Consumer import of prescription drugs

Last updated

Consumer import of prescription drugs refers to an individual person, typically a patient, getting prescription drugs from a foreign country for their own personal use in their own country.

Contents

Import mechanisms

People can have drugs shipped to them from online pharmacies. They may travel internationally for the purpose of medical tourism, and purchase drugs there to be used back home.

Causes

Individual consumers will only consider seeking drugs from other countries if they have some barrier to access in their own country. One barrier to access is high local prices compared to other markets. Another barrier to access could be legal restrictions preventing an individual from getting a drug they want or need.

International drug market prices

In some markets, drug prices are set or influenced by the prices in other, nearby markets. [1] In Europe, for example, people freely and easily travel to different countries, and the price of a certain drug in one country affects the price in other, nearby countries. [1] Having this kind of competitive exchange can keep prices low, but it can also lead to lowered drug accessibility. [1] Sometimes a manufacturer may choose not to offer a drug in one market, to ensure success in selling the drug at a higher price in a different market. [1]

Businesses, manufacturers and drug retailers wish to control the supply of pharmaceuticals in their own marketplace. [2] As such, if low-cost drugs entered a market from other lower-cost territories, what might develop is pure price-based selling. [2] The TRIPS agreement is an example of a World Trade Organization treaty which regulates how drugs can be traded in the international marketplace. [2]

Some developing countries might receive access to lower-cost drugs through compulsory licenses. [3] Compulsory licenses affect markets outside the country in which they are issued. [3]

Variation in legality

Drugs which are legal in one place may not be legal in another.

By region

Canada to United States

People in the United States have easy access to Canada. The quality of medicine in Canada is comparable to that of the United States. Drug prices are often much lower in Canada than in the United States. To save money, some consumers in the United States seek to purchase drugs in Canada. Different people have published different perspectives on this practice. [4]

One major on-line supplier, Canada Drugs, announced its closure on July 13, 2018, as part of an agreement with the U.S. Department of Justice. [5]

Two organizations, the Canadian International Pharmacy Association and the PharmacyChecker Verification Program, verify the safety and legitimacy of online pharmacies that ship from Canada to the United States. [6]

The average savings was 81% when purchased in Canada. [7]

Mexico to United States

In some cases, U.S. insurance companies will pay consumers of high-cost drugs to personally travel to Mexico to buy the same drugs at a much lower cost there. [8]

Society and culture

Petition for government reform

Consumers may feel that prescription drugs which are available to multiple countries to be of equivalent quality, and feel comfortable buying and using drugs by choosing to purchase from the country which offers the drugs at the lowest price.

Governments typically oversee the import of prescription drugs so bringing a prescription drug from a foreign country could be Illegal drug trade.

See also

Related Research Articles

<span class="mw-page-title-main">Medication</span> Substance used to diagnose, cure, treat, or prevent disease

A medication is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and relies on the science of pharmacology for continual advancement and on pharmacy for appropriate management.

<span class="mw-page-title-main">Over-the-counter drug</span> Medication available without a prescription

Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) rather than final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers the freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures.

A grey market or dark market is the trade of a commodity through distribution channels that are not authorized by the original manufacturer or trade mark proprietor. Grey market products are products traded outside the authorized manufacturer's channel.

<span class="mw-page-title-main">Generic drug</span> Pharmaceutical equivalent to a brand-name product

A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active chemical substance is the same, the medical profile of generics is equivalent in performance compared to their performance at the time when they were patented drugs. A generic drug has the same active pharmaceutical ingredient (API) as the original, but it may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging.

Prescription drug list prices in the United States continually are among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the 21st century, leading up to the American health care reform debate of 2009, and received renewed attention in 2015. One major reason for high prescription drug prices in the United States relative to other countries is the inability of government-granted monopolies in the American health care sector to use their bargaining power to negotiate lower prices, and the American payer ends up subsidizing the world's R&D spending on drugs.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

The Pharmaceutical Benefits Scheme (PBS) is a program of the Australian Government that subsidises prescription medication for Australian citizens and permanent residents, as well as international visitors covered by a reciprocal health care agreement. The PBS is separate to the Medicare Benefits Schedule, a list of health care services that can be claimed under Medicare, Australia's universal health care insurance scheme.

Virginia State Pharmacy Board v. Virginia Citizens Consumer Council, 425 U.S. 748 (1976), was a case in which the United States Supreme Court held that a state could not limit pharmacists’ right to provide information about prescription drug prices. This was an important case in determining the application of the First Amendment to commercial speech.

An online pharmacy, internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the Internet and sends orders to customers through mail, shipping companies, or online pharmacy web portal.

Humanitarian use licenses are provisions in a license whereby inventors and technology suppliers protect in advance the possibility of sharing their technology with people in need. Thus, humanitarian use licenses set the conditions for the provision of access to innovations for people in need at a royalty free basis or at lower costs. Humanitarian use licenses assure that products of research and development stay publicly available and that at the same time the incentive function of exclusive intellectual property rights are maintained.

In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. According to the American Pharmacists Association, "PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims." PBMs operate inside of integrated healthcare systems, as part of retail pharmacies, and as part of insurance companies.

Direct-to-consumer advertising (DTCA) refers to the marketing and advertising of pharmaceutical products directly to consumers as patients, as opposed to specifically targeting health professionals. The term is synonymous primarily with the advertising of prescription medicines via mass media platforms—most commonly on television and in magazines, but also via online platforms.

<span class="mw-page-title-main">Pharmacy (shop)</span> Shop that provides pharmaceutical drugs

A pharmacy is a retail shop which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.

Medication costs, also known as drug costs are a common health care cost for many people and health care systems. Prescription costs are the costs to the end consumer. Medication costs are influenced by multiple factors such as patents, stakeholder influence, and marketing expenses. A number of countries including Canada, parts of Europe, and Brazil use external reference pricing as a means to compare drug prices and to determine a base price for a particular medication. Other countries use pharmacoeconomics, which looks at the cost/benefit of a product in terms of quality of life, alternative treatments, and cost reduction or avoidance in other parts of the health care system. Structures like the UK's National Institute for Health and Clinical Excellence and to a lesser extent Canada's Common Drug Review evaluate products in this way.

Established in 2002, the Canadian International Pharmacy Association ("CIPA") is a Canadian association of licensed pharmacy businesses offering mail order pharmacy services to Canadian and international patients. CIPA members sell pharmaceuticals and maintenance medications to individuals upon receipt of a valid prescription. In addition to selling Health Canada approved medications from their licensed Canadian pharmacies, CIPA members also have relationships with regulated international pharmacies and inspected fulfillment centres that directly deliver medications to patients. Patients make the choice from where their medications will be delivered, and this is confirmed with them at time of purchase.

The cost of HIV treatment is a complicated issue with an extremely wide range of costs due to varying factors such as the type of antiretroviral therapy and the country in which the treatment is administered. The first line therapy of HIV, or the initial antiretroviral drug regimen for an HIV-infected patient, is generally cheaper than subsequent second-line or third-line therapies. There is also a great variability of drug prices among low, middle, and high income countries. In general, low-income countries have the lowest cost of antiretroviral therapy, while middle- and high-income tend to have considerably higher costs. Certain prices of HIV drugs may be high and difficult to afford due to patent barriers on antiretroviral drugs and slow regulatory approval for drugs, which may lead to indirect consequences such as greater HIV drug resistance and an increased number of opportunistic infections. Government and activist movements have taken efforts to limit the price of HIV drugs.

The online distribution of counterfeit medicines has been growing during the last decades. The role of Internet as an unregulated medicine market is the main reasons behind this phenomenon, especially the effectiveness of "spam" as a tool for advertising and promoting these products. Websites and social media are new powerful instruments that organized criminal groups could exploit to conduct their illicit businesses. The spread of this emerging threat worldwide poses a very high risk for the health and safety of unaware consumers.

Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, around five years later nearly 30, by 2008 200, and by 2015 300.

Specialty pharmacy refers to distribution channels designed to handle specialty drugs — pharmaceutical therapies that are either high cost, high complexity and/or high touch. High touch refers to higher degree of complexity in terms of distribution, administration, or patient management which drives up the cost of the drugs. In the early years specialty pharmacy providers attached "high-touch services to their overall price tags" arguing that patients who receive specialty pharmaceuticals "need high levels of ancillary and follow-up care to ensure that the drug spend is not wasted on them." An example of a specialty drug that would only be available through specialty pharmacy is interferon beta-1a (Avonex), a treatment for MS that requires a refrigerated chain of distribution and costs $17,000 a year. Some specialty pharmacies deal in pharmaceuticals that treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease (IBD) or Hepatitis C. "Specialty pharmacies are seen as a reliable distribution channel for expensive drugs, offering patients convenience and lower costs while maximizing insurance reimbursements from those companies that cover the drug. Patients typically pay the same co-payments whether or not their insurers cover the drug." As the market demanded specialization in drug distribution and clinical management of complex therapies, specialized pharma (SP) evolved.„ Specialty pharmacies may handle therapies that are biologics, and are injectable or infused. By 2008 the pharmacy benefit management dominated the specialty pharmacies market having acquired smaller specialty pharmacies. PBMs administer specialty pharmacies in their network and can "negotiate better prices and frequently offer a complete menu of specialty pharmaceuticals and related services to serve as an attractive 'one-stop shop' for health plans and employers."

Access to medicines refers to the reasonable ability for people to get needed medicines required to achieve health. Such access is deemed to be part of the right to health as supported by international law since 1946.

References

  1. 1 2 3 4 Vogler, Sabine; Paris, Valérie; Ferrario, Alessandra; Wirtz, Veronika J.; de Joncheere, Kees; Schneider, Peter; Pedersen, Hanne Bak; Dedet, Guillaume; Babar, Zaheer-Ud-Din (6 January 2017). "How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries" (PDF). Applied Health Economics and Health Policy. 15 (3): 307–321. doi:10.1007/s40258-016-0300-z. PMID   28063134. S2CID   4755170.
  2. 1 2 3 Pashkov, VM; Golovanova, IA; Olefir, AA (2016). "The impact of the legal regime of intellectual property protection in the pharmaceutical market". Wiadomosci Lekarskie. 69 (3 pt 2): 582–586. PMID   27717949.
  3. 1 2 Stavropoulou, Charitini; Valletti, Tommaso (10 January 2014). "Compulsory licensing and access to drugs" (PDF). The European Journal of Health Economics. 16 (1): 83–94. doi:10.1007/s10198-013-0556-2. PMID   24408475. S2CID   16287360.
  4. Shepherd, M (July 2007). "Drug importation and safety of drugs obtained from Canada". The Annals of Pharmacotherapy. 41 (7): 1288–91. doi:10.1345/aph.1k249. PMID   17578879. S2CID   46076280.
  5. "Canadian Pharmacy Online - Canada Pharmacy - Discount Prescription". Archived from the original on 2018-05-02. Retrieved 2018-05-02.
  6. "Which is the safest online pharmacy?". PharmacyChecker.com. PharmacyChecker.com. Retrieved 29 July 2020.
  7. Joe Graedon, "Can you trust Canadian online pharmacies?" The People's Pharmacy, 2020.
  8. Steps To Fix America's Broken Prescription Drug System