CANDADIAN PHARMACIES – THE WONDERS WE CREATED AND THE POTHOLES WE DUG

I used a Canadian Pharmacy to buy the eye drops I needed for my glaucoma. The medicine would have cost $90 a month in the U.S. Ordered through a Canadian pharmacy the thirty day price was $30. I chose an online pharmacy that, best I could tell, was legit. After speaking to a representative by phone, I placed my order, supplied proof that I was a licensed physician, and e-mailed a hand written prescription. At the time I was able to pay with a credit card. (That was three years ago and cards are no longer accepted. I wonder why?)

Under the Prescription Drug Marketing Act of 1987, it is illegal for foreign “e-pharmacies” or anyone other than the original manufacturer to bring prescription drugs into the country. My medication never touched ground in Canada. It was processed by a Canadian pharmacy, but was mailed directly to my home from a factory in Germany (once) and Turkey (once.) The drops were brought into the country legally.

I’m a doctor and Bernie Sanders thinks everyone should be able to do what I did. In 2017 the senator from Vermont introduced a bill that would allow the importation of prescription drugs from Canadian pharmacies, as long as they meet certain safety standards.” Bernie’s bill, of course, went nowhere.

For Americans who live near one of the nation’s boundaries, it’s possible to buy cheaper drugs by walking or driving over the border. There are special lanes in Tijuana for U.S. citizens to cross to Mexico and buy medications. A million Americans use them each year. The FDA told Vice News: it is “illegal” for individuals to import drugs into the U.S. for personal use. As a practical matter, customs allows Americans to bring in 90 days worth of medications for personal use.

Vice news used the price of insulin to show why so many people turn to medical tourism. The list price for a 5 pack of a brand of insulin made by Eli Lilly, (according to Vice) was $147 in 2007, $295 6 years later, and $530 by 2017. Insulin was first isolated and purified in the 1920s. People injected various forms of animal insulin for over 70 years and the medicine was safe and effective. In the late 1970s scientists at Genentech using microbes and recombinant technology learned how to make human insulin and since the 1980s most American diabetics have been injecting the human hormone.

90 percent of the global supply of insulin is made by Eli Lilly, Novo Nordics, and Sanofi. Eli Lilly told Vice News that their net cost to make a box of insulin pens is $122. That includes “manufacturing, labor, research and development, regulatory fees, promotional expenses, insulin donations and profits.” The list price is $530. In May 2019 Lilly introduced the generic version of its insulin (same drug, same packaging, and the same manufacturer). The price was cut in half. The head of the diabetic association, like the manufacturers who appeared before Congress, argued that the discounts that currently go to pharmacy benefit managers should go to the patient.³

In most states drugs ordered through legit Canadian pharmacies are not paid for by insurance or Medicaid or Medical. They require a lot effort by doctors and patients and take two weeks to get processed. If they are newly released they often aren’t cheap. Half of the businesses that sell pharmaceuticals on the web are located in the U.S. Some call themselves prescription referral services.

The National Association of Boards of Pharmacy claims “Rogue websites may be selling drugs that are counterfeit, contaminated, or otherwise unsafe.” I’m sure they are right. People have always been tricked by charlatans promoting cure-alls. It’s hard to know how often we or our friends have been fooled by internet fraudsters. People who use Canadian Pharmacies need to be attentive and cautious.

A number of international internet pharmacies import, process, and directly dispense medications. A private company earns its keep by certifying their legitimacy. Called PharmacyChecker.com, the “verifying” company charges an annual fee and insists that a licensed pharmacist makes sure the “medication is selected and labeled correctly.”

To be an “approved” marketer a pharmacy needs a license. US pharmacies also need a DEA (drug enforcement authority) license. International pharmacies are not allowed to send controlled substances to U.S. buyers. Each medication filled must have a valid prescription.

“In countries with the strongest regulations, Pharmacy Checker inspectors don’t visit pharmacies. They verify their licenses with the relevant governing body like the College of Pharmacists of Manitoba, and the Singapore Ministry of Health.

In Mauritius, Turkey and Singapore, company representatives conduct onsite inspections during the application process and every 1-2 years thereafter. In India they only certify pharmacies that dispense drugs that are made by manufacturers that have a global presence.

With regard to the drugs these pharmacies dispense: More than half the medications Americans take are made in other countries. The Swiss company Novartis produces pills in factories located in Spain, Germany, Switzerland, the U.S., the UK, Slovenia, Belgium, and Poland. Most of the North American supply of aspirin comes from China. Over the counter Prilosec and the cholesterol lowering drug Simvastatin often come from Puerto Rico and India.

FDA inspectors are supposed visit the plants that supply our drugs and make sure they “are clean, follow proper manufacturing techniques and contain what is on the label (and nothing else)” To date agency inspectors have visited a little over half of the factories they have approved. One day the FDA will have the money and manpower to comply with the law Congress passed but didn’t fund.

An agency of the Canadian government that regulates “foreign-sourced drug products… “conducted 35 inspections at foreign sites in the last five years” 76% of drug products imported into Canada come from countries whose plants Canadians (apparently) don’t inspect.

The companies that run American pharmacies are large and presumably politically influential. The two largest by revenue in 2014 were CVS and Walgreen. CVS Health took in $48 billion that year. One billion seven hundred thousand prescriptions accounted for over 70% of the company’s revenue. Mail-order service added an additional $88.4 billion. Walgreen’s gross income was over $76.billion and prescription drugs accounted for nearly 2/3 of sales.⁵