O Canada, We Stand on Guard for Thee. O Canada, Why Can't I Get Lipitor for Cheap?

Skyrocketing prescription drug prices in the U.S. have fueled interest among many American consumers in importing prescription drugs from Canada, where prices are much lower. Over the past several years, U.S. citizens have been heading to Canada to buy cheaper prescription drugs and they are crossing the border in person, by telephone, by fax, and by modem, in numbers estimated at a million or more, aided by a growing number of Internet middlemen. Although the market share represented by these purchases is still small, an estimated $500 million to $1 billion over the past year, in contrast to the $156.5 billion spent in retail pharmacies, it is likely to grow quickly. This is due to the many Americans who are paying too much for their prescription drugs or who can't afford to buy them at all. Yet does the idea of saving money outweigh the potential risk? Consumer safety trumps consumer choice in this case. Because "let the buyer beware" doesn't work when dealing with prescription drugs. Even an expert can't distinguish a safe and effective pill from a counterfeit pill or a substitute, contaminated, or an expired pill. And once they have entered the country, tracking and removing these would be extremely costly. Cheap imports mean drug companies are going to have to cut their prices which means they're going to have less money to put into research and development. That would dry up the funds that make a very innovative, productive industry possible. The result would be lost jobs and fewer new lifesaving drugs. Importation also means importing Canada's price controls. Throughout history governments have tried to put price controls on various products. It has never worked. It's led to distortions, evasions, black markets, waste, and inefficiency. The same thing will happen if there are price controls on drugs. Drug importation would also be the first step toward greater government control over the prescription drug industry. Right now the government exercises massive control and interference in other parts of the health care system. The drug industry is probably the freest part of the health care industry. Importation would be the first step toward bringing the drug industry into the same kind of restrictions, regulations, and price controls that have made a mess out of the rest of the health industry. Importation is not a long-term solution and companies will simply export fewer drugs to Canada. Since Canada's market is very tiny compared to the U.S. market and since it imports most of the drugs it needs for its own residents, within a year or two the price differential would disappear, much to the disadvantage of Canadians, and we will have gained very little. To summarize, the importation of prescription drugs from Canada is a threat to the American public are as follows; these drugs may or may not be completely safe and this chance is a way to big to be playing with people's lives, it creates a threat to research and development of new drugs, it may introduce Canadian price controls over drugs and would bring about a more government control of drugs since regulations and laws would have to be in place, and finally just the idea of importing drugs from another country to help the crisis that is our health care system is in no way a solution but just another potentially huge problem that would pose liability and feasibility issues.

Drug standards and regulations vary from country to country. The U.S Food and Drug Administration (FDA) are responsible only for drugs marketed and sold inside the United States. The FDA's closed distribution system allows them to maintain high standards for the manufacturing and distribution of drugs. Once consumers go outside that system, by either physically crossing the border to purchase drugs in another country or by using Internet pharmacies which are set up to serve as foreign store fronts, the FDA warns there may be potential health risks. The FDA has several concerns about imported drugs including: quality assurance concerns, counterfeit potential, presence of untested substances, the risk of unsupervised use, labeling and language issues, and lack of information. The NABP (National Association of Boards of Pharmacy) released their Position Paper on the "Importation of Foreign Prescription Drugs" which detailed the scope of the problem based on FDA/U.S. Customs Service Studies:

...The potential for harm exists even with medications obtained from Canada. Canadian drugs, like all foreign drugs, are outside the realm of the US Food and Drug Administration (FDA) approval process and oversight systems, including those manufactured here in the US and exported. FDA officials maintain that once these products leave the US and control of the manufacturer, there is no way to verify where they have been, the conditions under which they have been stored, and whether or not they have been tampered with or contaminated. In light of threatened terrorist attacks, the risk of tampering seems to be one of great significance... (National Association of Boards of Pharmacy, 3)

The NABP concluded that once patients and consumers go outside the U.S. regulatory system, they become vulnerable and put themselves at risk. To say the least, it's a case of "buyer beware". However, awareness cannot even protect against the hidden danger of possibly receiving expired drugs, contaminated pills, sub potent or super potent strengths, or even counterfeit drugs. Supporters of importing drugs from Canada argue that Health Canada, the Canadian version of the FDA, has health and safety standards similar to those in the United States. However, the FDA, which has the responsibilty and experitse, could not conclude that imported drugs would be safe. While importation supporters focus on the lack of evidence that importation has contributed to the deaths of American consumers, there are important risks that must be addressed. There is a growing trend of seniors traveling over the border to Canada in order to purchase prescription medications from authentic Canadian pharmacies which indeed may carry the same medications sold in the U.S. However, the bulk of American seniors do not have the option of traveling to Canada in person to purchase prescription drugs. This has led to the use of Canadian internet pharmacy sites. Seniors who may not be computer savvy have children and grandchildren to assist them in utillizing these internet sites. There are many challenges to ensuring that prescription drugs purchased over the internet from allegedly Canadian sources are indeed safe. A patient loses the safeguards of receiving a prescription for an FDA-approved drug from a licensed doctor and having that prescription filled from a licensed pharmacist. Some Canadian pharmacy websites advertise that they sell FDA-approved drugs or that they are FDA-approved pharmacies:

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