It’s widely known that Americans buy medications from Canada and other countries because the prices are much lower. What many people do not know is how people are doing this.
Even our foremost scholars on the issue of U.S. pharmaceutical prices don’t know. In an article published in the prestigious British Medical Journal (BMJ), readers are informed that:
“A modest proportion of U.S. citizens travel to Canada and Mexico to purchase lower priced prescription drugs.23”
That footnote – 23 – links to a 2016 Kaiser Family Foundation Health Survey, which includes the question:
“Have you or another family member living in your household ever bought prescription drugs from Canada or other countries outside the United States in order to pay a lower price, or not?”
Eight percent of respondents said that they had, which is about 20 million Americans, but the survey did not ask how they did it.
The data is far from perfect. I looked at several data sources when I wrote a report in 2015 called Online Pharmacies, Personal Drug Importation and Public Health. In one analysis of an FDA survey in 2012, I estimated that about six million Americans were purchasing medication from outside the U.S. over the Internet. I believe that figure is somewhat inflated.
The latest data from the U.S. Centers for Disease Control and Prevention from 2015, showed that about four million Americans import medication each year because of cost, a decrease from 2013. While that CDC figure doesn’t specify “how” imports were made, it does correspond well with a Consumer Reports survey from 2011, which showed that about 4.6 million American adults looked for more affordable medication on the Internet. As we all know – the affordable medication we find online is often from Canada or another country, not the U.S.
In writing about patients’ actions to obtain medication they can afford, it’s important that we look closely and at all reliable data with the goal of helping them do so safely. My point is that online ordering, not traveling to Canada and Mexico, is probably the method used by most Americans who are importing lower-cost medication for themselves.
The BMJ article was written by Drs. Aaron Kesselheim, Ravi Gupta, and others and is called “Affordability and availability of off-patent drugs in the United States—the case for importing from abroad: observational study.” It’s an excellent article recommending that the FDA permit importation of off-patent prescription drugs, manufactured in countries and under regulations known to be similarly rigorous to ours. The authors’ proposed medications for importation are those that have little to no competition in the U.S. and have seen exorbitant drug price increases. The poster child example being Daraprim, the drug that jumped in price overnight from $13.50 to $750/pill in 2015, and, at the time, was only six bucks per pill in the UK.
Another example is Lomustine, a cancer drug that has increased 1400% in the last few years—from $50 to $768 per pill—because there’s only one company, NextSource Biotechnology, allowed to sell it.
So, to come full circle, I hope Dr. Kesselheim and his colleagues understand that their patients can get this same drug from licensed pharmacies in Canada now, called CeeNu, for $25/pill online through the mail; and in accordance with their suggestions, the FDA should expressly permit such importation.
