This editorial by Sally Pipes was published in The Sun Journal on December 16, 2019. Pipes is president, CEO and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute.
Sally Pipes: Canadian drug imports are a dose of bad medicine
In the coming weeks, the Trump administration is expected to release a draft rule allowing state governments to import cheap prescription drugs from Canada.
The rule is well-intentioned. After all, it seems unfair that Canadians pay less for many name-brand prescription drugs than do Americans.
But the Trump administration’s drug importation plan won’t meaningfully reduce Americans’ bills at the pharmacy. Further, it could endanger their health — and the health of Canadians.
Canada can’t serve as America’s medicine cabinet; it’s simply too small. Our northern neighbor has barely one-tenth as many people as the United States.
Further, Canada doesn’t have enough drugs to meet the needs of its own citizens. Many of the most cutting-edge drugs are in short supply in Canada, if they’re available at all. One analysis of more than 240 new medicines brought to market between 2011 and 2018 found that less than half were available north of the border. Nearly 88 percent were available in the United States.
Roughly four in 10 Canadian households have struggled to fill prescriptions due to shortages, according to the Angus Reid Institute. The country’s health system faces shortfalls of about 2,000 drugs.
If Americans sourced just 20 percent of their prescriptions from Canada, our northern neighbor would run out of medicines in just six months, according to research from the University of Texas.
Canadian officials would not let that happen. They would prohibit their pharmacies and wholesalers from exporting drugs. Already, Prime Minister Justin Trudeau’s government has panned drug importation, warning the Trump administration that “Canada does not support actions that could adversely affect the supply of prescription drugs in Canada.”
Drug companies also wouldn’t cooperate with the administration’s importation plans. They’d sell just enough pills in Canada to meet local demand — not so many that firms could export large quantities to the United States.
Even if importation were logistically feasible, it still wouldn’t save Americans as much money as its proponents promise.
Consider the story of a 74-year-old Michigan man with type 1 diabetes who recently ventured north after hearing about Canada’s supposedly cheaper insulin prices. As the Detroit Free Press reported, he was dismayed to find that his prescription was more expensive out-of-pocket in Canada than it would have been at his local American pharmacy, where he could use his insurance card.
His experience is hardly unique. Canadian pharmacists have noted that “the flow of cross-border patients (has) slowed considerably” in recent years, as more and more Americans realize that filling prescriptions at their local pharmacies is often cheaper than heading north.
Canada often has lower sticker prices for medicines. But that doesn’t mean those drugs are actually less expensive for Americans after insurance discounts.
Importation isn’t merely impractical — it is potentially dangerous.
In 2017, several former FDA commissioners warned that importing drugs would “harm patients and consumers and compromise the carefully constructed system that guards the safety of our nation’s medical products.”
Even if federal and state officials tried to restrict imports to a handful of regulated Canadian pharmacies and wholesalers, many Americans would inevitably turn to thousands of online pharmacies that promise cheap “Canadian” drugs. In 2010, the National Association of Boards of Pharmacy reported that 96% of internet drug vendors were non-compliant with U.S. laws or pharmacy practice standards.
These online pharmacies often source their medications from developing countries that have few, if any, safety protections. A 2005 FDA investigation found that 85% of drugs from online pharmacies that claimed to be “Canadian” actually came from 27 different countries. Many of the medications were counterfeits. Some contained few, if any, active ingredients. Others contained dangerous substances such as mercury, rat poison and lead.
Canadian officials have already warned Americans about these safety concerns. Health Canada, the nation’s public health agency, has stated that it “does not assure that products being sold to U.S. citizens are safe, effective, and of high quality, and does not intend to do so in the future.”
Importing drugs from Canada won’t reduce Americans’ prescription bills. But it does threaten the public’s health. Let’s hope the administration’s proposed rule never becomes more than a draft.