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Helping Americans Get The Truth About Prescription Drug Savings
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Balanced Reporting About Americans Buying Meds Internationally From Online Pharmacies in the Wake of Operation Pangea

Each year, FDA participates in Pangea, a global operation that identifies and shuts down rogue Internet pharmacies, seizes allegedly dangerous medication, and arrests those responsible. We like that Pangea takes actions against rogue online pharmacies that threaten the public health. However, media stories about Pangea can frighten the American public away from safe online sources of affordable prescription medication because they often assert that foreign online pharmacies are all dangerous, which is absurd.

Thankfully, Dan Mangan of CNBC News reminded Americans last week that there are safe international online pharmacies. His article, “Patients cross borders for online deals on medication” explains that was created to help consumers avoid fake online pharmacies and have peace of mind when shopping for medication internationally. Lee Graczyk, head of, let them know why this is so important: “For some folks, this is the most viable way for them to fill their prescription at a price they can afford.”

The article points out that despite Federal restrictions, Americans purchase medication from outside the United States for personal use. Though the FDA does advise against personal drug importation (wrongly in our opinion), its enforcement is focused on large scale drug importation of medication by doctors, providers, or wholesalers, not individuals. In fact, FDA has never prosecuted anyone for importing medication for personal use. The article also brings up Maine’s recent law that removed state restrictions on personal drug importation. A similar bill was introduced in the South Carolina legislature.

Residents of these states want to facilitate drug importation to help people like Bill. As Mr. Mangan reports, Bill, a resident of New York City, was prescribed Copaxone for macular degeneration. Because Copaxone is not FDA-approved for that condition, Medicare didn’t cover it, leaving him with a ridiculously high out-of-pocket cost. At the suggestion of his doctor, Bill used a Canadian pharmacy. Instead of paying about $5,000 for a 28-day supply, he paid $1,200.

We’re happy with Mr. Mangan’s reporting, as coverage of crackdowns against dangerous pharmacy websites should include balanced information. His coverage included information collected from both supporters for and against personal drug importation and international online pharmacies, and he should be applauded for doing so.

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Obamacare Silver Plans Often Fall Short on Pharmacy Benefits

A new report shows that out-of-pocket prescription costs may be twice as high for plans created by the Affordable Care Act, also known as Obamacare, than traditional employer plans. This burden falls on patients with high deductibles who must pay out-of-pocket for 100% of their costs until they hit their deductible, which tends to be around $2,000 for Silver plans.

That isn’t to say these new plans are bad; preventative care is usually covered for free and can sometimes stave off the need for medications in the first place. The problem will usually hit hardest on those who depend on medications for a chronic condition. However, unforeseen medical issues could throw anyone into this cost predicament.

The goal of the Affordable Care Act was to make healthcare, well, affordable, and it won’t be for people who cannot afford drugs because of weak pharmacy benefits. The report also showed that Silver plans have higher co-insurance and co-pay rates than typical employer-sponsored plans.

If you’re finding yourself facing a high deductible, and generic alternatives at your local pharmacy are not available, you might consider an online pharmacy. You can save up to 90% on brand name medication from verified international pharmacies.

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Are Truvada Prices An Obstacle to Americans at High Risk for HIV?

AIDS prevention may be revolutionized if healthcare providers start to write more prescriptions for Truvada as a preventative measure for people at high risk for contracting HIV. As reported in the The New York Times, the U.S. Centers for Disease Control and Prevention is pushing for expanded use of Truvada as a prophylactic to prevent new HIV cases. To date, it has been primarily used to treat people who have already contracted HIV. If this recommendation is adopted, the number of prescriptions written for Truvada could increase from less than 10,000 per year to 500,000 per year, hopefully lowering the rate of new HIV infections, which has remained steady at 50,000 per year over the past decade.

But what if patients can’t access Truvada because of its cost? After all, a drug doesn’t work if a patient can’t afford to take it. The drug has a monthly cash price of about $1,500 at local U.S. pharmacies. Fortunately, Truvada is usually covered by insurance and Gilead offers an assistance program that covers the first $200 of a co-pay. They also have a program that covers the full cost of the drug for eligible uninsured or underinsured patients. Eligibility is not guaranteed to all!

Even if you’re insured and prescribed Truvada, the high cost might mean difficulties when it comes time to fill the prescription. Many pharmacy benefit formularies put the drug in tier 2 or 3, which means high co-pays. Other formularies place Truvada on a list of drugs that require pre-certification. In that case, the drug might not even be covered at all!

According to FiercePharma, dramatic increases in the number of prescriptions written for Truvada (and therefore requests for pharmacy benefit reimbursements) could increase co-pays and also curtail assistance programs. If that happens, patients may find themselves having to fork over a lot of cash for higher copays, deductibles or co-insurance. Some may very well end up stuck with a $1,500 per month bill.

For these patients, or anyone else who falls through the cracks, international online pharmacies may be an option. Truvada – the brand – is available for about $543.00 internationally; the generic – emtricitabine/tenofovir – not yet available in U.S. pharmacies, is $224.00. This could provide a lifeline for Americans who are prescribed Truvada in the coming years.

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Maine’s Drug Importation Law and International Online Pharmacies

I penned an op-ed for the Bangor Daily News’ weekend edition called “Maine’s Drug Importation Law Does not Endorse Online Pharmacies. Should it?” Maine passed a good law last year, lifting the state’s ban on personal prescription drug imports from pharmacies in Australia, Canada, New Zealand, and the United Kingdom. U.S. pharmacists and drug companies want Mainers to believe lifting the ban is not safe even though it is. But is it safe to order medications online from India and even island nations? It can be.  In my piece, I examine the issues, which are not black and white and therefore merit an open and honest discussion. It also clarifies the differences between dangerous rogue pharmacy sites that are bad for consumers and safe international ones that help Americans afford prescribed medication.

For those interested in knowing more about this issue please read the International Online Pharmacy Report.

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American Non-profit Pharmacies Offer Lower Prices

If you’ve never heard of a non-profit pharmacy, that’s ok – there are only three of them in the country. Non-profit pharmacies can charge lower prices because they don’t have to realize profits for shareholders or owners.

One such pharmacy, Community First Pharmacy, located in Hamilton, OH, has recently been praised for putting its customers ahead of profits. According to coverage in Daily Dayton News, one of the biggest hurdles is getting customers in the door, as many folks are under the wrong impression that the pharmacy only serves the uninsured or under-insured. That is not the case – Community First Pharmacy maintains two separate inventories, one for private-pay patients and one for uninsured and underinsured patients who need assistance with medication payment. The pharmacy also receives steeply discounted drugs by participating in the 340b program, a federal program open to non-profit healthcare organizations.

Overall, this system allows the pharmacy to profit from privately insured customers while offering low prices to those who could not otherwise afford their medicine. For instance, the pharmacy can match the popular $4/month plans found at retailers like Target or Walmart, or even offer a lower price, without having to make up the lost profit by marking up other drugs. One patient only paid $1.20 to get his prescription filled!

I couldn’t find much information on the other two non-profit pharmacies in the country.  Pharmacy Over the Rhine, located in Cincinnati, OH, serves local residents who often found it difficult get to actually get to a pharmacy, due to transportation or work issues. Like Community First, Pharmacy Over the Rhine serves anyone and is able to put profits on some medications toward lower costs for Americans who are struggling with their prescription bills.

I’m glad that these pharmacies are offering low-cost medication to those who need it most, and, in the case of Pharmacy Over the Rhine, providing accessibility to those who need it. Local pharmacies are struggling to stay afloat these days, and perhaps the non-profit model will be the wave of the future that lets them compete and serve their communities.


Lower Cost and Safe Foreign Drugs: An Inconvenient Truth?

While it’s a life (and wallet) saver for millions of Americans, it seems to me that safe personal drug importation is an inconvenient truth for the U.S. Food and Drug Administration. A couple of weeks ago, The New York Times published a Letter to the Editor, “Unsafe Foreign Drugs,” by FDA Deputy Commissioner Howard Sklamberg as a response to my op-ed. His letter didn’t refute the gist of my position: the FDA and other regulators should not scare Americans or fool policymakers into believing that genuine medications purchased by Americans from licensed pharmacies in Canada and other countries are as dangerous as counterfeit drugs.

Mr. Sklamberg wrote, “Gabriel Levitt criticizes the Food and Drug Administration’s position that unapproved foreign drugs pose the same health risks as counterfeit drugs.” In fact, I do more than criticize FDA’s position. Their position is false and illogical. When FDA talks about “foreign unapproved drugs,” it often means real medication available in foreign pharmacies. That medication is either exactly the same as the medication sold here or a foreign version with the same active ingredients as medication sold here. When FDA talks about “counterfeit drugs,” they generally mean fake medication: products sold by criminals that fool people into believing that they were manufactured legally. In other words, it’s medication not licensed for sale in any country because the manufacturers – “counterfeiters” – were not authorized by any regulatory authority to make the drug. Real medication that is made under good manufactured practices and properly prescribed to a patient is almost always safe and effective. Fake (counterfeit) medication is almost never safe.  For those reasons, claiming that drugs sold from pharmacies in other countries are as dangerous as counterfeit drugs is ridiculous.

Mr. Sklamberg cites the National Association of Boards of Pharmacy’s (NABP) data that only “3 percent of online pharmacies appear to meet state and federal laws” to show that most drug-selling websites are dangerous.  What he doesn’t tell you is that the 97% of online pharmacies which fall outside this scope includes safe pharmacies, for example,  licensed Canadian pharmacies in Manitoba that sell to Americans – in conformity with all Canada’s laws and rules. The NABP considers these “rogue” online pharmacies. Since the NABP represents U.S. boards of pharmacy, which are in turn heavily self-regulated by U.S. pharmacy interests, referring to all lower cost non-U.S. online pharmacies that sell to Americans as “rogue” appears commercially motivated. Furthermore, NABP takes considerable funding from drug companies for programs related to Internet pharmacy regulation and consumer communications, which also casts doubt on their independence.

Mr. Sklamberg writes: “Many sellers of unapproved foreign drugs falsely represent that they are from Canada to give the illusion that consumers are getting the same drugs approved for use in Canada.” That’s true; it is a problem, but that doesn’t mean there aren’t exceedingly safe non-U.S. online pharmacies. As we’ve explained on this blog, there are reputable Canadian pharmacies that have partnered with licensed pharmacies in other countries. Compare that to fake “Canadian” online pharmacies that publish the maple leaf and wave the Canadian flag. These are unethical, unsafe, and unrepentant operators often located in Russia and Eastern Europe.  The NABP conflates the two kinds of websites, strikingly similar to FDA’s conflation of foreign, but “real,” medications with counterfeit drugs.  If you want to find ones selling real medication, pursuant to a real prescription, dispensed by real licensed pharmacists, look for verified online pharmacies at

What consumers want and need is real information on which online pharmacies sell genuine prescription drugs, dispensed safely by licensed pharmacists, for the lowest prices. That’s why Americans who choose to order outside the U.S. benefit from the information provided by

To his defense, Mr. Sklamberg is an employee of the FDA and therefore is in the service of a bad law that restricts Americans from buying lower cost medications internationally. Hopefully he decides the best course for the public health is to encourage his agency to use its regulatory discretion to expand access to affordable medication internationally. FDA has considerable regulatory flexibility to do so.

And perhaps FDA is listening. My op-ed cited a particularly concerning provision of U.S. law, Section 708 of the Food and Drug Safety and Innovation Act, which facilitates the ability of regulators to destroy personally imported medication.  Section 708 cannot go into effect until regulations are drafted and available for public comment on the due process provided to Americans whose medication orders are seized. The FDA’s website identifies April 18th as the date it planned to publish the regulations, and that date has come and gone with no sign of their publication!

Maybe the FDA’s delay is due to the 8,000+ Americans who petitioned them to make sure those regulations don’t impede their access to prescribed medications. I’ll leave you with a few comments posted to that petition explaining why Americans depend on safe personal drug importation and should have access to it:

CT Robertsson Jr — DENTON, TX

I am 72 yrs old, take several medications, and am likely to need others in the future. The price for some of my current drugs is criminal. Americans should cease being the personal property of drug companies who have billions to spend on political influence. If we’re all about “freedom” and “competition”, then let’s act like it.

Barbara Simpson — MCKINNEY, TX

I cannot afford my medications at the price American Pharmacies charge. If I am unable to obtain them from Canada at a much lower price it will mean I will have to go without my medications.

Ellen Renee Dill — SMYRNA, GA

I am on a fixed income. My insurance doesn’t cover every drug prescribed.

Michael Catalanello — PONCHATOULA, LA

It’s a freedom issue.

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