There are millions of Americans with illnesses and diseases who have no prescription insurance and no money. At best, they split pills and take a lower dose than what the doctor prescribed or they go without. You know Jay Pee. I think that our for-profit medical system is a disgrace. I believe that a pharmacy owner should make a really good living and that a good surgeon should make a lot of money. That’s not what I mean for-profit medical system. The for-profit that I object to are the PBMs and the medical insurance companies. They provide no medical care. I like single payer.
We are medical professionals and we have an ethical obligation to serve every patient, rich or poor, insured and uninsured. The poor people need their medicine, but they are not going to pay the going retail prices at American pharmacy outlets. There are plenty of drugs that do not sell for $4.00.
When I see that look in their eyes and they say, “I can’t afford that.” I will ask a number of questions. When I am reasonably assured that they really don’t have the money and that they really need the expensive drug, I suggest a Canadian Pharmacy. I know, I know. That doesn’t feel right, but this is the 21st Century. They are not going to buy the prescription in an American pharmacy. We do not lose a penny, but, trust me, I have gained a very loyal customer.
India, by the way, is not a good option. The Indian pharmaceutical industry is a world leader, but the counterfeit problem is as high as 20% according to some experts. Drugs from Canada are pedigreed. They are safe.
Canadians go to Canadian pharmacies to get their prescriptions; they do not go online to a Canadian Internet Pharmacy. Canada has specific regulations that put a cap on the price of their prescription medications for Canadian Citizens, which is considered part of the Canadian Health Care System.
I am not here to debate health care systems, rather, I want to discuss for a moment the wide spread practice of ordering prescription medications over the internet from a so-called Canadian Internet Pharmacy.
The Food & Drug Administration (FDA) in the United States assures all medications approved for use in the United States meet specific requirements. These requirements are numerous and include things like quality, manufacturing, labeling, and storage. The facility where the medications are manufactured are certified and monitored, as well as the tracking of all of the ingredients to each medication.
“Chain of Custody”, in this situation, refers to the tracking of the ingredients of a medication from their point of origin to the manufacturer, followed by the tracking of the produced medication all the way to the pharmacy where the medication is dispensed. During this process, there are specific storage and handling requirements that need to followed and documented the entire process. At every point there is a United States, either federal or state, licensed entity that takes responsibility for this process.
When a medication is manufactured in another country for use in the United States, the FDA provides the same level of monitoring, following the “chain of custody” of the medication from the point that it was manufactured all the way to the pharmacy where the medication is dispensed to the patient.
When a medication is sold for use in another country, the FDA’s “chain of custody” is broken and the other country takes over with whatever laws they have. If a medication is manufactured by a United States FDA approved drug company, and is then exported to another country, that country then takes over the ownership of the medication. It is then illegal to import that medication back into the United States. The “chain of custody” has been broken and there is no guarantee that the medication has been stored and handled 100% appropriately.
The law states that there are certain situations where a patient may take a prescription to Canada and purchase up to a 90 days’ supply of medication and bring it back into the United States for personal use. These particular situations are limited to medications that are not currently available in the United States yet still necessary for specific illness. They do not include purchasing medications available in the United States just because they are cheaper from another country. Nowhere does it state that it is legal to order these medications over the internet and have them mailed to you. That said, it is done all the time by regular people who do not realize that they are “trafficking prescription medications across a federal border”.
Joe McCallion, a consumer safety officer in the FDA’s Office of Regulatory Affairs, sums it up this way: “If you buy drugs that come from outside the U.S., the FDA doesn’t know what you’re getting, which means safety can’t be assured.”
Just do a Google search and see how many Canadian Internet Pharmacies you find. These folks set up an internet store front in Canada and then market great deals on prescription medications. The actual warehouse may be in India or Malaysia or anywhere… There is absolutely zero FDA regulation on the “chain of custody” of these medications.
Not only may the manufacturing, storage and handling of these medications be inappropriate, the medication themselves may be counterfeit. Just use common sense, if a medication costs $120 for 30 days’ worth at your local pharmacy, and it costs $29.95 over the internet for the same medication, what’s the deal. If they do not need to worry about storage and handling or concern about the manufacturing plant being licensed and monitored, or even if the correct ingredients are being used, well then, we can cut corners and charge less money.
There have been multiple documented cases of medications being imported through Canadian Internet Pharmacies where the patient has gotten severe side effects or the medication has not worked. Upon evaluation, the medication was a counterfeit. There is no recourse if this happens; only the consumer who purchased it over the internet is to blame.
Please, do not order your medications from Canadian Internet Pharmacies. You do not know what you will be getting. If you are having trouble paying for your medications, talk with your pharmacist. They may have some ideas on a cheaper generic, or perhaps connect you with the manufacturer of the medication so you can use their “Patient Assistance Program”.
For more information, take a look at this publication.
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143561.htm
Thanks
Steve
I am a Canadian pharmacist. We do get US citizens coming into Canada to get their US rxs filled. Usually they want a full year’s supply, which we often don’t have in stock for them. Also, we cannot by law fill a US rx.They must get an rx signed by a Canadian doctor. So, a few steps they have to go through.
As a Canadian pharmacist, I do not like these transactions. I have no knowledge of, or relationship with, this person to whom I am selling medications. They do not want any relationship or counselling from me.
However, I do stand behind the quality of the meds I sell. We purchase our meds legally and above-board, yet I know that prices in Canada are usually much lower than in the US. We still have and sell generic colchicine (for example) due to the different regulatory regime here, and as the government (Federal, Provincial, Territorial)is the largest single payor for meds, prices here are not as inflated as in the US.
I don’t think that sending your patients to Canada is the best option, but sometimes it’s the only option. You should be aware that some pharmacies add a surcharge to the meds for these patients, on the assumption that if they can travel to Canada for their rxs, they can afford some extra fees, and you know: the patients are so happy because, even if they get charged an extra $100, they’re still paying less than they would in the US.
Very interesting post and comments. I do disagree with single payer system, which implies government run. What does our government do efficiently? You could argue the military is efficient, but given no restrictions it is very expensive. I also complain about the stingy pbm’s and how they treat pharmacy, but they do add efficiency through their prior auth system. Should every celebrex rx be filled without question? Health care reform is needed but not obamacare. There are two elements necessary for health care reform: 1) tort reform 2) patients must be made aware of the cost of their treatment. It is absurd when a patient requests trade name and doubles their copay and increases the cost of therapy 100 fold. My bumper sticker sums it up perfectly: If you think healthcare is expensive now, wait until it is free!
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Barry, are you new to the game? You give PBMs too much cred. They are the Tails wagging the dogs.
To me, buying Canadian drugs is pretty much the same as buying from the internet pig-in-a-poke from a warehouse somewhere within the Canadian borders, but where does the drug come from. The patient risks their own health by their own selves. How can they be sure that their ‘brand-name’ drug is a brand-name drug? All they really know is that they are paying less.
Drugs enter the US system indiscriminately, (think: methamphetamines, Epo, Viagra–what is the source of internet Viagra?, phenylpropanolamine and illegal drugs in the US).
US licensed professional pharmacy jobs in the US are undermined; essentially ‘shipping the job outside’, and it sure does a lot for the credibility of loudmouths (think Sarah Palin) and other decision-makers who arrange drug junkets for their constituents over the border while supporting PBMs, Big Pharma rascals, and anti-Buy American policies. But, then, integrity and credibility seems to be over-rated these days.