If you think political debate is contentious, try listening to physicians, pharmacists and patient advocacy groups discuss overseas pharmacies.
As a long-time managing editor of medical publications – and a medical center spokesperson prior to that – I can almost guarantee that eavesdropping on such conversations will have you yearning for the seemingly reasoned civility of campaign advertisements.
Suffice to say that, like many politicians, physicians, pharmacists and patient advocates see no room for nuanced conversation. Most pharmacists, physicians and other U.S. health care professionals contend that ordering such medications is plain wrong. It’s illegal and unsafe.
Many patient advocates – and a few outspoken health care professionals – say that if due diligence about the pharmacy is conducted, the medications are safe and significantly less expensive than those sold in the United States, thus affording patients ways to maintain and improve health without bankrupting themselves.
Here are some of the pros and cons so you can make a sound decision:
A recent Consumer Reports’ survey found that 60 percent of those surveyed wanted to cut health care costs. Many of those respondents said one way they make ends meet is to buy medications online from pharmacies outside the United States. Based on the survey, Consumer Reports estimated that 1.9 million Americans buy medications this way. International Business Times recently estimated more than 5 million Americans buy from overseas pharmacies. Although common, CR recommends against this practice, warning that some online vendors are rogue operations that sell counterfeit, substandard or even toxic versions of drugs. It recommends consumers pursue other ways to save on medical costs.
The differences in drug costs, however, are significant.
“Drug prices in the U.S. are shrouded in mystery, obscured by confidential rebates, multiple middlemen and the strict guarding of trade secrets,” as a Wall Street Journal report put it. One reason American pay high prices for prescription medications is that the United States market funds much of the global drug industry’s research and its efforts to develop new medicines.
An analysis by the newspaper comparing drugs sold in the United States and Norway found that U.S. prices were higher for 93 percent of 40 top branded drugs. Similar patterns appeared when U.S. prices were compared with those in England and Canada’s Ontario province. Throughout the developed world, branded prescription drugs are generally cheaper than in the United States, the newspaper concluded.
A real world example: Suzan Roll, a retired interior designer who lives in Palm City, Florida, told International Business Times that she has ordered expensive medications online for more than seven years. One savings example: she purchased an estrogen ring that would have cost her $240 through Medicare for only $79 on a website. When her son needed Lexapro, an antidepressant, she bought it for around $40 online instead of paying $125 at a local pharmacy.
“It was very convenient, and it saved us money,” she said.
Legality and enforcement
Importing drugs from overseas is illegal, so this has implications if you rely on online pharmacies that are outside the United States.
Officials at the Food and Drug Administration told the New York Times that the agency “typically does not object” to people buying imported medicine for personal use “under certain circumstances.” The circumstances include purchasing less than a three-month supply of drugs that are not available in the United States for treatment of serious conditions.
Although the FDA rarely prosecutes individuals importing medications for their personal use, the government does crack down on overseas pharmacies. Recently U.S. Customs and Border Protection seized such packages to “protect the consumer from harm,” reported Medscape.
If your order is seized in such a crackdown, you may never receive the medication or the money you paid.
In the recent raid, federal customs agents seized 50,000 packages spanning 115 countries — the largest crackdown to date on those selling prescription medicines online, according to International Business Times. In addition, 1,050 online pharmacies in 115 countries were raided or warned, 2,414 websites selling prescription drugs were shut down, and about 550 online advertisements were removed in the international crackdown.
The FDA also sent warning letters to the operators of 400 online pharmacies that sell unapproved or mislabeled medicines or medical devices and seized 814 parcels containing antidepressants, hormone replacement therapies and drugs to treat high cholesterol and erectile dysfunction at international mailrooms in New York, Chicago and Miami.
On the critical issue of safety, it is not as black and white as the U.S. government might suggest, according to Gabriel Levitt, vice president of PharmacyChecker.com — a company that helps Americans find the drugs they need through lower-cost pharmacies, many of which are in Canada and other foreign countries.
Levitt took special exception to a statement from Howard R. Sklamberg, a deputy commissioner at the FDA, who said that foreign unapproved drugs posed the same health risks as counterfeit drugs. (You can see Sklamberg’s testimony about counterfeit and unapproved medication before Congress on the subject here.)
“That assertion is just not true and will scare lawmakers and consumers into believing that all imported drugs bought online are dangerous. He spells out this distinction in his blog.
When FDA talks about “foreign unapproved drugs,” it often means real medication available in foreign pharmacies. That medication is either exactly the same as the medication sold here or a foreign version with the same active ingredients as medication sold here. When FDA talks about “counterfeit drugs,” they generally mean fake medication: products sold by criminals that fool people into believing that they were manufactured legally.
Want more assurance? According to a report by NPR, researchers from the National Bureau of Economic Research ordered samples of drugs commonly used by Americans — including Viagra, Celebrex, Lipitor, Nexium and Zoloft — from 41 online pharmacies based in the United States, Canada, Australia, Europe or Asia. The researchers selected the pharmacies through online searches, just as consumers do.
The results: The 328 medication samples they tested that were obtained from any type of certified pharmacy were found to be legitimate. Those that were certified by PharmacyChecker and the Canadian International Pharmacy Association were half as expensive as the drugs ordered from U.S.-based outlets.
It is an inconvenient truth,” PharmacyChecker.com’s Levitt told The Hill newspaper, “but millions of Americans will find their lifeline of affordable and safe medication gone if there is a broad-based, ill-considered crackdown against foreign online pharmacies.”
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