This article summarizes good things and bad that are happening online with drug prices and savings, economics, legislation, politics, and even ethics that relate to access by Americans to more affordable medication offered by safe international online pharmacies. If you’re a consumer – especially an American consumer facing high drug costs – you should read this. When you’re done (or even right now!) we recommend joining RxRights to help play a role in making medication more affordable for all Americans.

Next year, we’re planning to focus more attention on local Americans pharmacies: what they’re doing right, wrong, and in between, and how you can save and take advantage of their in-store opportunities to improve your health! But for now, the international online pharmacy report…

The Good

The money Americans could save on brand name drugs by shopping at safe international online pharmacies continued to increase in 2013. In 2011 , we reported potential savings of 80%, then a mind-boggling 85% in 2012, and now 87.6% in 2013! Savings have proliferated because America’s trading partners, such as Australia, Canada, the states of the European Union, New Zealand, the United Kingdom, and Turkey, generally, have kept brand drug prices stable, whereas in America they increased by an estimated 13% last year.

The pricing data referred to above is from our prescription drug price savings research released this past September. In that report we looked at popular prescription drugs that are not always covered by health insurance plans, including new plans offered as a result of Obamacare. An extreme example of savings is on the drug Abilify 10 mg, a medication prescribed for depression; $9,007.08 could be saved annually by purchasing the drug from the lowest-cost online pharmacy verified by PharmacyChecker.com compared with a retail pharmacy in New York City.  A more common example of potential annual savings from international pharmacies is the $3,935.28 savings on Spiriva Handihaler 18 mcg. Drug prices are out of control in the U.S., especially for those with no domestic generic alternative, and access to international online pharmacies is as urgent as ever.

It would, of course, be better if Americans could find more reasonable prices on brand name drugs at their local pharmacies.

This year, the State of Maine expressly legalized personal drug importation from licensed pharmacies in Australia, Canada, New Zealand, and the United Kingdom. The new law helps re-open international pharmacy benefit programs previously offered by local governments and companies in Maine that were temporarily shut down in 2012. Those programs, which had operated without problems for years, were shut down by a former Attorney General because pharmacies in other countries are not licensed in Maine. In their great wisdom, and in overwhelmingly bi-partisan fashion, Maine’s legislators recognized that good pharmacies in other countries are licensed by authorities other than the Maine Pharmacy Board, and therefore voted to allow those licensed pharmacies to sell to consumers in Maine.

Congressmen Keith Ellison (D-MN) introduced H.R. 3715 – the Personal Prescription Drug Importation Fairness Act of 2013 – to expressly legalize personal drug importation from many countries with excellent pharmaceutical and pharmacy regulations. The bill’s co-sponsors are Dana Rohrabacher (R-CA) and Jan Schakowsky (D-IL). This bill is very simple; if it passes, Americans would no longer be technically breaking the law when buying lower cost medications from Canada and other countries. It would remove the unfair stigma that Americans may feel about buying lower cost drugs from outside the U.S., encourage safe use of international online pharmacies instead of scaring Americans away from them, and, most importantly, improve the financial well-being and health of Americans because they could more easily access medications at lower prices.

The deal that President Barack Obama made with Big Pharma may not be an albatross around the president’s neck in 2014. In that deal, the president agreed to drop support for drug importation reform and drug price negotiations to lower U.S. prices in exchange for support from Big Pharma to help pass Obamacare and provide discounts of $80 billion over ten years for federal programs such as Medicare. Well, that deal is done. Unfortunately, politics can be a dirty business where deals are made with devils for the ‘greater good.’ If consumer groups push to expose Big Pharma’s hoax that buying medications internationally is inherently not safe, and also show their members of Congress that it is very safe when done right, then President Obama may very well gracefully come up with a plan to support them and facilitate safe personal drug importation, which he supported as a senator and presidential candidate.

The media reported favorably about personal drug importation and online pharmacies in 2013, despite the efforts of groups supported by Big Pharma, such as  NABP, Alliance for Safe Online Pharmacies, and the Partnership for Safe Medicines, that influence the media to wrongly conflate safe international online pharmacies with rogue pharmacy sites. Warnings about rogue online pharmacies are good, but scaring people away from more affordable and safe medication is bad – literally bad for the public health. Bringing the truth to a wider audience, the New York Times reported that Americans are buying safe medications online from abroad because they can’t afford medications domestically.  The New York Times Well Blog even gave a shout out to PharmacyChecker.com to help those Americans who would like to buy lower cost medication online but are, rightfully, afraid of rogue online pharmacies. The most pro-consumer, practical, and fun media attention came from MoneyTalksNews, where Americans are given straight talk about buying meds overseas. For more, check out PharmacyChecker.com In The News.

The Bad

As many of you know, under current regulatory practice, the unethical federal law that technically bans Americans from buying safe, and much lower cost, medications in Canada and abroad is not enforced to the extent that Americans are never prosecuted and over 99% of orders are successfully delivered (again see MoneyTalksNews). Unconscionable as it may be, numerous groups, mostly funded by drug companies and U.S. pharmacies, may continue to seek to curtail such access to affordable medicine in 2014.

The Pharmaceutical Research and Manufacturers of America (PhRMA) has teamed up with pharmacy owners in Maine to overturn its new law, citing inflated safety concerns and its effects on U.S. pharmacies’ businesses. Humbug on their safety concerns, since licensed pharmacies in many other countries are just as safe as American ones; sympathy to local Maine pharmacies because they cannot compete with lower prices from foreign pharmacies. Maine Attorney General Janet Mills responded forcefully that the law should stand. Both PhRMA’s and AG Mill’s legal positions are linked to from here.

I’m not sure what could be worse for someone’s medical treatment than seizing and destroying their prescription orders, ones dispensed by licensed pharmacies and pharmacists. When people don’t take needed medication they often get sick and sometimes even die. Section 708 of the Food and Drug Administration Safety and Innovation Act of 2012, which became law in July 2012, requires the Secretaries of Health and Human Services and Homeland Security to draft regulations pertaining to the detention and destruction of personally imported medications (those valued at $2,500 or less). Let’s take a deep breath…there’s no need to worry…yet.

Currently, international prescription orders, at least as reported by consumers of PharmacyChecker.com-approved online pharmacies, are virtually never seized. And, looking at the big picture, the issue is complicated because the Department of Health and Human Services, through the U.S. Food and Drug Administration (FDA) is rightfully concerned about personal drug importations from rogue online pharmacies. The question is will FDA draft regulations that seek to minimize entry of unsafe medications but maximize entry of safe and affordable, personally imported medications – despite the regulatory ban?

We reported on the dangers of NABP’s application to the Internet Corporation of Assigned Names and Numbers (ICANN) to operate an Internet registry (meaning .com, .net, .biz, .gov, etc.) called .Pharmacy. Essentially, if NABP is granted the sole power to issue domains that end in .Pharmacy, international online pharmacies, including those approved by PharmacyChecker.com, will be barred from using the designation. Walgreens, CVS, Rite Aid, and the other U.S. pharmacy corporations with high drug prices will of course be granted .Pharmacy. The pharmaceutical and U.S. pharmacy industries are funding NABP’s application, and could end up spending millions of dollars to maintain the .Pharmacy registry. If NABP’s application is approved, Big Pharma will likely fund media blitzes with a wave of misinformation communicating that only websites ending in .Pharmacy are safe, bringing us all into an Orwellian-type nightmare where big corporations control “online truth.” Then again, perhaps ICANN will rise to the occasion and include safeguards against a grotesquely anti-consumer initiative. Another possibility is that Americans will ignore the .Pharmacy designation because they know its bunk.

While the Center for Safe Internet Pharmacies  may not be sponsored by Big Pharma, a quick look at its website shows that it’s mostly an information clearinghouse for reports, data, and media stories that all support Big Pharma’s online pharmacy agenda. CSIP’s members include Google and the other search engines, credit card companies, domain registrars (including Go Daddy), mail carriers, and payment processors. Some of these members, most famously Google, have been fined by the government for their alleged roles in allowing dangerous online pharmacies to use their services.

This past year I was invited to provide testimony before the House Judiciary Subcommittee on the Courts, Intellectual Property and the Internet, in which I describe how CSIP may overreach in its cooperation with pharmaceutical industry groups in ways that can be easily viewed as anti-competitive and anti-consumer. We hope that Google takes the lead in withdrawing from this group.

The Ugly

Like most government agencies, the FDA does good and bad. For instance, the FDA’s efforts to create more international agreements on inspections of drug manufacturing plants, in which one regulatory authority relies on the inspection reports of another, are commendable. Such cooperation makes government more efficient. After all, if Canada has inspected its own drug manufacturing plants, and Canada’s inspections are equally as rigorous as ours then it’s duplicative for us to inspect those same plants.

In contrast, the FDA deserved criticism for its lax oversight of a compounding pharmacy in Massachusetts, one that manufactured and distributed tainted steroid injections, causing fungal meningitis – killing 64 and sickening 754 people. This was not the fault of FDA alone, as the Massachusetts Board of Pharmacy shared oversight; both regulators were aware of problems at New England Compounding Center as early as 2004.

“The ugly” – in our metaphor – refers to the FDA’s position on international online pharmacies through its BeSafeRx program. The stated intention of that program is good: “FDA BeSafeRx is a national campaign to raise awareness of the dangers of buying prescription medicines from fake online pharmacies.” However, we believe the program misleads Americans that there are no safe international online pharmacy options available and that is bad (or ugly!).

We also believe that the FDA knows that international online pharmacies approved by PharmacyChecker.com require prescriptions and sell safe prescription medications, one’s that are legally manufactured under stringent government regulations. These international options give Americans access to much lower cost medication. The FDA, nonetheless, continues to communicate that the signs of a “fake online pharmacy” include that it is “located outside the U.S.” – or “offer deep discounts or cheap prices that seem too good to be true.” Licensed pharmacies located outside the U.S. are not fake, and they do sell drugs at prices that probably seem too good to be true to cash strapped Americans but they are true. It’s one thing for private companies to misinform; it’s another for government to do so.

We continue to hope that FDA changes course in its Be Safe Rx campaign to be more honest. Americans deserve it.

Wishing you a happy, healthy, and affordable New Year,

Gabriel Levitt
Vice President
PharmacyChecker.com