Drug importation is not the solution to prescription drug costs

https://www.bendbulletin.com/home/6981704-151/guest-column-drug-importation-is-not-the-solution

State lawmakers are tired of waiting on their federal counterparts to act on prescription drug prices.

The state Senate recently held a hearing on a bill that would call on the Board of Pharmacy to import prescription drugs from Canada. A companion bill, which would require the Oregon Health Authority to enact an importation program, is pending in the state House of Representatives.

As a pharmacist, I see and feel my patients’ pain from the high cost of medications that only seems to grow more expensive each year. Their frustration is my profession’s collective frustration too.

I can understand why they — or anyone — would think purchasing drugs from outside the U.S. would make prescriptions more affordable.

Yet importing prescription medication from Canada or other countries would be a cure worse than the disease. It would threaten what patients need even more than lower prices: safety and choice.

Our patients’ safety is our top concern, and the reality of so-called “Canadian” drug sites is that most are not Canadian, nor do they sell Health Canada-reviewed or approved medications. A 2017 review by the National Board of Pharmacies showed many of these sites do not require a valid prescription — a troublesome prospect in light of the nation’s opioid crisis.

Worse, several were found to sell counterfeit medications. The World Health Organization estimates that 1 in 10 medicines in developing countries is counterfeit — a significant public health threat, which Americans are immune to given the Food and Drug Administration’s “track and trace” system that is the safest in the world.

Consider the ramifications of counterfeit medicine. A fake Rolex may give you the wrong time, but it won’t kill or maim you.

As a pharmacist, my job is to know what’s in my patients’ medications and how to mitigate potential side effects and drug interactions. The problem with fake medications is there’s no way to know what’s in them until it’s too late.

Even if state health authorities could somehow verify the safety of Canadian drugs, it’s Pollyannaish to believe that Canada, which is experiencing widespread drug shortages, would allow its limited supply to be exported.

Christopher Ward, a Canadian health consultant explains that “in Canada, we have faced significant drug shortages. There’s no way there’d be support for this type of operation.”

And even if Canada had excess supply, it likely wouldn’t sell to the U.S. at the same price Canada charges its citizens. Doing so would cause public outcry given the chronic funding shortfalls experienced by the country’s universal health care system.

“Canada’s pricing controls don’t apply to exports,” notes Canadian health care expert Tim Squire.

Foreign countries like Canada are able to offer their citizens cheaper drug prices because their governments use price controls. This is unfair to American patients who are forced to subsidize the artificially low cost of these drugs in foreign countries. Yet foreign patients pay the price in lack of access. If manufacturers can’t meet the low prices demanded by governments, their citizens simply go without.

Canadians only have access to about 50 percent of the new medicines that Americans enjoy. That number falls to just 33 percent for Australians.

So what’s the solution to rising drug prices if not importation? Reforming the opaque supply chain. Transparent prices, absent middlemen who increase drug prices by more than $150 billion annually, can reduce costs in the same way they do in virtually every other sector of the economy.

In the meantime, Oregon shouldn’t fall for the siren song of prescription drug importation.

Filed under: General Problems