Well, here we go again, another bill that would formally legalize a practice that has been going on for decades: Americans importing meds from Canadian pharmacies, at the very least to cut down on their drug bills, and in some cases even to afford life-saving medicines. Sorry to sound cynical, but I’ve seen these bills before and Big Pharma is always behind their failure – but what about this time?

The bill, H.R. 2228, was introduced by Representative Chellie Pingree (D-ME) barely a week ago and co-sponsored by Dana Rohrabacher (R-CA), and is entitled “Safe and Affordable Drugs from Canada Act of 2015.” It seems to mirror legislation in the Senate, S. 122, introduced by Sens. John McCain (R-NV) and Amy Klobuchar (D-MN), which has the same title.

The bills are focused on Canadian pharmacies only, not the wider landscape of international online pharmacies, which are often based in Canada: ones that millions of Americans have benefited from for over a decade. If H.R. 2228 passes, the FDA would be required to publish a list of approved Canadian pharmacies from which Americans could legally import, for personal use, non-controlled, non-biologic, and non-temperature sensitive, prescription medications. That would include the majority of maintenance prescription drugs that Americans are currently importing for personal use.

I support this bill 100%. Even though our program is open to safe and licensed pharmacies in other countries, not just ones in Canada and the U.S., the new bill moves the public policy and economic justice needle in the right direction. The practice of international pharmacy began with Americans crossing the border to buy lower cost medications in Canada and then, with the advent of the Internet, buying through mail order. Current law, technically, bans the practice and, unjustly, views it as a criminal act – even though no one has been prosecuted for it. The new bill in the House and Senate would lift the unethical ban on buying lower cost medications for their own use from Canada. Amen and Word Up to that!

So head on over to RxRights.org to contact your elected representatives and let them know you want them to vote for the Safe and Affordable Drugs from Canada Act of 2015!

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Is it legal to order medications online? Yes. If you live in the U.S., you can legally order medications online for mail order, such as from Walgreens or CVS. Is it legal to order medications from an online pharmacy located in a foreign country – to personally import it? Technically, no; but people who import small quantities of prescription medication for their own use, according to the FDA, are not prosecuted for doing so. There are a lot of nuances and quirky details when it comes to laws and regulations that apply to online pharmacies. Some laws are there to protect your health and safety; others seem more bent on protecting the profits of big drug companies – and there’s a lot in between. It’s complicated.

So this week, in our continuing quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing the next section of our report called Online Pharmacies, Personal Drug Importation, and Public Health

(more…)

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Continuing our quest to get the truth out and for our elected leaders in Congress to take bold action to protect online access to safe and affordable medication, we’re publishing a section a week of our report called Online Pharmacies, Personal Drug Importation, and Public Health. Our report refutes a flawed GAO report about Internet pharmacies.

This week we look at the evidence that proves that illegal personal drug importation is not inherently unsafe. First of all, when Americans buy medication from a licensed pharmacy in Canada, India, Turkey, or the UK, the pharmacy itself is legal in those countries: after all its licensed. Unfortunately, it’s technically illegal under most circumstances for a consumer to import meds for their own use from those pharmacies. It’s very common for groups funded by big drug companies to confuse consumers and even lawmakers that this illegality means the practice is inherently not safe, but that’s not true…

Illegal Doesn’t Mean Unsafe

The GAO report misconstrues safety and legality in its analysis of Internet pharmacies. The report states: “By violating federal and state laws, rogue Internet pharmacies threaten the public health.” For about fifteen years, often in violation of federal and state laws, millions of Americans have safely imported medication ordered online, pursuant to a valid prescription for their own use. As evidenced throughout this report, it’s not the violation of federal or state laws that threaten the public health but the actions of rogue pharmacy operators who sell fake or otherwise dangerous medication, or real medication without requiring a prescription.

The facts about personal drug importation are as follows: 1) Through orders placed online, tens of millions of Americans have imported medication from licensed pharmacies that require a prescription over the past 15 years with no reported deaths or serious adverse effects; 2) the practice is technically illegal under most circumstances; 3) there is no evidence that shows personal drug importation of non-controlled medication where a prescription is required is inherently unsafe; 4) according to the FDA, no one has ever been prosecuted for importing small quantities of prescription drugs for personal use.1

If an American receives a drug ordered online that was dispensed and mailed properly from a licensed pharmacy, it makes no difference from a safety perspective whether the product came from a U.S. or foreign licensed pharmacy, as long as the drug has the right amount of the active ingredient, treats the condition as intended, and is administered in the manner intended by the physician who prescribed the drug. Like those sold in U.S. pharmacies, medications ordered from credentialed international online pharmacies are produced in factories employing Good Manufacturing Practices (GMP) and are distributed, stored, dispensed, and mailed properly. The drugs are the same as or foreign versions of those sold in U.S. pharmacies.


1“Should You Use an Overseas Pharmacy,” MoneyTalksNews.com, 2/1/2013. An email written by Christopher Kelly, Center for Drug Evaluation and Research, FDA, states: “FDA is not aware of any actions taken against an individual resulting from their purchase of small quantities of unapproved drugs for personal use.” http://www.moneytalksnews.com/2013/02/01/is-it-safe-to-use-an-overseas-pharmacy/, [Last accessed 12/17/2013].

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Safe online pharmacies outside the U.S. sell popular brand name medicine at prices that average 85% lower than American pharmacies, according to our new analysis of online and local U.S. pharmacy prices. The analysis compares cash prices for top-selling brand name medications in the U.S. to prices for the same medicines abroad. All international online pharmacies in the study are licensed and require prescriptions.

The savings ranged from 82% for Celebrex to 91% for Nexium. Annual dollar savings averaged just over $3,000. The study noted the rising costs of prescription drugs in America and, perhaps surprisingly, the fact that these same drugs are becoming cheaper abroad. Average savings have increased from 80% in March, 2011.

For more information, view the press release. To view price comparisons among online pharmacies, visit PharmacyChecker.com.

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Prescription drug costs in the U.S. remain high, and consumers are constantly looking for ways to save. We recommend verified online pharmacies, such as those listed on PharmacyChecker.com.

However, if you need your medication immediately, an online or mail order pharmacy won’t cut it. Luckily, there are many other options to save; for example, many chain drug stores offer low cost generics and manufacturers offer coupons for their products.

Discount drug cards also offer savings and can be used in pharmacies across the United States for a wide variety of brand name and generic drugs. They seem like the perfect solution if you need medicine right away – just print the drug card, bring it to your local pharmacy, and count the savings!

But just because they can be used quickly, doesn’t mean they offer the best price on your medicine. Different drug cards carry different discounts. While one offers 70% savings on a drug, say Lipitor, another card might not have any savings at all.

There is no way to easily find the best price among different drug cards, and for some you can’t even find out the price of your medicine until you have a prescription. We investigated the prices for three different drugs for three different cards and compared them to the cash price at a local pharmacy and prices from PharmacyChecker.com-approved international online pharmacies.

As shown below, we found the average savings using the lowest-cost online pharmacy was 82%, but savings averaged only 23% across the discount drug cards. We recommend using a PharmacyChecker.com-approved online international pharmacy for brand name medications and for many generics. If you need a medicine right away, though, it’s best to print out a few drug cards and head down to the local pharmacy.

Drug Prices Using Prescription Cards vs. Online Pharmacy

Drug Bricks and Mortar Pharmacy* RxFreeCard.com EasyDrugCard.com RxSavingsPlus.com PharmacyChecker.com-approved Online Pharmacy**
Lipitor 40 mg (30) $225.99 $184.68 $178.09 $189.64 $35.00
Plavix 75 mg (30) $257.99 $214.00 $203.85 $216.74 $49.20
Simvastatin 40 mg (30) (Generic Zocor) $49.99 $4.00 $13.36 $33.30 $12.30

*Local Pharmacy in New York City, prices collected 8/20/2012
**Lowest price as listed on PharmacyChecker.com on 8/23/2012

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For the last six months the WSJ has actively reported on fake Avastin purchased by some medical clinics in the United States. The latest report focuses on the fact that the owner of the foreign wholesaler that shipped the fake Avastin to the U.S. is also the owner of a large international online pharmacy called CanadaDrugs.com. The WSJ reporting makes it clear that the wholesale business is separate from CanadaDrugs.com.

CanadaDrugs.com is a long-standing member of the PharmacyChecker.com Verification Program. It takes orders online filled by licensed pharmacies that require a valid prescription. It does not sell Avastin and the WSJ didn’t report any safety problems associated with its operation.

PharmacyChecker.com’s programs are designed to provide information to consumers seeking safe and affordable medication online for their own use. We recognize that importation by medical clinics does occur and the reason is that drug prices of many drugs are unusually high in the United States. We believe that wholesale drug importation presents unique drug supply and safety challenges that should be addressed but are not related to personal drug importation.

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Americans are speaking out against the provisions of a new law signed by President Obama on July 9th that will hinder their access to safe and affordable medication. In a news story last week on a Minneapolis-St. Paul NBC affiliate, Kare 11, we learn about Minnesotans who could be negatively affected by Section 708 of Food and Drug Administration Innovation and Safety Act, which allows for the seizure and destruction of personally imported medication.

Rico Anderson imports his prescription medicine for Crohn’s disease from Canada, paying $135 for a one month supply. In the U.S., this medicine would cost over $700 a month. That’s almost $7,000 dollars in annual savings. In contemplating having to face higher U.S. prices, Mr. Rico lamented that: “if it gets to a point where you’re deciding if you have to buy your medicine or pay your mortgage or put food on your table what are you going to do?”

The NBC report features Lee Graczyk, lead organizer of RxRights, a prescription affordability advocacy group. Days before the law passed Mr. Graczyk emphasized both the economic and health costs that result from unaffordable medication: “People are using this option because they cannot afford to buy the medications here. If this law passes, they can’t afford to buy the medications and stop taking the medications, they not only put their health at risk, but as a nation, it’s going to cost us more money.”

Visit RxRights.org to learn how Americans can fight back and protect their access to safe personal prescription drug importation from verified online pharmacies.

To compare prices on prescription medication from Canada and other foreign countries visit PharmacyChecker.com.

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A new study, reviewed in Medpage Today, finds that seniors falling into the Medicare Part D prescription drug coverage gap, often referred to as the “doughnut hole,” reduced the number of monthly anti-depressant prescriptions they filled by 12.1% compared to those with full coverage. In 2012, Part D plans share drug costs with enrollees up to $2,930. With co-pays, premiums, and deductibles seniors pay about $1,500 up to that point. After $2,930 the doughnut hole begins and plan enrollees pay out-of-pocket until they have spent $4,700 – after which the plans pay for 95% of drug costs.

The study also showed that those in the doughnut hole were more likely to go without other medications. Monthly use of heart failure drugs and anti-diabetics fell by 12.9% and 13.4%, respectively, relative to the group with full drug coverage. The study, Effects of Medicare Part D Coverage On Medication and Medical Treatment On Elderly Beneficiaries With Depression, was published in the July issue of Archives of General Psychiatry.

We’ve previously reported that the doughnut hole is a serious health issue for America’s seniors who are unable to afford needed medication. The new healthcare law offers seniors substantial discounts in the doughnut hole on brand name medications, and by 2020 the doughnut hole will supposedly be closed. The discounts help seniors to access medicine, but the crisis of skipped medicine will persist through the decade. Until then, it’s critical that seniors do not stop taking needed medications.

Medicare enrollees in the doughnut hole face very high drug costs for popular products such as Lexapro, Cymbalta and Abilify, all used to treat depression. These very medications are, on average, 80% less expensive if ordered from the lowest priced verified online pharmacies. See the chart below for price comparisons of verified international online pharmacies and a U.S. bricks and mortar pharmacy.

Prices for Three-month Supplies of Popular Anti-Depressants

Drug U.S. Bricks and Mortar Pharmacy* Lowest Pharmacy-Checker.com Listed Price** Savings Over 3 Months Percent Savings Savings Over 1 Year
Abilify 10 mg $1,881.99 $332.10 $1,549.89 82.35% $6.199.56
Cymbalta 30 mg $637.00 $133.20 $503.80 79.09% $6,199.56
Lexapro 10 mg $351.00 $84.61 $266.40 75.90% $1,065.60
Average: $956.66 $183.30 $773.36 80.84% $3,093

* Pharmacy in New York City, price collected 7/5/2012
**Lowest price listed on PharmacyChecker.com as of 7/5/2012

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UPDATE: the video showing Senator’s Snowe’s floor remarks is no longer available. Please consult the congressional record for this date to read Senator Snowe’s full remarks.

In support of Senator John McCain’s amendment to facilitate safe personal drug importation from credentialed online pharmacies, Senator Olympia Snowe spoke comprehensively, passionately and honestly about the issue. Though the amendment did not pass, Americans interested in online pharmacies and drug affordability should be aware of some of Ms. Snowe’s most pertinent points in support of personal drug importation. The full senate floor presentation is available for viewing as well.

  1. “Americans are facing tremendous increases in prescription drug prices for far too long and I think it’s at a point in which Congress should address this issue,” said Senator Snowe.In 2010 AARP found that retail prices for the most popular brand name drugs increased 41.5% while the consumer price index rose just 13%. In other words the cost of prescription drugs rose more than three times as much as the inflation rate.”
  2.  Senator Snowe wisely reminded her colleagues that most of “America’s” drug products are already manufactured overseas. Senator Snowe points out that the very medications America consumes come from manufacturing facilities in over 50 countries and “not all of those facilities are even inspected….”
  3. We need a more competitive pharmaceutical market. Senator Snowe points out (by quoting a former Pfizer CEO) that more competition from imported medication will lead to lower prices, higher quality products, and more innovation.
  4. The amendment is far more modest than previous drug importation bills and only calls for the Secretary of Health and Human Services (HHS) to make a list of approved online pharmacies for personal drug importation but it would not allow for greater “wholesale” drug importation. PharmacyChecker.com already provides such a list that consumers can freely access. Ironically, while Senator Snowe didn’t mention it, the Secretary of Health and Human Services, Kathleen Sebelius, actually published such a list when she was governor of Kansas for a state drug importation program.

 For those interested in learning more about why personal drug importation should be made more available to Americans please watch Senator Snowe’s floor remarks.


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On May 14th, an article appeared in ForeignAffairs.com called “Dangerous Doses: Fighting Fraud In The Global Medicine Supply Chain.” Authors Tim Mackey, Bryan Liang, and Tom Cubic simultaneously report on the counterfeit drug threats and tragedies experienced globally while deceptively attempting to link safe international online pharmacies to this problem. Our vice president, Gabriel Levitt responded in Telling the whole truth about online pharmacies. His response is published below.


Telling the whole truth about international online pharmacies

Over a decade of experience and empirical studies [See “Unveiling the Mystery of Online Pharmacies: an Audit Study” in National Bureau of Economic Research] have shown that credentialed international online pharmacies sell safe and affordable medication, not counterfeit drugs, to Americans who otherwise might cut back or not take their medications at all. These credentialed websites work with licensed pharmacies that require a prescription and meet high safety standards for mail-order pharmacy. They just happen not to be located in the United States, which explains their low prices. They are not a part of the counterfeit drug threat but the authors of this article would like you to think that they are

So why do these authors take this position? Although not well disclosed, the two senior authors are directly affiliated with pharmaceutical corporate interests. Pharmaceutical companies in the U.S. do not want their sales undercut by lower cost imports of the same exact medicines they sell here because it negatively affects their profits. No one disputes this. Bryan Liang maintains a leadership position with the Partnership for Safe Medicines (PSM), which is largely funded by pharmaceutical companies and is currently led by the Deputy VP of Public Relations for the Pharmaceutical Researchers and Manufacturers of America (PhRMA). Thomas Cubic is head of the Pharmaceutical Security Institute (PSI), an organization of pharmaceutical company members. I believe the two entities share an office in Virginia.

The pharmaceutical industry has focused a lot of its lobbying muscle against drug importation laws that could help millions of Americans obtain needed medication. The pharmaceutical industry position is advocated on many levels through Liang’s Partnership for Safe Medicines and Cubic’s PSI, as well as through PhRMA and the National Association of Boards of Pharmacy with the goal of preventing non-US online pharmacies from selling to Americans even if they are safe. A careful reader would certainly find their position in this article.

The authors here accurately acknowledge that a majority of the world’s counterfeit drugs and the subsequent sickness and death they cause are found in countries with weak drug regulations and/or enforcement of laws. But they try and equate huge tragedies in developing countries where counterfeit drugs kill hundreds of thousands with the real but different dangers posed by the Internet.

Let’s just make one thing clear: The counterfeit drug problems found through online pharmacies in the rich countries are real but miniscule compared to the tragedies reported about in poorer countries. In fact, examples provided in this article perfectly reflect the sharp dichotomy in the numbers of counterfeit drug victims in the United States and in poorer countries. Eleven years ago one young American named Ryan Haight, 18, tragically died from an overdose of pills purchased online, which he should have never received. But it’s worth noting that the drug, Vicodin, was real – not counterfeit. In this case, the problem was dispensing medications without proper medical supervision – not counterfeit drugs. The people who sold him the Vicodin went to jail. In Niger, a much larger tragedy occurred – 2,500 people died out of 50,000 who were inoculated with bogus medication. Of course this had nothing to do with U.S. drug importation or online pharmacies. One might have expected the authors to mention the 238 Americans who died after ingesting fake Heparin, which was circulating thorough the legal U.S. drug supply in 2007 and 2008. This, too, had nothing to do with online pharmacies but exceeds in victims any reported incidents having to do with the Internet.

The authors would like you to believe that CanadaDrugs.com, a credentialed international online pharmacy, is a part of the counterfeit drug problem so as to foster actions that could block access to such sites. They state that one of its suppliers is responsible for the counterfeit Avastin in the United States. They fail to mention, however that the counterfeit Avastin had nothing to do with online pharmacies, safe or otherwise. As it happens, many pharmacies in the United States have at one time or another unintentionally sold counterfeit medication – including CVS and Walgreens, which is not a reason to shut them down.

The source of the most recent large scale problem with intentionally sold substandard medications distributed in the United States is in fact GlaxoSmithKline. They were fined $750 million for intentionally distributing millions of substandard pills all across the country. These products were manufactured at their facility in Puerto Rico. U.S. Marshalls confiscated $2 billion of products from the plant in 2005, the largest such seizure in history and worth at least four times the value of all drugs imported by Americans from Canada each year.

There is no doubt that companies and people operating websites that purposefully sell fake drugs or even real drugs without a prescription need to be shut down, and in many cases criminally prosecuted. Victims of bogus online pharmacies certainly go underreported and the problem is very serious. But it’s a different problem from the large scale counterfeit operations that are killing hundreds of thousands of people in poorer countries – a crisis that demands immediate action to prevent the next massacre. The UNDOC may in fact be a better venue for international enforcement efforts, as the authors point out, because police actions may exceed the WHO’s mandate. Interpol’s enforcement work in Operation Pangea definitely took out a lot of bad guys – more such efforts are needed. Certainly working in concert, tapping their respective strengths, UNDOC, Interpol, WHO-IMPACT can bring us to a better place where the counterfeit drug threat goes on the decline.

But when it comes to the American pharmaceutical market, we find 48 million Americans not filling a prescription each year due to cost – an underreported crisis from which many die. Some of these Americans seek affordable and genuine medication online from Canada and other countries to acquire needed medication.

To directly address the core of Foreign Affairs readers, we must not allow our foreign policy and multilateral actions to disadvantage American consumers who are struggling or can’t afford prescription medication. So as we ramp up our efforts to stop criminals from infesting the world with fake drugs let’s not enact policies that will block the access of Americans to life saving medications simply because it improves our corporate balance sheets.

Gabriel Levitt

Vice President
PharmacyChecker.com

President
United Nations Association Brooklyn Chapter

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