Drug prices got you down? Try Canada

By Arthur Vidro

Last year my breathing medicine skyrocketed in price. It didn’t skyrocket for everyone. It depends on your health insurance. If you’re in a generous plan, great. If not, then like me, you’ll sometimes feel financial pain.

I’m insured through the Affordable Care Act. Each year you choose a new plan. It’s up to the consumer to put in the time and legwork to figure out one’s needs and determine what each plan covers. Though figuring that out is tricky, I did my due diligence in late 2017 and carefully chose a plan that covered my anticipated needs for 2018. If during the year your needs change, you’re out of luck. My needs didn’t change, but I was out of luck anyway.

For the first several months of the year, I was paying $30 on my copay for a month’s supply of Qvar, an oral inhaler manufactured by Teva. There is no generic version available in the U.S.

When June rolled around, I learned at the pharmacy that the manufacturer had stopped making the product and had replaced it with a purportedly different kind of Qvar—billed as new and improved, naturally. When I looked into it, I realized there was nothing new about the medication itself. The only newness lay in the inhalation mechanism. But that presented a chance for the manufacturer to call it a new product and possibly to jack up the price.

My insurance plan covered the old Qvar that was no longer on the market, but it did not cover this “new and improved” version. So, starting in June, my monthly co-pay for Qvar rose to $247.

That was the price for people without insurance, and it was the price for people like me who had insurance but whose insurance did not cover the medicine.

But fear not. My insurance company told me if I could get written verification that I needed this drug from my prescribing doctor, then they would cover it.

So I jumped through hoops. I got the written information from my doctor, and the pharmacy was kind enough to relay the information electronically to Anthem. I quickly received a letter from Anthem saying, “We have approved coverage for your request.”

But that letter was misleading. I did not have coverage. At best, I had fractional coverage.

Because when I ran over to the pharmacy, I learned that the insurance company would now happily pay $15.51 while requiring me to pay $231.49. That’s right. Even with so-called coverage obtained from jumping through hoops, I would now be responsible for 93.7 percent of the full payment. That was out of my budget, so I didn’t pay. I looked for alternatives.

Could the pharmacy somehow come up with the old, non-improved version of Qvar? No, it was off the market.

Could the manufacturer sell it to me direct? After all, there must be a surplus stock of it somewhere. Nope, not allowed.

I wondered if perhaps I didn’t really need the medicine. So I went without it—and quickly developed ever-progressing bronchitis. During the summer of bronchial suffering, I thought deeper about alternatives. And then I remembered Mrs. Ashley, who lived around the block from us when I was growing up.

I recalled a cool summer evening in my younger days where my family was on the street having a talk with the Ashleys, who were out for a stroll. During that conversation, Mrs. Ashley explained about her need for a medicine that was extremely expensive, so much so that she was now buying it at a much more affordable price, via mail from Canada. Another alternative!

I visited my doctor, who prescribed a dose of steroids to remedy the bronchitis and a prescription for a different inhaler to tide me over until the purchase could be made from Canada. She tried to dissuade me from buying from Canada, and I understood her reasons, but I’m the patient, it’s my health, and I decided to overrule the doctor’s suggestion. I phoned Canada and set up an account.

My pharmacy helped greatly by forwarding to Canada my Qvar prescription that was languishing on file.

How much did I save by ordering from Canada? The Qvar costs me $30 a month. No insurance needed. That’s the same Qvar, manufactured by the same Teva, that’s fetching $247 in the U.S.

It makes you wonder: If the drug is sold in other countries at $30, surely the manufacturer is earning a sufficient profit by selling it at that price. Which points out the ridiculousness of the American health care system when it comes to drug pricing.

Oh, and although there is no generic version of Qvar available to pharmacies in the U.S., the generic version is available through Canada. The batch I got worked fine and cost even less than $30.

The illogic of drug pricing is enough to drive one batty.

 

Canada cannot be America's pharmacy

By Peter J. Pitts

Drug importation is no longer a pipe dream. Now it's a pipe bomb.

The Department of Health and Human Services (HHS) recently floated a proposal dubbed the "Safe Importation Action Plan" to allow Americans to use Canada as their personal pharmacy.

The Food and Drug Administration (FDA) has stated over and over that our government cannot vouch for the safety and efficacy of Canadian medicines. Pushing this policy through would needlessly threaten patient health and well-being. And, it's infeasible: Canada simply doesn't have enough drugs to share with the U.S.

The action plan offers two paths forward for drug importation. First, states, wholesalers or pharmacists could submit plans for demonstration projects for HHS to review outlining how they would import Health-Canada approved drugs. Second, manufacturers could import versions of existing FDA- approved drugs into the U.S.

The plan sounds reasonable enough, but neither the Trump administration or any state that's been pondering drug importation has ever consulted the Canadian government. Had they done so, they'd see that our neighbors to the north have some serious concerns with the proposal.

Canadian officials have already stated that "Canada does not support actions that could adversely affect the supply of prescription drugs in Canada and potentially raise costs of prescription drugs for Canadians."

These concerns are justified.

Canada is just 1/10 the size of the U.S. with a mere 37 million people. Given the sheer magnitude of the U.S. population—a whopping 329 million people—there's no way Canada could cover drugs for all Americans.

The strain on the Canadian medicine supply would likely lead to shortages and increased costs for Canadian patients. If Canada filled 10 percent of U.S. prescriptions, Canada's drug supply would run out in less than eight months, according to one study.

Even if Canada had an endless supply of treatments, drug importation is dangerous. Though the Trump administration's new plan states that the drugs would be verified before importation, the Canadian government has stated that it cannot guarantee a drug's effectiveness.

Counterfeit drugs are very common in foreign markets. One out of 10 medications is fake, according to a 2017 report by the World Health Organization. From April 2016 to March 2017 alone, Health Canada seized close to 5,500 packages of counterfeit drugs.

Some counterfeits have few, if any, active ingredients. Patients who purchase these medications may not realize they're taking ineffective drugs until their health condition fails to improve. Other counterfeit drugs are composed of potentially deadly substances, such as paint thinner, antifreeze, arsenic and uranium.

Access to high-quality medicines is a crucial issue, but drug importation is not the answer. The Trump administration's drug importation plan would create more problems than it would solve by jeopardizing Canada's drug supply and exposing Americans to deadly counterfeits.