[For a 2019 update on this issue, visit our blog post: NY State Authorizes Paper Prescriptions to Fill in Foreign Pharmacies]
To save money on prescription drugs, it is often necessary to have a prescription in hand to send to an international online pharmacy or shop around at local pharmacies to compare their prices and discounts. However, some U.S. states, like New York, now require that most health professionals write prescriptions electronically, without giving you a paper prescription.
So are you out of luck if you need a paper prescription?
The rules, for example, in New York (where e-prescribing becomes mandatory on March 27, 2016) provide exceptions to allow written prescriptions. One of these is when the prescription is “to be dispensed by a pharmacy located outside the state.” Therefore, in New York, a doctor can still legally hand you a prescription if you intend to have it filled outside of New York. (You can read this for yourself in paragraph (c)(5) of Title 10 NYCRR Section 80.64).
The New York law also says that a doctor who gives you a written prescription is supposed to report the issuance of that prescription to the New York Department of Health within 48 hours. However, the law does not explain how this to be done, so I asked the Department of Health. My question was forwarded to a pharmacist consultant with the department who called me back this morning. He told me that if a written prescription is given to a patient under one of the exceptions, “there is currently no functionality for reporting that to the Department of Health.” Instead, he said “the fact that a written prescription was given should just be noted in the patient’s chart.”
I also asked the pharmacist if a doctor can give a patient a written prescription so they can shop it around to find an affordable price or discount. He said that that is acceptable “if it’s deemed necessary by the doctor.” Again, he said that this should be noted in the patient’s chart.
UPDATE: Shortly after publishing this blog post, the Department of Health updated its FAQ about e-Prescribing, changing its advice on this topic. It has created an email address (firstname.lastname@example.org) to which a practitioner should send a message if a written prescription is given (see details in the FAQ in answers to Q139 to Q143). It would seem prudent to also make a note in the patient’s chart for the reason for the written prescription.
E-prescribing is practiced to some degree in all 50 states and 60% of all NY prescribers already e-prescribe. Minnesota has adopted a comprehensive e-prescribing program. But only NY, as of March 27th, will issue fines to prescribers who don’t follow the rules.
The e-prescribing laws were originally enacted to cut down on improper dispensing of controlled substances but are being extended to all prescriptions. The reasons given in New York are “to minimize medication errors” and “the integration of prescription records directly into the patient’s electronic medical record.” In addition, “Electronic prescribing has the potential to reduce prescription theft and forgery.” That’s all well and good, but it is also important that it does not interfere with the overall delivery of good medical care — which includes making sure that patients are able to afford their medicine.
Tagged with: e-prescribing, legal, New York Department of Health
The article “Taming Drug Prices by Pulling Back the Curtain Online” in the New York Times (February 10, 2016) features a new website, Blink Health, which shows reduced drug prices available through local U.S. pharmacies. Its limitation is that savings are mostly on generic drugs, which, for the most part, are already fairly inexpensive. Describing Blink and a similar site, GoodRx, the article notes that, “The sites cannot help much with brand-name drugs, which are made by a single manufacturer and carry prices that can be as high as hundreds of thousands of dollars.”
The article fails to mention that the largest pharmacy savings on the Internet are from international online pharmacies which can offer you the lowest prices worldwide. These prices can be found on PharmacyChecker.com, which “pulls back the curtain” even further than Blink Health and GoodRx by exposing the huge gap (often more than 80%) between drug prices in the U.S. and those in other countries — such as Australia, Canada, India, New Zealand, Turkey, and the UK. You can also find discounted local U.S. pharmacy prices on PharmacyChecker.com.
The table below shows the lowest prices on popular brand name drugs found on PharmacyChecker.com, BlinkHealth.com, and GoodRx.com in comparison to regular U.S. pharmacy pricing.
Lowest Prices and Greatest Savings on Brand Name Drugs Using PharmacyChecker, Blink Health, and GoodRx
(Strength and Quantity*)
at Local Pharmacy
Off Regular Price (Source)
(250-50; 180 doses )
|$100.99||Not Available||$946.72||$1,179.00 ||91% (PC)
(10 mg; 90 pills)
(5 mg; 180 pills)
|$391.99||$1,046.28 ||$961.67||$1,141.00 ||66% (PC)
(100 mg; 90 pills)
|$101.15||$1,139.64 ||$1,046.94 ||$1,290.00 ||92% (PC)
(20 mg; 90 pills)
|$347.59||$1,045.31 ||$960.81||$1,141.00 ||70% (PC)
Prices as of February 10, 2016
* Quantity represents a standard 3 month supply.
Tagged with: Advair Diskus, Blink Health, Crestor, Eliquis, GoodRx, international online pharmacies, Januvia, local pharmacies, pharmacychecker.com, Xarelto
In the article “I.P.F., Not Aging, Could Be Causing Breathlessness” in the New York Times this week, columnist Jane Brody explains that the drug Esbriet (pirfenidone) can “slow the loss of lung function and significantly reduce deaths” from an incurable lung disease called idiopathic pulmonary fibrosis, or I.P.F.
The article notes that Esbriet was approved in the U.S. in 2014 and now 14,000 people have begun treatment, which costs $94,000 per year. The article also notes that the drug has been available for several years in other parts of the world (including Japan, India, Europe and Canada).
What the article does not mention is that this incredible drug can be purchased at just a fraction of the cost through many online pharmacies which dispense it from licensed pharmacies outside the U.S – where the cost is only about $2,000 per year, rather than $94,000 per year.
The standard dose of Esbriet is 801 mg per day – 3 capsules, each containing 267 mg of pirfenidone, according to the NIH website DailyMed. Outside the U.S., pirfenidone is sold as 200 mg capsules (so 4 capsules would provide a similar dose – 800 mg). In the U.S., the price of each 267 mg capsule (without any discount) comes out to about $85, while a 200 mg capsule from outside the U.S. costs about $1.50 (prices listed at http://www.pharmacychecker.com/generic/price-comparison/pirfenidone/200+mg/)
Why must Americans (and our government programs) pay 40 to 50 times more than to get this drug in the U.S. than from elsewhere?
Tagged with: Drug Prices, Esbriet, Idiopathic Pulmonary Fibrosis, international pharmacies, life-saving drugs, Online Pharmacies, Pirfenidone