Prescription drugs: The facts about Canada

FROM CONSUMER REPORTS,
OCT. 2005

Canada's drug distribution and pricing systems are less likely to foster counterfeiting.

Even though the practice is illegal, Americans in droves have been importing prescription drugs from Canada. Last year, an estimated 2 million U.S. citizens spent $800 million on medicines purchased from Canadian pharmacies by fax, phone, or Web site. That's 33 percent more than in 2003. A long list of states and cities, including Kansas, Illinois, Minnesota, Missouri, New Hampshire, Wisconsin, Boston, and Portland, Maine, have set up programs to help residents and employees import Canadian drugs priced on average 25 to 50 percent below those on the U.S. market.

What's happening is controversial. The U.S. Food and Drug Administration stands foursquare against imports, arguing that it cannot ensure they are safe. Many Americans, however, believe that buying from Canada, a familiar next-door neighbor, is no more dangerous than picking up a prescription at a local drugstore. Almost 70 percent of the 1,400 people surveyed by the Henry J. Kaiser Family Foundation and the Harvard School of Public Health in November 2004 said that allowing citizens to order drugs from Canada would make medicines more affordable without sacrificing safety or quality.

Here's the reality of the government's arguments against buying from Canada:

Canadian drugs are not as safe as U.S. drugs. False. The FDA maintains that "many drugs obtained from foreign sources that purport and appear to be the same as U.S.-approved prescription drugs, are, in fact, of unknown quality." Furthermore, FDA officials have expressed the concern that news of product recalls issued in Canada may not reach U.S. consumers.

But Canada's manufacturing and regulatory system is comparable to that of the U.S., according to an October 2003 study by the state of Illinois' Office of Special Advocate for Prescription Drugs. FDA critics counter, moreover, that the agency cannot entirely ensure the safety of drugs manufactured in the U.S.

The Illinois study also concluded that Canada's pricing and distribution system is less likely to foster the drug counterfeiting that concerns the FDA. Drugs in the U.S. typically move through multiple vendors (manufacturers, wholesalers, repackagers, retailers, second repackagers, etc.) before reaching the patient. In Canada, medications are dispensed mainly in typical dosages and shipped in sealed packages directly from manufacturer to pharmacy. In a June 2004 report, the U.S. Government Accountability Office said that all of the prescription drugs it ordered from Canadian Internet pharmacies contained the proper chemical compositions, were shipped in accordance with special handling requirements, and arrived undamaged.

In addition, if a recall is issued for a drug sold in Canada, Canadian pharmacies are required to alert all consumers who purchased the affected lot, regardless of where they live.

Canadian drugs are not always cheaper. True. To see how much consumers can expect to save by buying from Canadian pharmacies, we asked PharmacyChecker.com, a group that evaluates online pharmacies, to compare drug prices from its highest-rated Canadian and U.S. Web sites. (See Brand name vs. generic costs.) When we compared the lowest prices of five well-known brand-name drugs from both Canadian and U.S. sources, the Canadian pharmacies saved consumers between $72 and $226 per prescription (including shipping charges). Such medications are cheaper in Canada in large part because its federal Patented Medicine Prices Review Board has the authority to limit prices that it deems to be excessive.

But in a similar comparison, a U.S. site had the best prices for the five most prescribed generic drugs. Because generic drugs cost less, the savings are less: from $7 to $31 per prescription. "The larger, more competitive generic market in the U.S. helps keep prices down," says Thomas McGinnis, the FDA's director of pharmacy affairs.

You could get arrested. True but unlikely. Ordering prescriptions from Canadian Web sites violates the Federal Food, Drug, and Cosmetic Act, which generally makes it a crime for anyone other than the original manufacturer to import a drug, even if it was first manufactured in the U.S.

So far, however, the FDA has focused its enforcement efforts only on those who "commercialize" drug importation. One example: RxDepot, an Oklahoma prescription drug service that was forced to shut down in 2003. But there are currently no plans to charge consumers. McGinnis says, "We are allowed to exercise enforcement discretion, and it's not our policy to go after individuals."

Many Internet sites are not legitimate pharmacies. True but avoidable. Many Web sites selling medications have been created to lure U.S. consumers seeking cheaper prices. Patients who order from such sites run the risk of receiving medications that are subpotent, improperly handled, or counterfeit. Furthermore, the FDA says some Web sites may not tell you that a drug they sell you is obtained from an overseas supplier. "You may be sent a drug that originated in Australia, Great Britain, or Pakistan," says McGinnis. "We don't know anything about the strength, quality, or purity of those medications."

WHAT TO DO

The flow of prescription drugs from Canada may not last forever. Ujjal Dosanjh, the Canadian Health Minister, proposed on June 29 that a new supply network be established to keep tabs on the nation's drugs and that bulk shipments to the U.S. be stopped if the system detects a shortage. In addition, he proposed a requirement that "an established patient-practitioner relationship" should exist before a physician may prescribe any medications. Whether or not this means that U.S. citizens will have to meet face-to-face with a Canadian doctor before they can purchase drugs will not be determined until sometime this fall, when the minister plans to introduce legislation.

But whatever happens, you should take the following steps before ordering:

• Check Consumer Reports Best Buy Drugs (www.CRBestBuyDrugs.org) to learn about drug options, including generics and over-the-counter drugs, that could save you money.
• Ask your doctor to prescribe generic drugs, which cost much less than brand-name drugs. Remember to buy them in the U.S., where they are generally cheaper than in Canada.
• If you need a high-priced, brand-name drug, check with the Partnership for Prescription Assistance (www.pparx.com; 888-477-2669), which lets you find out in one step whether you are eligible for any of the 275 programs that offer cost savings to consumers.
• If ordering from Canada is the only way you can afford the medication you need, go to PharmacyChecker.com for recommendations of approved outlets.