Can I get cheaper drugs from other countries?

June 13, 2010Carole 3 Comments »

A reader wanted to know  if I could  post about using drugs from overseas pharmacies so I did a little research and pulled together some internet links for you to read about this topic in more detail if you are interested. It turns out to be a very complicated question with both personal and international implications. The short answer is, “Yes, you can buy cheaper drugs from overseas”–.

BUT, there are worrisome issues you should consider.

1). Is your re-imported drug safe and effective? It turns out that there is no consumer protection mechanism in place for you to be guaranteed that the drug you buy on-line is the same when it is re-imported. When drugs are manufactured here, the FDA requires that drug makers meet certain requirements to sell to the US consumer. If the drug maker screws up and an approved drug has problems, the FDA can force them to remove it from market or even shut down the manufacturing plant. When a US company manufactures drugs overseas for the US market, the FDA also inspects those plants and holds the manufacturer responsible for careful control of its product and importation into the US as its primary market. The same oversight does not apply when drugs are produced for sale overseas and then re-imported to the US as a secondary market. You can’t be 100% sure that the re-imported drug was maintained properly in storage and transport. The FDA summarized their concerns in this testimony to the Senate Committee on Heath, Education, Labor and Pensions.

2). Are your re-imported drugs the real thing? Counterfeit drugs produced overseas are big business and a big problem, especially in developing countries.  Your risks of getting counterfeit drugs are probably less from Canada than from some of the developing countries, according to the CDC, but it is impossible to know whether you have the real thing unless it is subjected to a chemical analysis. The CDC has published some recommendations for  consumers regarding the risks associated with buying drugs overseas, even from Canadian on-line pharmacies.

3). Is your on-line pharmacy legit? The National Association of Boards of Pharmacy has advice for consumers on how to tell if their on-line pharmacy is legitimate. They  post a list of on-line pharmacy sites that they DO NOT RECOMMEND because these sites appear to be out of compliance with US pharmaceutical standards. They also post a list of recommended sites. The NABP explains the five criteria for non-compliance that get a site black-listed. Number one criteria for rejection is that the pharmacy is not located in the US so the recommended on-line pharmacies are all based  in the US, an obvious limitation of this list.

It turns out that safety and efficacy aren’t the only issues to be solved. I think there has to be a way for the FDA to extend its oversight to re-importation of drugs, but presently, there doesn’t appear to be consensus on how to assure safe re-importation of drugs and even less political will to do it. I assume that providing FDA oversight to reimported drugs, if it could be done, would probably add to the cost of those re-imported drugs, making them less tempting to US consumers.

The whole topic of how drugs are priced is really complicated because drug prices vary depending on the market. For instance, pharmaceutical companies will provide life saving drugs (like AIDs drugs) to developing countries at prices near the cost of production. However, our more affluent domestic market will pay more for the same drug because the costs here include costs of development, not just production.

When we pay for a drug, we are paying for decades of research on the drug we are using and also paying for all the failed drugs that never made it to market. Many more drugs are stopped somewhere along the long path from basic research to clinical trials  and never receive FDA approval. Those drug development costs are real costs and have to be made up somewhere. It is unlikely that the government will ever step in to do drug development research with our tax dollars (unlike some other countries whose governments subsidize drug development) so drug development will stay in the private business sector. If we want private pharmaceutical companies to produce new drugs for us, it will be subject to the laws of capitalism. There is no free lunch here.

Pharmaceutical companies have expressed concerns that new drug development will decline or disappear if their ability to recoup those drug development expenses decreases as more of us find cheap sources for drugs. Already, drug makers are reluctant to make drugs for diseases that aren’t widespread (orphan drugs) because they know they will never recoup the drug development costs because the market for the drug is too small. The Canadians aren’t happy about reimportation either because they are concerned their own population’s drug supply will be shorted.  The economics and international business aspect becomes surprisingly complicated.

Drug reimportation practices in the United States” provides a impartial overview of the competing viewpoints surrounding drug reimportation. If you want to read a summary of arguments FOR reimportation, you can find the PRO argument put forward by the Center for American Progress in 2004. If you want to read the argument against reimportation presented by Pharmaceuticals Research and Manufacturers Research Association (PhRMA), you can find the pharmaceutical anti-reimportation argument here. This is not a comprehensive overview of all the viewpoints out there. Everyone has a dog in this fight, apparently.

My husband is employed by a global pharmaceutical company so our family directly benefits from this industry. We  look for healthcare bargains where we can find them, like everyone else. We both have elderly parents on fixed incomes who are concerned about the cost of drugs they need to stay healthy. So like you,  I’d love to see better availability of inexpensive, safe and effective drugs. It’s not obvious to me how we will get all three –low price plus safety and effectiveness-through unregulated re-importation as it exists today.

The physicians I worked with discouraged patients from buying their fertility drugs overseas because they didn’t want to have to worry about whether the drug would be active. There are enough variables to control and manage to get a stimulation cycle to go well without adding the variable of re-imported drugs. The bottom line is that there is some gambling involved with using re-imported drugs. You may get a safe and effective drug. Or not. The problem is there is no way for you to know for sure.

© 2010, Carole. All rights reserved.

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