As a licensed pharmacist in both Canada and the United States, I have the opportunity to see two different health care systems up close, and I am familiar with the benefits and flaws in each.
Each day in my current clinical practice in Florida, I help patients through financial access issues so they can afford the medications they need to treat diabetes, heart failure, cancer and other serious illnesses. I have seen drugs that once cost pennies per tablet increase exponentially in cost simply because the product was sold from one company to another with no change in formulation or additional research.
Clearly, answers are needed, but my experience on both sides of the border allow me to say unequivocally that drug importation will not fix America’s issues with pharmaceutical costs. Furthermore, it’s not even going to happen.
As generous as Canadians are, we will not suffer drug shortages simply to help Americans have cheaper prices. The United States is going to have to repair its own problems.
If the U.S. government foolishly moves forward with ill-conceived plans to import medicine from Canada, or if several states (including Florida, where I practice) get the greenlight to implement their own importation plans, it will make it much easier for rogue manufacturers in the third world to make fake medicines, apply realistic-looking labels and sell them to Americans. People in this country who think they are getting a great deal will end up getting sicker because their conditions aren’t being effectively treated or, worse, will be harmed by whatever ingredients counterfeiters add to the adulterated product.
I can attest that identifying counterfeit medicine is very difficult. Even though I have experience checking into provincial licensing bodies for legitimate Canadian online pharmacies, I was fooled by CanadaDrugs.com, which had all of the proper documentation but was sentenced to pay $34 million in fines and forfeitures in 2018 for introducing misbranded drugs into interstate commerce. Authorities know of at least one death related to these counterfeit medications.
The black market for counterfeit pharmaceuticals coming through Canada is salivating at the prospect of Americans attempting wholesale drug importation because it will give criminal enterprises greater access to an enormous market. For Americans, it will be an expensive, pointless and dangerous exercise because, again, Canada does not have the inventory of pharmaceuticals to meet its own needs and satisfy American demands.
If we want to actually address drug affordability, policymakers should ask the people who know the system and sit with patients every day to help them figure out how to pay for medicines: the pharmacists. There are several actions we would recommend to reduce prices:
— Get more generics into the market. Every time we see three manufacturers introduce generic alternatives, the price drops.
— We need less money taken out of the system by pharmacy benefit managers. Doesn’t anyone wonder how PBMs became Fortune 500 companies without ever providing any kind of patient care? By removing the role of insurers and middlemen profiting from the system, patients could have access to a range of medications at lower prices.
Recently, congressional legislation removed the gag clauses in pharmacy contracts, so now pharmacists can tell patients if there is a cheaper price available than what is being offered through the co-pay of their insurance. That’s a good start.
— Also, helping pharmacists participate in comprehensive medication management can help reduce costs while better enabling patients to improve their health outcomes. This has worked well in Canada with programs like MedsCheck in Ontario.
Canada and the United States, of course, have very different pricing systems for medications. In Canada, the government legislates prices for drugs nationally during the approval process as well as at the provincial level for inclusion on provincial formularies, which in turn sets the price for private drug plans and cash-paying patients.
In Ontario, the executive officer for the Ontario Drug Benefit Formulary will negotiate prices for the drugs to be covered, for plan participants such as seniors, those on disability and welfare, so generics are often excluded if the price is more than 50 percent of the cost of the branded product. If we want greater affordability in the United States, some hard health policy discussions are going to be necessary.
Drug importation is nothing more than political theater with potentially disastrous ramifications. It postpones real debates about what it will take to bring down health care costs. Let’s start a dialogue on real solutions instead of playing dangerous games.
Joy Wright, Pharm.D., is a dual Canadian and American citizen and a licensed pharmacist in Florida and Ontario, Canada, and she has previously served on the boards of the Ontario Pharmacists Association and the Florida Pharmacists Association and is still active in both her county pharmacy association and FPA as well as the Florida Society of Health System Pharmacists, American Society of Health-System Pharmacists and American College of Clinical Pharmacy.
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