Medical/supplemental insurance for India
Oct 6th, 2014, 11:36 AM
#22
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We now know dozens who have taken Rifaximin for India travel with no illness and no side effects. Most were traveling for work, but we took it for 12 days on vacation because our travel doc raved about it - she said that 100% of her patients who take avoid getting sick and 50% who don't take it get some sort of intestinal disturbance. She sees a lot of high profile performers, politicians, deal makers etc. (I know - a little obnoxious, see my trip report..were we important enough for Rifaximin??), but I trusted her advice.
It has been used in the US for years as a treatment for traveler's diarrhea, but has been routinely prescribed in Europe for decades as a preventative for traveler's diarrhea and recently tested and advocated for that by the FDA.
We travel often to Latin America and have never taken it there, so chances are we wouldn't have gotten sick in India. But because we were going for a relatively short time and we love spicy, authentic food, our travel doc convinced us. (We also avoided meat, chicken and fish.) The only downside I can think of is the price. It was outrageous when we took it two years ago even though partly covered by insurance. I think there now is a generic.
Of course, talk to your doc to see if it's right for you.
It has been used in the US for years as a treatment for traveler's diarrhea, but has been routinely prescribed in Europe for decades as a preventative for traveler's diarrhea and recently tested and advocated for that by the FDA.
We travel often to Latin America and have never taken it there, so chances are we wouldn't have gotten sick in India. But because we were going for a relatively short time and we love spicy, authentic food, our travel doc convinced us. (We also avoided meat, chicken and fish.) The only downside I can think of is the price. It was outrageous when we took it two years ago even though partly covered by insurance. I think there now is a generic.
Of course, talk to your doc to see if it's right for you.
Oct 6th, 2014, 11:48 AM
#23
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Re: buffets...I agree with thursday about no meat/chicken/fish from a buffet, even at the Oberoi. I don't remember much about the Oberoi breakfast except that it was a little too westernized and over the top for my tastes.
If any of you are going to Devi Ghar near Udaipur, they will prepare any kind of street food for you using high end ingredients. Just take a photo of the food that looks appealing.
If any of you are going to Devi Ghar near Udaipur, they will prepare any kind of street food for you using high end ingredients. Just take a photo of the food that looks appealing.
Oct 9th, 2014, 05:00 PM
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We always travel with antibiotics Incase we get sick. karen was very sick last trip and in 6 hours after starting abx, and careful hydration she was on the mend.. Even when you are cautious it can happen, and you don't know where you picked up something.
Oct 28th, 2014, 09:23 PM
#26
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Just back from my longtime doc (who also was a longtime epidemiologist battling all sorts of nasty bugs all over the world prior to forming a practice...and happens to be one of the leading travel docs in LA.) So I trust him implicitly, especially because he's done so much field work in Cambodia, India and Indonesia and knows what he's talking about.
Got all our shots, scripts written and the usual run-down of all the possible risks. The only thing that came up as slightly surprising was that he agreed that, if you can afford Rifaximin, it's a much more effective treatment for TD than Cipro (which apparently is not as effective in India) -- but that it should NOT be taken as a preventative. Not sure if that's just cuz he knows that we're not independently wealthy and could never afford a 3 week supply of it. But he also mentioned that if price is of concern, Azithromycin is also an effective substitute--not as effective, but effective nonetheless.
I can't understand how anyone could ever afford this medication given that 60 pills costs roughly around $1500-$2000. We're going for 3 weeks. That's more than a substantial part of our overall trip cost. Also, as an update to the open question, there is no generic version of Rifaximin currently on the market, unfortunately.
I'm all for miracle cures but a little diarrhea is certainly not the end of the world. Not something I'd be willing to shell out that much money to prevent (even if my doc did recommend it).
So long story short is that we'll probably get a handful of the Rifaximin (6-8 each) for treatment of active TD rather than a ZPack just for its significant efficacy. But since I'd probably need to make as much as the Pitt-Jolies to afford this as a preventative (even if doc recommended it as such), I think I'll just stick with the daily Pepto pill as our preventative for good measure (whether that actually works or not, remains to be seen).
CAVEAT EMPTOR: this is my doc and by no means is this post meant to be a reflection on what others should do. Everyone should consult their own doctors and make decisions for themselves based on their medical history, risk level and specific destinations.
Got all our shots, scripts written and the usual run-down of all the possible risks. The only thing that came up as slightly surprising was that he agreed that, if you can afford Rifaximin, it's a much more effective treatment for TD than Cipro (which apparently is not as effective in India) -- but that it should NOT be taken as a preventative. Not sure if that's just cuz he knows that we're not independently wealthy and could never afford a 3 week supply of it. But he also mentioned that if price is of concern, Azithromycin is also an effective substitute--not as effective, but effective nonetheless.
I can't understand how anyone could ever afford this medication given that 60 pills costs roughly around $1500-$2000. We're going for 3 weeks. That's more than a substantial part of our overall trip cost. Also, as an update to the open question, there is no generic version of Rifaximin currently on the market, unfortunately.
I'm all for miracle cures but a little diarrhea is certainly not the end of the world. Not something I'd be willing to shell out that much money to prevent (even if my doc did recommend it).
So long story short is that we'll probably get a handful of the Rifaximin (6-8 each) for treatment of active TD rather than a ZPack just for its significant efficacy. But since I'd probably need to make as much as the Pitt-Jolies to afford this as a preventative (even if doc recommended it as such), I think I'll just stick with the daily Pepto pill as our preventative for good measure (whether that actually works or not, remains to be seen).
CAVEAT EMPTOR: this is my doc and by no means is this post meant to be a reflection on what others should do. Everyone should consult their own doctors and make decisions for themselves based on their medical history, risk level and specific destinations.
Oct 28th, 2014, 11:53 PM
#27
The bugs started developing immunity to Cipro several years ago. I have been taking something else along at least since 2010.
I am not at all enthusiastic about taking pills to prevent something that may well not happen, but I rarely get sick when I travel. My feet, on the other hand....
I am not at all enthusiastic about taking pills to prevent something that may well not happen, but I rarely get sick when I travel. My feet, on the other hand....
Oct 29th, 2014, 06:22 AM
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Hi filmwill, Did you check the cost of the Rifaximin or is that what your doc reported? When we went to India in 2012 it was indeed super expensive, but our insurance paid for most of it. I think our cost was $400 for two weeks.
But in the last year or so the cost has decreased substantially. When our friends went in 2013, although there was no generic version the tablets were down to about $1-$1.50 each. It is also available as a generic in the Boots pharmacy in Heathrow. Here it is advertised on one of the online pharmacies for $.89-$1.27 depending on the quantity purchased:
http://www.inhousepharmacy.biz/p-111...rifaximin.aspx
Our doc (who treats large groups of travelers - film crews, musicians, field workers, business people) suggested Rifaximim because she said 60% of her patients who didn't take it got sick in India, even if they were careful. And 0% of those who took it became ill. We got a second opinion from our internist who agreed. I'm not sure we really needed it because we've been fine in some dicey areas, but because it was noninvasive with zero side effects, I would definitely take it again the next time we go.
But in the last year or so the cost has decreased substantially. When our friends went in 2013, although there was no generic version the tablets were down to about $1-$1.50 each. It is also available as a generic in the Boots pharmacy in Heathrow. Here it is advertised on one of the online pharmacies for $.89-$1.27 depending on the quantity purchased:
http://www.inhousepharmacy.biz/p-111...rifaximin.aspx
Our doc (who treats large groups of travelers - film crews, musicians, field workers, business people) suggested Rifaximim because she said 60% of her patients who didn't take it got sick in India, even if they were careful. And 0% of those who took it became ill. We got a second opinion from our internist who agreed. I'm not sure we really needed it because we've been fine in some dicey areas, but because it was noninvasive with zero side effects, I would definitely take it again the next time we go.
Oct 29th, 2014, 06:59 AM
#30
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I found that pharmacy by random googling, so I can't endorse it. A psychiatrist friend who went with a group of doctors got his for a good price at Costco with a coupon. We didn't agonize about the decision because so many of our friends had taken it and our doctor was so enthusiastic about the wonders of Rifaximin (she had gotten sick in India). But, as filmwill said, you should trust your physician for medical advice.
Oct 29th, 2014, 07:17 AM
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OK, apparently there are some organizations that verify online pharmacies. I will do some more digging and probably order that way if our insurance is not covering it. Looks like about $1 per pill based on generic version available in Canada.
Oct 30th, 2014, 01:24 PM
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We got trip insurance from Insuremytrip, for $414 (covered both of us) for a 25-day trip this past Feb. It gave us $50K in medical, $100K medical evacuation, plus cancellation, interruption, etc.
We ate yogurt every morning we were in India (although we also eat yogurt fairly often at home). Our guides and driver were VERY specific about places they recommended for us to eat. We ventured out on our own once and a while, but still ate only at recommended places. We avoided street food, although by the time we got to Udaipur, we were tempted but did not succumb. (We really were unimpressed with the hotel food in Udaipur, but the two restaurants we would have gone to instead were totally booked.) We never got sick, once. We ate at breakfast buffets, or had food cooked to order for breakfast at all our hotels. Oh, and the lady who gave us a "cookery class" in Delhi and her husband also had suggestions for us to follow. I've never felt so taken care of on any of our travels!
We ate seafood in Kerala. It was fantastic. Tried mutton or chicken when offered non-veggie options, and preferred chicken most of the time. Mutton is as likely to be goat as it is lamb. We did learn, fairly early in our trip, that the best drink to have was beer or bottled water. (Although in Kerala, we fell in love with lemonade with ginger.)
Kerala is setting itself up as a Medical Tourism destination. (There will billboards to that effect all the way in from the airport and back.) Our biggest medical "issue" was insect bites in Kerala. My husband, for the 1st time in our 38 years together, was attacked by mosquitos (instead of me). DO take along benedryl.
We ate yogurt every morning we were in India (although we also eat yogurt fairly often at home). Our guides and driver were VERY specific about places they recommended for us to eat. We ventured out on our own once and a while, but still ate only at recommended places. We avoided street food, although by the time we got to Udaipur, we were tempted but did not succumb. (We really were unimpressed with the hotel food in Udaipur, but the two restaurants we would have gone to instead were totally booked.) We never got sick, once. We ate at breakfast buffets, or had food cooked to order for breakfast at all our hotels. Oh, and the lady who gave us a "cookery class" in Delhi and her husband also had suggestions for us to follow. I've never felt so taken care of on any of our travels!
We ate seafood in Kerala. It was fantastic. Tried mutton or chicken when offered non-veggie options, and preferred chicken most of the time. Mutton is as likely to be goat as it is lamb. We did learn, fairly early in our trip, that the best drink to have was beer or bottled water. (Although in Kerala, we fell in love with lemonade with ginger.)
Kerala is setting itself up as a Medical Tourism destination. (There will billboards to that effect all the way in from the airport and back.) Our biggest medical "issue" was insect bites in Kerala. My husband, for the 1st time in our 38 years together, was attacked by mosquitos (instead of me). DO take along benedryl.
Oct 30th, 2014, 05:59 PM
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We got Rifaximin last year from our local drug store in NYC with no problem and only our usual co-pay. We have very good prescription insurance, so maybe that was the reason. We ended up not taking it but we were very, very careful about our food. But we did eat Oberoi buffets when they had them. We never once had any GI problems in three weeks in India.
Just as important as evacuation insurance is cancellation insurance once you reach "a certain age". We have had to cancel trips due to pretrip problems which is big problem if you have had to repay without refunds.
Good news...if you bought your airline tickets with FF points and needed to return early, the rebooking fee is very small compared to last minute tickets especially Business. We did this last June with BA and they found seats for us overnight.
Just as important as evacuation insurance is cancellation insurance once you reach "a certain age". We have had to cancel trips due to pretrip problems which is big problem if you have had to repay without refunds.
Good news...if you bought your airline tickets with FF points and needed to return early, the rebooking fee is very small compared to last minute tickets especially Business. We did this last June with BA and they found seats for us overnight.
Nov 10th, 2014, 02:03 PM
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For anyone who has used rifamixin as a preventive, can you tell me what dosage you were given? I've spoken with 2 different doctors who don't know about its use for preventing TD, so I'd like to give them a nudge. Thanks.
Nov 10th, 2014, 04:27 PM
#37
I've had to go to Canada to get reasonably priced drugs after losing my US health insurance, and have found a company called Canadian Pharmacy King to be very cost effective. Just checked out their price for generic Rifaximin (and it comes from India!!!) and 200mg with 100 qty is only $50….the dosage if you get TD is 200 mg/ 3X day for 3 days….so you'll have a lot to share with fellow travelers! There are various reports about it's efficacy for prevention….so check this out online.
FYI, we always get Medjet Assist for medical evacuation….there's a discount for AARP members too.
FYI, we always get Medjet Assist for medical evacuation….there's a discount for AARP members too.
Nov 10th, 2014, 06:09 PM
#38
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Agreed...everything is more affordable outside the US! 
As a follow-up, we ended up getting it but only as a treatment and not a preventative.
Our prescription insurance (which is amazing--wish our regular medical plan was as good!) covered a ton of the cost.
To be clear, we got 18 pills (6 days of treatment x 3 pills/day). The retail cost of this was close to $700! Luckily, the cost ended up being $55 after insurance kicked in.
But my doc was pretty clear about the fact that he only felt strongly about its efficacy as a treatment for TD (vs as a preventative). Again, that's just my doc...and the way we're going about it.
As a follow-up, we ended up getting it but only as a treatment and not a preventative.
Our prescription insurance (which is amazing--wish our regular medical plan was as good!) covered a ton of the cost.
To be clear, we got 18 pills (6 days of treatment x 3 pills/day). The retail cost of this was close to $700! Luckily, the cost ended up being $55 after insurance kicked in.
But my doc was pretty clear about the fact that he only felt strongly about its efficacy as a treatment for TD (vs as a preventative). Again, that's just my doc...and the way we're going about it.
Nov 10th, 2014, 06:49 PM
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Rifaximin is an antibiotic that fights intestinal bacterial infection. Its available EVERYWHERE in India with different Brand names like RCIFAX, Rifaximin, RIFAGUT, RIXMIN & TORFIX.
Each tablet of 200mg will cost u around INR 10.00 eachI just checked with my friend who is MD in India.
Each tablet of 200mg will cost u around INR 10.00 eachI just checked with my friend who is MD in India.
Nov 12th, 2014, 02:17 PM
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fillwill, Congrats on your great prescription plan. We're there with you...Still have our stockpiled supply of Tamiflu from the SARS scare of '07.
FromDC, No surprise that's Rifaximin is available in India! The dosage we were prescribed was 2 x 200 mg tablets (2 a day). We did not take it on travel days, just on the ground.
I recently saw my travel doc about something else and she sent me a link about a German study that was conducted over 4 years in India and SE Asia.
http://www.thelancet.com/journals/la...221-4/abstract
She said Rifaximin is now routinely prescribed as a preventative for European business travelers. She's such a fan that I asked if she was getting a kickback from Big Pharma, but she said that many of her patients get the generic version online. She's so enthusiastic, she reported, because she still has a 100% success rate of prevention among her patients, with no side effects. (Again, just one opinion - everybody should check with his or her own doc.)
FromDC, No surprise that's Rifaximin is available in India! The dosage we were prescribed was 2 x 200 mg tablets (2 a day). We did not take it on travel days, just on the ground.
I recently saw my travel doc about something else and she sent me a link about a German study that was conducted over 4 years in India and SE Asia.
http://www.thelancet.com/journals/la...221-4/abstract
She said Rifaximin is now routinely prescribed as a preventative for European business travelers. She's such a fan that I asked if she was getting a kickback from Big Pharma, but she said that many of her patients get the generic version online. She's so enthusiastic, she reported, because she still has a 100% success rate of prevention among her patients, with no side effects. (Again, just one opinion - everybody should check with his or her own doc.)
