PURCHASE PRESCRIPTION DRUGS FROM ABROAD? WHY NOT?

A few weeks ago drug company Turing Pharmaceuticals raised the price of a toxoplasmosis drug, Diatrim, from $13.50 to $750 per tablet, an increase of 5,000 percent. This medication is used with other medications to treat a serious parasitic infection of the body, brain, or eye or to prevent toxoplasmosis infection in people with HIV. Turiing's CEO Martin Shkreli explained that the company needed to make a profit on the drug. The price increase meant that the annual cost of treatment for people who need this medication will be anywhere from $336,000 to $635,000 depending on the patient's weight. The uproar this news caused has led to renewed concern about meteoric price increases in the pharmaceutical industry, generating an aggressive dialogue among political candidates, while resurfacing the question why Americans should not purchase their medications from abroad - especially Canada - since the price for medications in most developed countries is significantly lower than in ours.

It is not difficult to understand why many are tempted to purchase their medications elsewhere. We pay the highest prices in the world for our prescription drugs. Take for example the popular acid reflux drug Nexicum. An insurer in the U.S. pays on average $215 per customer. In the Netherlands the same prescription costs $23. A 30 tablet supply of Abilify costs $711 at Walgreens, but only $200 in Canada. A 10 capsule dose of Tamiflu sells for $112 in the U.S., and less than $50 in Canada. The IMS Institute for Healthcare Informatics, in a 2012 study, estimated that U.S. residents spend about $900 per year on prescription drugs, while the average Canadian spends $420, and Europeans spend on average $375.

During the 1990's travel agencies began organizing bus trips into Canada for seniors who wanted to purchase cheap brand-name drugs. These trips continue to be popular. It is technically illegal for individuals to importy drugs into the U.S. However, officials tend to use enforcement discretion and allow participants to bring in up to a 90-day supply of medication for personal use if they can provide documentation from their U.S. physician.

When I decided to research the viability of purchasing medications from abroad, I thought I would make the case for legalizing their importation. Given the vast differences of drug prices between us and the rest of the world this seemed logical. However, after digging into the subject matter it became clear to me that the issue is not that simple, and that falling in line with politicians who are shooting from the hip to effect legalization could generate troubling advice for people who react to cost alone. 

One reason for not allowing importation of prescription drugs is that the FDA won't be able to guarantee the safety of drugs coming in from a foreign country. This includes Canada. Drugs from foreign pharmacies are not subject to the agency's jurisdiction, could be mislabeled, counterfeit, or otherwise adulterated. Legality aside, bus tours taking passengers to brick and mortar pharmacies in Canada are pretty safe. However, these tours are only practical for residents of border states. The rest of us depend on web-based pharmacies, many of which are illegitimate, and often sell counterfeit drugs.In 2007 the FDA seized 9,600 websites and more than $41 million worth of illegal drugs worldwide. Many sites claimed to be Canadian. However, a sting operation discovered that only 15% of drugs claiming to be Canadian were actually from Canada. The remaining 85% came from 27 different countries. In 2011 the National Association of Boards of Pharmacy reviewed more than 8,300 online pharmacies. Just over 3 percent proved to be legitimate.

Anyone deciding to still take a chance on web-based pharmacies to save on the cost of prescriptions should access one of the following sites. They are designed to help insure that you are dealing with a legitimate online business:

VIPPS - the Verified Internet Pharmacy Practice Site.

CIPA - the Canadian International Pharmacy Association website.

PharmacyChecker

Any of these accredit online pharmacies, and PharmacyChecker also claims that their pharmacies offer drug prices that are up to 80% lower in price than those in U.S. pharmacies. In short, buyer beware. Know who you are dealing with.

Of course this still begs the question: Why do Americans pay two to six times more than the rest of the world for brand-name prescription drugs?

Other countries feature single payer nationalized healthcare systems. They contyrol pricing by negotiating as a single entity with pharmaceutical companies. Their governments essentially decide who can sell what at what price. In the U.S. companies negotiate with individual insurance companies, hospitals and private plans, resulting in an unregulated market driven pricing structure. Besides, by law the federal government-run Medicare system cannot negotiate with the pharmaceutical industry. If Medicare were allowed to negotiate directly, as one of the largest buyers of prescription drugs, it could potentially drive the prices of drugs down. The Veterans Administration has that ability, and within the V.A. system drug prices are 10% to 20% lower than elsewhere. Finally, pharmaceutical companies claim that the average cost of developing a new drug is about $1 billion. Since they are forced to sell at lower prices abroad, U.S. consumers pay higher prices to make up for reduced revenue from foreign sales.

Meanwhile all of us are well advised to do our homework, research the legitimacy of web-based pharmacies, recognize that there is a lot of fraud in the system and, perhaps, just contact several local pharmacies to find the best price.