Summary: Buying medications by mail from Canada? You’re not alone. A friend from California explained how she started out on this path, and why she thinks this will save a lot of money — although, strictly speaking, the Food and Drug Administration considers the practice illegal, and has reportedly intercepted some shipments of medications from other countries.
My friend explained that this journey began when one of her kids was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The doctor treating him prescribed a common medication, Concerta, which her kid took for a couple of months.
But significant side effects set in: blurry vision and dizziness, which impaired her son’s everyday life. They went back to the doctor, who recommended a lower dose. Cutting the dose didn’t remove the side effects, however; by this time, a psychiatrist who was treating the child recommended that he be taken off Concerta and put on Strattera, at an 18-mg dose, she said.
The family is insured by Kaiser, so the prescription went to a Kaiser pharmacy, she said. “Then I got a call from them saying ‘we want to check — given the plan you have, this prescription for 100 pills was ringing up at $999.’
“I said ‘no, we can’t do that,’ ” she said.
Asking questions and choosing a different path
What followed was a back-and-forth between the psychiatrist and the pharmacist about the price. Strattera is not on the Kaiser formulary, she said, so the price is the cash or out-of-pocket price. (The family deductible on their Kaiser silver level HMO is $3,000, and individual out-of-pocket limit is $6,350, while the family out-of-pocket is $12,700.)
Because the recommended medication was going to cost about $10 a pill, she said, “We looked if there were any other medications on the formulary that would serve the same function. But there weren’t any: we knew we had to get him off anything in that family, but they were all in that family.”
Knowing that some people order medications from Canada, she did some research. Eli Lilly makes Strattera, and in the United States, only the brand name is available. Another company had produced a generic, but Eli Lilly’s patent was upheld in court — though that clued her to the fact that there is a generic.
“So I looked into pharmacies in Canada,” she said. “They had a much cheaper price for the brand name. And they had a generic that was cheaper still” at the site she found, Canada Drugs.
For 84 capsules of the brand name, the cost is $418.56 or $4.98 a capsule.
For a 90-pill prescription at 18 mg, she said, it was $127.89 for the generic, or $1.42 a capsule.
“My first thought was is this legitimate, are we buying the same drugs we would get in the US?”
Is this legal? Is it common?
On the FDA website, the FDA says it’s not legal. But people do this all the time; this New York Times article says: “In surveys from 2011 by the Centers for Disease Control and Prevention, about 2 percent of adults and about 5 percent of the uninsured said they had bought prescription drugs from other countries. The figures most likely underestimated the practice because people may be reluctant to admit to doing something illegal, even though the law is rarely enforced in such cases.”
“I contacted the psychiatrist at Kaiser,” my friend said. “I didn’t know if it was even legal for her to write me a prescription to get something from Canada. For all I know she would have said ‘we can’t do this, I’m sorry.’
“But she was incredibly willing to work with us she was super-impressed with the information I had collected. I asked her to look at the web site, see if it was the same drug. She was completely satisfied.”
She found Canada Drugs, she said, by “Googling around.” They are accredited by several organizations, listed on the page. “I won’t say I spent a lot of time looking into them,” she said. “Between that and having my doctor’s stamp of approval, I said ‘let’s give it a try.’ “
They’ve received just one order, she said, via the United States Postal Service. Unless you pay an expediting fee, it takes a month for an order to reach you, but there is no shipping charge for regular mail. She signed up for $30 expedited shipping, and that means it comes within a week.
“I’ve been happy enough that we’ve started to order other drugs,” she said. Her husband is asthmatic, and he uses Advair. At Kaiser, they would pay $330 for a 60-day supply of medication; at Canada Drugs it’s less than half that, she said.
Who’s ordering from Canada? And who wants this to stop?
The question of ordering prescriptions from Canada and elsewhere is not a new one. The Canada Drugs site is supporting the campaign below to allow imports of medications; U.S. parties like the FDA, the National Association of Boards of Pharmacy and others oppose this. (Of course, they would lose money if people began buying medication in volume by mail.)
The question of who’s credentialing online providers is a complicated one. I wrote a blog post talking about some of the issues, which you can read here. Generally, the entities who want to be in charge of making these decisions seem to have conflicts based on money or industry ties, so it’s hard to do your homework. Of course Canada Drug wants you to be able to buy from them, and of course the U.S. pharmacists don’t want to allow that.
Oh, and back to my California friend: This is not the first time she’s paid cash to save money instead of using her insurance. Last year, one member of her family needed an MRI, and the charge under their then insurance would have been $860. That was a PPO, not Kaiser, and they had not met their deductible, which my friend pointed out to the woman at the front desk.
“I remember thinking this is awful, how do people pay who don’t have insurance,” my friend said. “I asked her, and she said they’d pay $500.
“And she saw me thinking and said, ‘I can give you that price too.'”