, then the flasks won't be necessary at all.

"I'm smellin' a lot of 'if' comin' off this plan." (Jayne Cobb, Firefly) :rolleyes:
 
Links above not accessible without membership. Can you pass on info contained within?
When I write "Humira cost spain" into google I'm able to delete the window that cover costs (X in upper right corner). Here are they:
- USA: 2246 USD
- CAN: 1950...
- Spain: 1498...
- Netherlands: 1498...
- New Zealand: 1481...
- England: 1102...
- Switzerland: 881...
(info is from 2013!!!)
 
The 2024 Camino guides will be coming out little by little. Here is a collection of the ones that are out so far.
The first site requires a $49 membership fee, so I won't be using that, but thanks for mentioning it as a resource. I already registered with the second site and posted my question about availability and cost of Humira in Spain. Hope to hear from them soon.

Thanks.
Check my previous post.
 
Hi there,
bring your charts translated to Spanish and prescriptions translated to Spanish.
Go to the Farmacy and pay for your Humira in case you have to!

And bring Humira with you in a chilled cooler from the states and keep it in the right temperature till it is used.
Take a shot the day you will be leaving and after that according to the doctor´s order. Maybe only 3 shots in Spain.

This is NOT rocket science.
 
The 2024 Camino guides will be coming out little by little. Here is a collection of the ones that are out so far.
Patients who are prescribed Humira are offered all information when at home or travelling and the cooler bags by the doctor and nurse in Sweden. Must be so all over the world?
 
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Ah.... this is why these adverts run on TV: the meds force you to mortage your home. So sorry about the coat of this and the limitations this means for your family.
 
Technical backpack for day trips with backpack cover and internal compartment for the hydration bladder. Ideal daypack for excursions where we need a medium capacity backpack. The back with Air Flow System creates large air channels that will keep our back as cool as possible.

€83,-
When I write "Humira cost spain" into google I'm able to delete the window that cover costs (X in upper right corner). Here are they:
- USA: 2246 USD
- CAN: 1950...
- Spain: 1498...
- Netherlands: 1498...
- New Zealand: 1481...
- England: 1102...
- Switzerland: 881...
(info is from 2013!!!)

Thanks for checking that, Kinky. It's just a little less expensive than in the U.S. If it turns out that my husband's prescription plan will cover most of the cost, and if Humira is reliably available in the larger towns/cities, we may not have to shlep it along in insulated flasks, a cumbersome and worrying task. I will see if I can find the names of some major farmacias in Pamplona, Burgos, Leon, etc. Then I'll email or call them if necessary to find out if they carry the medicine.
 
Thanks for checking that, Kinky. It's just a little less expensive than in the U.S. If it turns out that my husband's prescription plan will cover most of the cost, and if Humira is reliably available in the larger towns/cities, we may not have to shlep it along in insulated flasks, a cumbersome and worrying task. I will see if I can find the names of some major farmacias in Pamplona, Burgos, Leon, etc. Then I'll email or call them if necessary to find out if they carry the medicine.
I'm sure your USA Humira provider have all the info about buying it in Spain but whether they will tell you that that's something else... "Employees" in Spanish pharmacies are so educated that for minor medical issues you really don't have to go to medical centers. There are pharmacies not only in larger towns you've mentioned but in most smaller also. But in case of Humira etc. treatments, it's best to be prepared. Maybe try to find Spanish association of pharmacies and address the question to them?

Wish you all the best!
 
As I mentioned in some previous threads, my husband and I are making plans to walk the Camino starting in April 2017. His health has been a concern, as he has been suffering from an autoimmune condition that would prevent him from going if it remains uncontrolled.

His doctor has recommended that he start taking Humira for his condition and is very confident that it will control the problem. Humira is a medicine that has live biologics. It can't be frozen, nor can it be kept at temperatures higher than 77 degrees F (25C). It's given via injection every two weeks. It's recommended that Humira be kept refrigerated, but it can be kept at room temperature at no higher than 77 degrees F (25C) for no longer than 14 days.

So, given the conditions of the Camino from early April to mid-May (our Camino time frame), is there any way for my husband to be able to walk the Camino and carry/store Humira along the way?

I don't think it's possible to carry it along in a chilled cooler, as that would be cumbersome and the outdoor temperatures too unreliable. Carrying it unprotected in his pack is even more chancy. From everything I've read, there is often snow or freezing temperatures in the Pyrenees in early April. If the Humira gets frozen, it's no good for use. By mid-to-late May, it could be getting pretty warm in Galicia, so temps over 77 degrees (25C) may be a problem. Even on days with the ideal temperature range, the medicine may get too hot inside his pack.

He would prefer to buy the Humira in the U.S. and bring it along, as it's very expensive (full cost is about $2,000 per injection; he will need 5 injections during our 2-month stay in Spain), but our insurance will cover most of the cost. If he were to buy it in Spain, it would be prohibitively expensive and probably not available except in cities (Humira is not a common medicine). So the biggest problems are storage and transportation. I hesitate to use a transport service, as we could not be certain the medicine would be stored properly.

Any suggestions/solutions/advice would be very welcome.
hi ,,,, I was on humira but it wasn't too good for me so my specialist has put me on Xeljanz,,,, tablet one morning one night every day and is much better for me !!!!!,,,, and then no problem on your camino cos its a tablet ,,,,, ask your doctor and see if it will work for your problem ,,,,, and good luck with that
 
A selection of Camino Jewellery
I come from a pharmaceutical family and have always been impressed with the quality of Spanish farmacias and their staff. There are enough major cities and towns along the Francese that I do not see that this will be a problem but it can't hurt to follow KinkyOne's suggestion. My Canadian private insurer supplementary drug plan always coughed up for prescriptions filled along the way but you should check with your insurer--- my guess is that they'll only be too happy as Spanish drug prices are well below US and even Canadian ones-- and usually by the same manufacturer.
 
I can only comment on a small piece of this puzzle. I think you will find that Spanish pharmacies sell or can quickly get almost any medication available in the US. When I was in Fuenterroble, a tiny town on the Vdlp, the pharmacist made a trip to Salamanca to pick up a prescription drug I needed (I didn't have a prescription btw, that's another feature of Spanish pharmacies -- you can get many prescription drugs without a prescription, presumably if the pharmacist makes the determination that you know what you need and you have received medical advice -- I had just run out of it and had the box).

The other thing I will say is that it could be an opportunity for a less than honest Spanish pharmacist to make $$$$ from you. That's because if a Spaniard goes to get a prescription medicine in a pharmacy, he/she pays the subsidized price, which is peanuts. The pharmacist cuts out a little square off the box of medication and attaches it to a form, to indicate that the person did not pay the market price, but rather the subsidized price. The pharmacist is then reimbursed for the difference. When I got my prescriptions in Fuenterroble, a Spanish friend noted that the pharmacist had cut out those little boxes on what I already had paid market price for, meaning that he was likely to get reimbursed for a charge he didn't incur. My costs were in the 75 € range, so I imagine the temptation will be that much greater when it's as expensive as the drug you mention. Not sure there's anything we can do about that (and actually I can't vouch for the truth of this explanation, it was just what a Spanish friend told me). But I did think it was interesting.

I will be walking in small town Spain in about three weeks, and am happy to ask about the availability of Humira if someone reminds me to do it.
 
I can only comment on a small piece of this puzzle. I think you will find that Spanish pharmacies sell or can quickly get almost any medication available in the US. When I was in Fuenterroble, a tiny town on the Vdlp, the pharmacist made a trip to Salamanca to pick up a prescription drug I needed (I didn't have a prescription btw, that's another feature of Spanish pharmacies -- you can get many prescription drugs without a prescription, presumably if the pharmacist makes the determination that you know what you need and you have received medical advice -- I had just run out of it and had the box).

The other thing I will say is that it could be an opportunity for a less than honest Spanish pharmacist to make $$$$ from you. That's because if a Spaniard goes to get a prescription medicine in a pharmacy, he/she pays the subsidized price, which is peanuts. The pharmacist cuts out a little square off the box of medication and attaches it to a form, to indicate that the person did not pay the market price, but rather the subsidized price. The pharmacist is then reimbursed for the difference. When I got my prescriptions in Fuenterroble, a Spanish friend noted that the pharmacist had cut out those little boxes on what I already had paid market price for, meaning that he was likely to get reimbursed for a charge he didn't incur. My costs were in the 75 € range, so I imagine the temptation will be that much greater when it's as expensive as the drug you mention. Not sure there's anything we can do about that (and actually I can't vouch for the truth of this explanation, it was just what a Spanish friend told me). But I did think it was interesting.

I will be walking in small town Spain in about three weeks, and am happy to ask about the availability of Humira if someone reminds me to do it.

If we get overcharged for Humira, most of the cost will be borne by our prescription plan (assuming they will pay for overseas meds; still have to check on that). So if the pharmacist wants to cheat us, we won't be out of pocket very much. For us, getting the medicine is more important than busting a dishonest pharmacist. Thanks for the tip. And I'll be checking this thread for some time to see if you or someone else on the road has current info on Humira's availability.
 
St James' Way - Self-guided 4-7 day Walking Packages, Reading to Southampton, 110 kms
If we get overcharged for Humira, most of the cost will be borne by our prescription plan (assuming they will pay for overseas meds; still have to check on that). So if the pharmacist wants to cheat us, we won't be out of pocket very much. For us, getting the medicine is more important than busting a dishonest pharmacist. Thanks for the tip. And I'll be checking this thread for some time to see if you or someone else on the road has current info on Humira's availability.

Well, I probably didn't explain myself very clearly. There is absolutely no risk to the consumer buying the product. The price is clearly listed on the box. As a non-Spaniard without Spanish health insurance, you will pay the full market price (which in your case, you can submit to your insurance company back home). The trick comes in what the Spanish pharmacist may do. He may take a little piece of your medicine box and submit it to the Spanish government. That little piece of the box is the piece he takes any time a Spaniard with insurance buys the medicine. He then gets reimbursed for the difference between the subsidized amount (which is all the Spaniard paid) and the full market price (which is the price the pharmacist would charge to someone without insurance). But in your case, since you have not paid the subsidized amount, but have in fact paid the full market price, he is applying for a reimbursement for a cost that he never bore. Make sense? Sorry if I'm garbling it. But I really should check this out with someone like @Castilian to make sure I have my facts straight. It may be that I am falsely maligning Spanish pharmacists.

And, if you remember to send me a PM in late May, I will remember to ask in several pharmacies about the availability of Humira. :)
 
Well, I probably didn't explain myself very clearly. There is absolutely no risk to the consumer buying the product. The price is clearly listed on the box. As a non-Spaniard without Spanish health insurance, you will pay the full market price (which in your case, you can submit to your insurance company back home). The trick comes in what the Spanish pharmacist may do. He may take a little piece of your medicine box and submit it to the Spanish government. That little piece of the box is the piece he takes any time a Spaniard with insurance buys the medicine. He then gets reimbursed for the difference between the subsidized amount (which is all the Spaniard paid) and the full market price (which is the price the pharmacist would charge to someone without insurance). But in your case, since you have not paid the subsidized amount, but have in fact paid the full market price, he is applying for a reimbursement for a cost that he never bore. Make sense? Sorry if I'm garbling it.

And, if you remember to send me a PM in late May, I will remember to ask in several pharmacies about the availability of Humira. :)

Thanks for the explanation; I didn't quite understand the situation in your first post. I'll put a reminder to myself on my calendar to PM you in late May. Thanks so much for your help!
 
You might also want to ask your your doctor about alternatives. Explain what you're going to be doing and see what he says. If he know the situation, he may be able to find a way to make it possible. Either an alternate medication, or a way to handle the Humira while travelling that none of us thought of.
 
A selection of Camino Jewellery
So, given the conditions of the Camino from early April to mid-May (our Camino time frame), is there any way for my husband to be able to walk the Camino and carry/store Humira along the way?
Talk with the doctor to find out if the medicine must be taken at exactly 14 days intervals or if it can be taken a few days early or a few days late.

Now this suggestion may not be practical but you might be able to get someone to airmail the medicine from the US every two weeks to various pharmacies along the way (arranged with them ahead of time.) The pharmacies might be able to then store it for your arrival. That is why you want to know how closely you must adhere to the drug's schedule.

The pharmaceutical company could give advice on how to keep the drug at the right temperature when shipping or walking.
 
Spanish medical care really is world class. As this drug is only needed once every two weeks it makes it easier. If it were me I would email some pharmacies along the way with my approximate arrival dates and the drug I need, and ask them to ensure they have supplies - I would get a Spanish sim card on arrival and keep in touch by telephone. The only problem you might have is language, but usually there is someone in the pharmacy who speaks English, or if not grab a fellow pilgrim who speaks Spanish and let them do the talking.
 
I've followed up on a lot of the suggestions in this thread, and instead of bringing 5 doses of Humira to Spain, I now think it would be better to buy the Humira as needed in Spain (with some advance scheduling to be sure it will be there when my husband needs it). It is available in Spain (thanks, KinkyOne. I checked out that second site -- a gem for good information). I think that's the safest approach to take to ensure that the med is fresh and has been kept under proper conditions.

My husband is going to check with the Penn State prescription plan to see if it covers the costs and if prescriptions will be needed from his doc in the States. Since the Humira will be a maintenance medication for a serious condition, we believe that it probably won't matter to the plan where he buys the medicine, especially, as some have noted, it's less expensive in Spain than in the U.S.

My husband will be seeing his doctor in about two weeks, so I will follow up on your suggestion, Rick, to get the doc's recommendations about this situation.

My Spanish has improved from long-ago high-school level (i.e. nearly nonexistent) to just barely passable, thanks to three months in Nicaragua this past winter, but I need to keep working on it to be ready to make arrangements by email or phone in Spain. However, it's good to know (thanks, Kanga) that other Spanish-speaking pilgrims will undoubtedly be able to help me if I need it.

Thanks everyone! In less than two days since I started this thread, you all came up with wonderful ideas and information, and what I thought might become a problem that would cancel our pilgrimage now appears very solvable. :)

When I have all the necessary facts and solution to this problem, I'll be sure to post it for any future pilgrims in similar situations.
 
€2,-/day will present your project to thousands of visitors each day. All interested in the Camino de Santiago.
A suggestion which I have made during pilgrim training is that, if someone has a serious or complex medical condition, they should have their specialist write up a protocol of diagnosis and treatment, and have a professional medical translator (not google!! not a grade XII teacher!!) put it into Castilian (OHIP in Ontario will not cover these costs-- I have no idea if a private insurer will). This may save valuable time and avoid confusion if you need to involve medical personnel in Spain.
 
I've followed up on a lot of the suggestions in this thread, and instead of bringing 5 doses of Humira to Spain, I now think it would be better to buy the Humira as needed in Spain (with some advance scheduling to be sure it will be there when my husband needs it). It is available in Spain (thanks, KinkyOne. I checked out that second site -- a gem for good information). I think that's the safest approach to take to ensure that the med is fresh and has been kept under proper conditions.

My husband is going to check with the Penn State prescription plan to see if it covers the costs and if prescriptions will be needed from his doc in the States. Since the Humira will be a maintenance medication for a serious condition, we believe that it probably won't matter to the plan where he buys the medicine, especially, as some have noted, it's less expensive in Spain than in the U.S.

My husband will be seeing his doctor in about two weeks, so I will follow up on your suggestion, Rick, to get the doc's recommendations about this situation.

My Spanish has improved from long-ago high-school level (i.e. nearly nonexistent) to just barely passable, thanks to three months in Nicaragua this past winter, but I need to keep working on it to be ready to make arrangements by email or phone in Spain. However, it's good to know (thanks, Kanga) that other Spanish-speaking pilgrims will undoubtedly be able to help me if I need it.

Thanks everyone! In less than two days since I started this thread, you all came up with wonderful ideas and information, and what I thought might become a problem that would cancel our pilgrimage now appears very solvable. :)

When I have all the necessary facts and solution to this problem, I'll be sure to post it for any future pilgrims in similar situations.
My daughter is also hiking the Camino Frances and needs to either bring or purchase Humira while there. What did you end up doing? Thank you.
 

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