Americans pay the highest prices for medications of any industrialized nation. According to studies by Boston University School of Public Health and the Canadian Medicines Price Review Board. Prices are 67% higher than Canada and 112% in Italy.
Prescription drug prices are expected to rise 17% in 2003. Many Medicare patients are already facing extremely difficult decisions: to cut back on doctor visits, the amount or duration medication, or reduce an already critically tight budget elsewhere, such as the amount or quality of food.
One remedy that is growing in popularity is to buy medications from Canada or other countries either in person, through the mail or on the Internet.
A poll reported October 9, 2003 by the Wall Street Journal Online and Harris Interactive Health-Care organizations, said the number of patients buying medications in Canada or another country rose from 5% to 7% in the past year. The more a patient spends on medication, the more likely they are so seek lower prices outside the US economy. Those who said they would shop outside the US if they could, rose from 40% to 48%.
Panos Kanavos, a lecturer at the London School of Economics speaking at an AARP conference on Prescription Drug Policy in the United States on June 10, 2003, explained that prices are lower in European Union (EU) because private insurance plays a more limited role; near universal access to drugs through national formularies; stronger regulation of drug prices via a variety of mechanisms; more modest co-payments, with exemptions for certain vulnerable populations; bans on direct-to-consumer advertising; and significant and rising levels of "parallel trade (prescription drugs manufactured in one EU country that are being freely sold in other EU countries.
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He suggested creating the right incentives for stakeholders to control costs, promoting evidence-based use of pharmaceuticals, and considering greater use of "reference pricing" where prices are pegged to a benchmark drug of similar therapeutic value, although such schemes must be set up carefully.
Drug companies fear that if their income streams are reduced, research and programs to supply drugs at reduced prices to third-world countries will have to be curtailed. This could mean less drugs coming to market, drugs coming to market more slowly, and/or other nations would have to pay more for drugs.
The appeal of substantially reduced medications is so tempting, that several cities and states have been looking into buying drugs from Canada for their state government employees, in spite of the fact that this breaks Federal law. Illinois, Michigan, Iowa and Minnesota and other states are talking to consultants, looking into the feasibility of the concept. However, if state governments are allowed to buy drugs for their employees, it will be difficult to tell the average citizen that they can't do the same for themselves.
The prospect is so alarming to American drug companies that several have put limits on how much medication Canadian pharmacies can buy. This does not sit well with the American consumer who already feels that drug company profits are too high.
In the Wall Street Journal Online and Harris Interactive Health-Care poll, 77% said it would be "unreasonable (and 55% said it would be very unreasonable) for pharmaceutical companies to block Canadian pharmacies from selling medications to US citizens. In a USA Today/CNN/Gallup survey, 71% of those polled favored legalizing prescription drug imports from Canada.
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In fact, the Food and Drug Administration (FDA), the government agency responsible for approving the sale of drugs and insuring their safety and efficacy, has raised alarms that importing medications from other countries might result in improperly or incorrectly labeled drugs that may have reduced quality control in the manufacturing process resulting in poor quality, tainted or even dangerous products.
In a letter to the Ram Kamath and Scott McKibbon, Special Advocates for Prescription Drugs for the state of Illinois, William K. Hubbard and Associate Commissioner for Policy & Planning for the FDA said, "Your report wrongly assumes regulatory oversight by Canadian health authorities of drugs exported to our citizens, when those authorities have not been willing or able to guarantee the safety of drugs sold to Americans. We understand that you did not include Health Canada in your fact-finding trip to Canada, nor otherwise sought assurances from Canadian health authorities that they would assure that drugs imported to Americans meet FDA's standards for drug quality, safety and purity. Your report also assumes the safety of drugs that happen to be imported across the U.S.-Canadian border. While we have often noted that Canadian health authorities set high standards for drugs sold to their citizens, we have also consistently observed that drugs sold outside of the U.S. and Canadian systems (e.g., over the Internet) often do not meet such high standards. Indeed, we have seen concrete examples of drugs sold to Americans by Canadian Internet pharmacies that pose a risk to our citizens."
Full text of letter to Illinois by FDA
It's a major crisis and one that is not going away anytime soon. Many feel that Medical, if not the entire health care system, needs a major overhaul, but just how to accomplish the complex and highly emotional task remains to be seen. Hercules solved the problem of the Gordian knot by cutting it to bits with his sword, unfortunately such a physical solution won't work with this project. It will take a few statesmen with the good of the people in mind, not partisan politics, and the longer we wait, the more people suffer.
Addendum
On November 6, 2003 the FDA informed CanaRx Services, Inc. (CanaRx), the business supplying prescription drugs to the City of Springfield, Mass., that "its operations are illegal under federal law and that it continues to put American patients at risk by providing them with unapproved, illegal, and potentially risky foreign prescription drugs." It is safe to assume the next step would be legal action to block further importation of medications. We will continue to monitor these events.
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