Shopping for Drugs
Table of Contents
- Executive Summary
- Introduction
- Comparing Prices
- Therapeutic Drug Substitution
- Pill Splitting
- Generic Drug Substitutes
- Switching to Over-the-Counter Drugs
- Mail-Order Pharmacies
- Global Options
- Financial Assistance to Lower Drug Costs
- Price Comparisons for Specific Drugs
- Conclusion
- Notes
- Appendix
- About the Author
Global Options
"Only branded drugs still under patent protection are cheaper in Canada; generic drugs are cheaper in the United States."
Pundits complain that drugs are cheaper in Canada. However, this is true only for branded drugs still under patent protection. Generic medications - the ones that represent the best value for most patients - tend to be cheaper in the United States.55 Nonetheless, Internet pharmacies based in Canada have recently become popular with some consumers.56
This avenue is not without risks however. For one thing, Internet pharmacies claiming to be Canadian may not be. A study of Internet pharmacies appearing in the Annals of Internal Medicine found that only about 11 percent revealed the actual locations of the business.57 A more recent study found that about one-third of Internet pharmacies purported to be Canadian were located elsewhere.58 Furthermore, under the Prescription Drug Marketing Act of 1988, it is illegal to re-import drugs into the United States from foreign countries.
FDA officials say it is impossible for them to vouch for the safety and authenticity of drugs coming from sources outside the United States.59 Prior to the 1988 act, counterfeit drugs were making their way onto pharmacy shelves after having been smuggled into the United States.60 In two widely reported cases:
- About two million counterfeit birth control pills containing little or no active ingredient were smuggled into the United States.
- U.S. customs inspectors seized 1,800 counterfeit bottles of the antibiotic Ceclor.
Americans obtaining drugs abroad for personal use face similar hazards. In recent hearings, the FDA confirmed that some of the drugs illegally reimported into the United States for personal use are likely to be counterfeit, expired, incorrect dosage, tainted or mislabeled.61 Other potential risks of drug reimportation include fake or unapproved drugs, poor quality control involving packaging and storage, and a possibly incorrect diagnosis if the prescription is obtained online.62
The World Health Organization (WHO) and others estimate that anywhere from 5 percent to 8 percent of drugs shipped to the United States are counterfeit, substandard or unapproved for use in this country.63 Furthermore, a survey of foreign drug manufactures conducted for the Association of International Pharmaceutical Manufacturers found that about 12 percent of drugs consumed in Russia were counterfeit.64 Another report estimated that up to 90 percent of the Viagra sold in Shanghai, China, was counterfeit.65 Worldwide, the market in counterfeit drugs is estimated to be somewhere between $20 billion and $48 billion.66
As more Americans turn to foreign sources for prescription medications, the market in counterfeit drugs is bound to rise. But of course drugs obtained at low prices are not bargains if they jeopardize patients' health.
