Crossing Borders
Drugs bought from Canada can save your money but may also risk your life. Here's how to save both
McKibbin, Goodno, and others began looking across the border as prescription drug prices soared in this country, rising much faster than the rate of inflation. The average cost of widely used brand-name drugs went from $33.76 in 2000 to $60.38 in 2003, according to a study by the AARP Public Policy Institute. "So what you see is sick people choosing not to buy drugs, and in my view that's the real health risk here," says Goodno. "We felt we had to do something."
That something turned out to be Canadian imports, which were attractive for two reasons. First, the Canadian government has a national healthcare system that sets drug prices, which can be 70 percent lower than in the United States (table, Page 44). Second, the Canadian drug-safety system mirrors that of the United States, with a federal agency--Health Canada--regulating drugs based on therapeutic value and good manufacturing standards, and with local pharmacy boards licensing and inspecting all pharmacies.
Loose law. Plus, while the U.S. government has been adamant about keeping American drugs under FDA oversight, blocking all unapproved imports, the agency--so far--has interpreted the law to allow a "personal use" exemption, which means a person with a valid U.S. prescription from a doctor can bring in up to a 90-day supply of a drug.
Minnesota was the first state to put all these elements together. It sent a team of pharmacy inspectors to Canada who looked at the credentials, licensing, suppliers, and volume capacity of eight pharmacies interested in selling to the American public. The state selected two of these pharmacies for a site, minnesotarxconnect.com, that launched early this year: Total Care Pharmacy in Calgary and Granville Pharmacy in Vancouver. (Two more pharmacies were added this spring.)
At the site, consumers are provided a list of drugs and advised to order only refills and not to order narcotics. They download an application in which they list their complete medical history and attach a valid U.S. prescription, and fax it to the pharmacy. The pharmacy forwards the information to a Canadian physician for review, and the doctor then writes it up as a Canadian prescription (U.S. prescriptions are not valid in Canada). Payment is usually by credit card, and in two to three weeks the customer gets a 90-day supply of the drug. Insurance companies generally reimburse for the drugs as they would for U.S. prescriptions.
Wisconsin, after its own inspections, soon followed with a similar system ( drugsavings .wi.gov) with similar requirements for both consumers and drugstores. North Dakota and New Hampshire also added websites, which link directly to the Canadian stores, which have their own patient information forms. A few cities, such as Columbia, S.C., and Washington, D.C., have added "tagalong" links to city web pages that direct consumers to the state sites. (Springfield, Mass., has gone even further and contracted with a Canadian drug clearinghouse to supply specific drugs to city employees and retirees.)
All this due diligence sounds good on paper, say Hubbard and other critics, but in reality the programs have serious holes. "The big problem is that Canada can't supply all these drugs from legitimate sources," says Marvin Shepherd, director of the pharmacoeconomics center at the University of Texas-Austin. The country has a small population, and drug companies such as Pfizer and GlaxoSmithKline limit what they send north of the border. Pharmacies are thought to turn to sources like China, Israel, and Mexico to fill American orders. "We don't really know the pedigree of these drugs," says Tom McGinnis, FDA's director of pharmacy affairs. Druggists may think they are getting the real deal from their wholesalers and distributors, but the products may be manufactured badly or not equivalent to FDA-approved medications. Indeed, Hubbard listed 15 violations of good pharmacy practice that turned up in Minnesota's own inspections and noted that Wisconsin's Canadian partners shipped unapproved drugs in violation of their contract with the state.
advertisement
