For several years, people who work for the state of Maine, the city of Portland and one large employer claim they saved some $10 million by purchasing prescription medicines through a Canadian mail-order pharmacy. But the savings ended last summer after the former state attorney general banned such businesses from doing licensed business in Maine. The move put an end to buying less expensive meds from brokers over the Canadian border.
Now, though, an effort is under way to reverse that decision. A state senator introduced a bill that would specifically license mail-order pharmacies in Canada, the United Kingdom, New Zealand and Australia so they can dispense drugs to Maine residents, MaineBiz reports. Existing law says the state must license a pharmacy that ships prescriptions inside Maine, but another section indicates Maine does not have authority to license pharmacies located outside the US.
The bill, which is called an 'Act To Ensure Consumer Choice in the Purchase of Prescription Drugs,' skirts the ban by including this key sentence: "The dispensing of drugs for personal use to an individual resident of the state from a mail order prescription pharmacy located and licensed in a nation referenced in (federal law) does not constitute the practice of pharmacy" (here is the bill).
If passed, the legislation may rekindle concerns over importing drugs from Canada, which was a contentious topic a few years ago and factored heavily in the push to eliminate counterfeit medicines, an issue that reappeared on radar screens in a big way last year when fake Avastin was discovered to have been ordered from facilities in Canada and elsewhere (read here).
Not surprisingly, the pharmaceutical industry objects to the bill. In a statement to state legislature, MaineBiz notes that the Pharmaceutical Research & Manufacturers of America trade group argues that passage would jeopardize patient safety for a variety of reasons, including the possibility of counterfeit meds entering the supply chain, and that savings would actually be minor.
PhRMA urged legislators "to consider the safety and liability concerns associated with importing and facilitating the importation of pharmaceuticals from abroad," and warned that "pharmacies that claim to be Canadian, Irish or British over the Internet might have no ties at all to (those countries). And many pharmacies based in these countries obtain their drugs from Third World sources such as India, Thailand and the Philippines" (here is the statement).
Last fall, the FDA and law enforcement authorities took various actions against more than 4,100 Internet pharmacies, including filing civil and criminal charges, seizing products and closing down web sites (see this). CanaRx, the Canadian broker that was shipping drugs to Maine employees until last summer, was previously on the FDA radar screen. The agency issued a 2003 warning letter for illegal practices that may harm consumers (here is the letter).
However, Chris Collins, a senior program advisor at CanaRx, argues that "these programs are not Internet pharmacies. They are a network of bricks-and-mortar pharmacies in four countries," he tells MaineBiz. "We're dealing directly with real pharmacies and pharmacists in countries that have laws and regulations that are at least as strong as those in the US, and maybe even stronger." And he claimed that savings ranged from 30 percent to 80 percent.
26 Comments
PhRMA is against this?! Imagine that. They would have more credibility if they dropped the "safety & liability" bs and just said we're losing money on every Rx filled outside the U.S.
1. If the definition of the "practice of pharmacy" is changed by the State Pharmacy Board for the benefit of CanaRx, then who is next? Would anything (such as federal regulations) stop CVS Caremark from moving their Maine pharmacies to one of these countries and forcing policyholders, potentially including Maine federal oversight and enforcement employees, into using the CVS Caremark foreign mail order pharmacy?
2. Supporters of the the new law claim that there have been no safety issues, but how do they know this and how have they verified it?
Also, if CanaRx gets the definition of the practice of pharmacy changed, wouldn't they still need to have a state pharmacy board license as a drug distributor? Does the federal govt have state drug wholesaler and licensure as part of the Prescription Drug Marketing Act or, as part of receipt of federal funds- Medicaid for example?
A good friend of mine is a neuro-radiologist and although busy and occasionally needed at the hospital for complicated cases, many MRIs, CAT scans and x-rays are sent to India, etc for reading on the cheap.
I find it hard to believe that there are not many competent, ethical and quality pharmacies in Canada that offer U.S. citizens a significant cost savings.
Lastly John, wait and see what happens to care for the masses as we slowly convert to a single payer system. You'll wish you could get it by mail.
Interesting perspective.
You ain't seen nothing yet.
You might want to do some homework on average compensation for family practice & pediatricians. Many drug reps have greater annual compensation than these physicians- and that is insane.
According to the Center for Medicare and Medicaid Services, spending for physician services in 2011 was $541B, or $1700 per person. (I underestimate the size of the US population in my previous calculation). That's not all salary, in part because the IRS requires that cash flows above a certain amount be taken out of the business as dividends. It also reflects the inefficiency of individual practices which exist mainly so that each MD can rule as king or queen of her own domain.
The healthcare system you are waging a rearguard action to defend costs twice as much per capita as that of the US and Canada, and delivers a lower median life expectancy, poorer prenatal care and higher childhood mortality that either of the above countries.
And yes, I've heard the argument from physicians a million times before that anything we do to restrict their current earnings or ability to do any damn thing they please will destroy the healthcare system. But you guys have been reined in elsewhere, and the results are far better than we get here.
Despite this, in some cases premiums have continued to increase- up to 34% as of April 1- for some Maine individual policyholders.
In addition, under Maine state health care reform which was passed recently, there is no insurance bureau review of premium rate increase proposals by the state bureau of insurance unless the AVERAGE rate increase is over 9 or 10%.
So, last year, some older Maine individual policyholders above the age of 55 who are more likely to be on drugs such as Plavix or Lipitor saw an average premium increase of over 20%.
According to the recent Express Scripts (and now, Medco) drug trends report, traditional meds prices declined slightly. Specialty is increasing and expected to continue increasing.
The CanaRx FDA Warning Letter and drug list indicate that they do not distribute injectable or infused drugs, so the ability to achieve cost savings is further limited. It also needs to be weighed against the increased logistics costs, and potentially, increased CanaRx associated legal, oversight and enforcement costs.
While I am not an actuary, it seems like it would be difficult to verify current and future CanaRx cost savings.
Most people nowadays choose the narrative first, then exaggerate whatever supports it & ignore whatever goes against it.
I have no argument with salespeople making big bucks. SALESPEOPLE. Pharma reps are not salespeople. After 35 years working with them in every facet of their mission from hiring, training, marketing and medical they are nothing but a marketing parrot with minimal medical knowledge with rare exception. An average high school graduate could do the job with no problem. So they are overpaid relative to many physicians. And by the way, they really bear no true liability for what they say and DON'T KNOW, except possibly getting fired to move to another gig.
Physicians have a high level of responsibility and accountability. To try and equate the two jobs is a pathetic joke.
If you or a family member ever unfortunately have some type of cancer, don't go to an oncologist, go to an Amgen, Bristol Myers or JnJ rep for treatment.
If I were over there I would skip the process altogether, go straight into pharma and buy that house in the English countryside.
I would say the unrealistic and for the most part unearned adoration the public has for the body mechanics we call physicians is a joke, when they spend all of 5-10 min with a patient for a diagnosis. It took three or four physicians (depending on the interpretation of events) before one of them was able to diagnose my wife's 22 cm (that's right, the size of a soccer ball) tumor in her abdomen. It's about time they got their version of Hatch-Waxman
Imagine what national expenditures for car repair would be if we let our mechanics decide what work needed to be done on our cars, paid them by the procedure, and had them send the bill to a third party for reimbursement. I imagine you'd be running into quite a few of them at your country club.
I'm not sure I follow you're cancer gibe. I'll certainly require the services of a surgeon if I develop a solid tumor. Just as you'll need the products of my industry if you develop HCV, a multi-drug resistant bacterial infection, MS, epilepsy, lymphoma, leukemia, HIV, etc. Physicians, researchers, and farmers all play important roles in society. Your role is not as unique as your comment is intended to convey.
Imagine waiting to pick up your car on Friday evening and be told to wait until Monday because the mechanic had to leave early to take his daughter to soccer practice.
I guess you have a computer hook up at home to diagnois problems with your car? Maybe you do listen to a good mechanic if your vehicle has problems.
Fat Old Man - let that "body mechanic" make a mistake and you will no doubt be first in line at the lawyers office. As a cardiologist friend told me one time, you're not paying for 30 minutes, but for 30 years of education, experience and learning.
Thanks, but given a choice, I'd take my chances and the extra $50K that I'll spend on health insurance over the next 10 years.
Besides, you've already agreed to euthanize me if the need ever arises. In fact, you expressed some interest in doing it gratis in the absence of need. Isn't that the type of esprit de corps we need from our medical professionals?
Maybe, just maybe, MDs use their training and experience to a small degree. However, pharma reps are legally ONLY allowed to parrot the PI, something even the worst doctor can do on their smart phone.