Rising costs for medicines in the United States are prompting thousands of Americans to buy prescription drugs in Canada, a practice fueled by the rise of Internet pharmacies. The cross-border trade in medicines raises concerns among U.S. officials.
For several years, Americans have looked northward for their prescription drugs. Drugs are cheaper in Canada because of the favorable exchange rate and Canadian regulations limiting prices.
Now, new Internet pharmacies are luring retired Americans seeking discounted drugs. Concentrated in the provinces of Ontario and Manitoba and the city of Calgary, the on-line stores offer prescription drugs at discounts of up to 70 percent.
Carol Wolk, who lives in New Jersey, bought drugs on-line for the first time last September. She purchased anti-cholesterol medication from a Canadian company for half the price of the drug's cost at home. "One thing I thought was amazingly easy," she said, "was that they accepted the photocopy of the doctor's prescription and I felt if there was any delay in receiving the medication, I still have the prescription in hand and can take it out locally and have it filled."
Mrs. Wolk says that not all drugs were cheaper. She says blood pressure medication was more expensive and quite often the correct quantity or proper dosage was not available. Despite the savings over the Internet, she still likes the convenience of going to a local pharmacy.
For many Americans living near the border, visiting a traditional pharmacy in Canada is an easy way to buy cheaper drugs.
Arthur Konviser is a senior vice-president for Shoppers Drug Mart, Canada's largest drugstore chain. He said, "The patient has decided in their economic wisdom to come north of the border and have their prescriptions filled here. So price is a driving factor."
For both Canadian drug stores and Internet pharmacies, a Canadian doctor must approve all prescriptions. Only 90-day supplies can be dispensed.
Mr. Konviser said American prescriptions are only filled after careful evaluation. He cautions against using on-line pharmacies, saying they are dangerous.
This is a concern echoed by Peggy Doetzel, the U.S. Food and Drug Administration's associate commissioner for policy.
She fears that on-line pharmacies will not recognize possible conflicts between different medications or properly explain dosages. She says when drugs are bought directly from a drug store there is direct contact between a pharmacist and patient.
Ms. Doetzel said, "When people go over the border to purchase their medications, at least they have the advantage of walking into a facility and examining that facility, they come face to face with the pharmacist there and have the ability to judge the facility. When you purchase something over the Internet, you don't have that at all."
According Royal Canadian Meds, an on-line pharmacy in Winnipeg, there is no difficulty in ensuring patient safety.
Customer service manager Brandy O'Reilly says a customer must fill out medical history form and a Canadian doctor reviews the prescription. She said conflicts are usually not a problem, since most of the packages the company sends are repeat prescriptions for people with chronic conditions. She said, "The requirements that we do have to meet is that we can only send a 90-day supply, not any more than that. We can't ship any controlled substances. So, no narcotics, and the other thing that is inside the package has to be a copy of the customer's prescriptions."
According to the U.S. Customs Service Web site, Americans entering the country from Mexico or Canada can bring in limited amounts of prescription drugs, but only if the drugs are legal in the United States.
The AARP is an organization for older Americans. David Gross, a policy analyst for the group, says senior citizens pay the most for prescriptions, because they typically do not have full insurance and cannot use group discounts. To help them, the organization runs a discount mail-order drug service. Mr. Gross said, "We're also looking at ways to reduce prices that people are charged. There may be cases where a less expensive medication might be just as effective as a more costly medication."
Mr. Gross says the quickest way to stop the cross-border trade is to lower drug costs in the United States. In the meantime, AARP is trying to educate members about cheaper drug options.