As we move out of 2015 and into 2016 with a strong wave of hostility rising throughout the country about high drug prices, what I’m about to report may seem incongruous. Fewer Americans seem to be buying lower cost medications from other countries. For the past few years, largely based on data from the CDC in 2013, I’ve published the number five million as the approximate number of Americans who, due to high drug prices, import medication annually for personal use. But a newer CDC report published in 2015 (that I recently came across) puts that number closer to four million, a 20% decrease.

If drug prices are going up, and Americans are fed up with prescription costs, wouldn’t you expect more people to be buying lower cost medications from outside the country? With fewer Americans buying medication internationally, potentially one million, how many of them are simply not taking prescribed medication? Are our most trusted authorities scaring Americans away from obtaining lower cost medications from other countries, or has affordable access improved over the past few years?

To answer some of these questions, we can go back to the beginning of the year when we learned that the numbers of Americans not filling a prescription due to cost dropped from 50 million to 35 million. Thirty-five million Americans not taking prescribed medication each year is a disgraceful indictment of our healthcare system, but the improving trend, nonetheless, is one variable to explain fewer Americans purchasing medication from another country.

CDC’s data is crystal clear that Americans without insurance are far more likely to buy lower cost foreign medication compared to the privately insured, 4.2% and 1.0%, respectively. People on Medicaid are even less likely to buy prescription drugs from another country: 0.7%. That low number, however, may be due to disproportionately lower access to the Internet, which is how many Americans buy foreign medications for personal use. Because of Obamacare, like it or not, 17 million more Americans are insured, which is another variable to explain fewer foreign medication purchases. To hammer that home: while we’ve reported how many newly insured are woefully underinsured, the fact stands that millions more have a pharmacy benefit because of their new health insurance that helps lower their out-of-pocket drug costs.

Despite the media frenzy about high drug prices, particularly medication identified as specialty, biologic, and oncology drugs, many popular medications are not very expensive – even in the U.S. And the “patent cliff” of a couple of years back, through which many “blockbuster” brand drugs, such as Lipitor, Plavix, Cymbalta, and Seroquel, became available in the U.S. as much lower cost generic versions, has vastly improved affordability.

The aforementioned ones are the good reasons why Americans who once needed foreign medication no longer do, but we remain in a public health crisis of high drug prices: tens of millions of Americans are still not getting medications due to cost, going bankrupt as they suffer through cancer, and having to choose between food and medicine! And, unfortunately, in the midst of this crisis, fewer Americans are buying more affordable medication from other countries because they are being wrongly scared away from doing so.

The following government agencies, associations, advocacy groups, and companies adamantly declare that Americans should not buy medications from other countries online: the FDA, National Association of Boards of Pharmacy, Alliance for Safe Online Pharmacies, Center for Safe Internet Pharmacies, Partnership for Safe Medicines, and LegitScript. All of those entities are funded by, allied with, or vigorously lobbied by big pharmaceutical interests that view safe personal drug importation as a commercial threat. They all say it’s not safe to buy medication online for personal import, that any online pharmacy not based in the U.S. should be avoided, and conflate rogue or fake online pharmacies with safe international online pharmacies.

To debunk their efforts, at the beginning of this year, I published an in depth report to try and prove, with facts, data, and commonsense, why scaring Americans away from all international online pharmacies and overzealous enforcement actions against the safest international online pharmacies is bad for the public health. My position is simple, and it brings us back to the question of whether it’s good or bad that one million fewer Americans are buying medication from a foreign pharmacy each year. It depends. There is no doubt that high drug costs lead to tens of millions of people skipping or forgoing their prescribed medications all together. Many studies have shown – here’s one – that not taking medications as prescribed results in more sickness, hospitalizations and even deaths. If the decrease in personally imported medications is due to expanded domestic access then that’s great! On the other hand, if people were scared away from safe international online pharmacies they could afford and didn’t get medical treatments they needed, then obviously that’s bad. We can’t be certain which factor was more prevalent, and to what degree, in reducing foreign purchases: greater access domestically vs. fear of foreign online pharmacies.

But here’s what I am certain of: for the many millions of Americans who might forgo prescribed medications in 2016 due to domestic costs, access to purchase lower cost medication from a licensed foreign pharmacy is a lifeline, despite the federal restrictions against the practice. The CDC states the following: “It is unknown whether adverse health outcomes and higher healthcare costs are associated with the cost-reduction strategies of…obtaining prescription drugs from abroad.” What is known is that the FDA, or the groups mentioned above that tell people not to buy medications from abroad, have never reported a serious adverse reaction by a patient who ordered a medication online from a foreign pharmacy that required a valid prescription. This is now after about 15 years of international online pharmacy practice. As strongly indicated in peer reviewed studies, the international online pharmacies vetted in the PharmacyChecker.com Verification Program are the safest such options. Scaring people who can’t afford local pharmacies away from them is bad for the public health and unethical.

It’s important to note that another reason fewer people may be buying medication from outside the U.S. is because they no longer trust websites that don’t require a prescription or have not been verified by a credentialing group (such as PharmacyChecker or the NABP). The FDA, NABP and the cast of characters mentioned above (who are allied with the pharmaceutical industry) have been vocal against buying from ‘no-prescription’ sites and we support that message in combatting rogue online pharmacies.

As we end the year tar-and-feathering the likes of Martin Shkreli, charging fraud and market manipulation by Valeant Pharmaceuticals, and lamenting the insanity of normal generic drugs spiking in price by thousands of percent, let’s not forget that the pervasive and ubiquitous obstacle to sane policies to lower drug prices in America is the lobbying power of the global drug giants and the trade association that represents them, the Pharmaceutical Researchers and Manufacturers of America.

Hopefully, big pharma’s unjust stranglehold on the U.S. taxpayer and consumer, in which U.S. prices on the same drugs are twice as high as in other advanced economies, will weaken in 2016. If you’re in the U.S. and you come to PharmacyChecker.com seeking information on more affordable medication online and to view our price comparisons of international online pharmacies, you may (and we hope you do) learn that your local pharmacy is cheaper or comparable to a foreign one, due to our new local pharmacy pricing information (which we aim to expand). But if you can’t afford your meds at your local pharmacy, we know that our website’s information helps you find some of the safest international online pharmacy options and lowest drug prices. Access to that information can keep you healthy (and alive) in the New Year…and with a lot more money in your pocket.

Happy New Year!