According to a study published in the Journal of the American Medical Association (JAMA), 1.5% of adults in the U.S. who take prescription drugs purchase them from outside the U.S. to save money each year. That’s about 2.3 million people. In 2016, my review of a similar set of data estimated about four million per year. The Kaiser Family Foundation’s 2016 poll data was used to support an estimate showing that 19 million people, 8% of the adult population, have imported lower cost prescription drugs for personal use. What’s going on?
The JAMA study authors used 2015-2017 government data from the U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey (NHIS), which collected an assortment of health information from 61,238 individuals. As explained in the JAMA study:
“Survey respondents were asked whether they bought prescription drugs from a country other than the US to save money during the past 12 months. We defined respondents as purchasers of medications outside the US if they answered yes to the question.”
Past estimates, including my own, have also used NHIS data but may have extrapolated incorrectly. The percentages should be applied not to the general adult population but to those who take prescription drugs. The adult population is about 256 million. In this study, the sample population of 61,238 represented 152.2 million people who take prescription drugs. The JAMA study found that 1.5% purchased medications outside the U.S. to save money, which comes out to about 2.3 million. My past estimates looked at 1.6%, which was an earlier NHIS estimate of adults who import, of 256 million people, which came out to a little over 4 million people.
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Canada is a good option for Americans seeking to access their medications at a lower cost through personal drug importation, but even I agree with the pharmaceutical industry when they say that wholesale drug importation on a large scale is not workable with Canada. Why? Simply because Canada is too small a nation to supply the U.S. market. I have written that there is much more promise if importation is expanded to the European Union. We already rely on the EU to assess U.S. drug safety, and current events have only brought that into greater focus.
Due to the world’s efforts to quell Covid-19, Regulatory Focus reported on increased cooperation between the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). These drug regulators have engaged in regular consultations since 2003 in order to share insights and best practices. In 2014, that same cooperation led to the creation of Mutual Recognition Agreements (MRA). Due to an MRA between the FDA and EMA, the U.S. can rely on EU inspections of drug manufacturing establishments in any EU country. That means we have a lot of faith in EU pharmaceutical safety standards.
The World Health Organization is really on my mind. Last week, I noted my overall support for the WHO but pointed to weaknesses in its approach to research and studies about online pharmacies. Then, two days later, I read The New York Times Editorial Board’s take in an article called Don’t Leave the W.H.O. Strengthen It, and I just have to recommend you read it.
President Trump has stated that we will withdraw from the WHO, stating things about the organization that are not true – but also making legitimate criticisms. Do we quit the Department of Health and Human Services or the U.S. Food and Drug Administration because of their many failures? I mean on the political fringes of U.S. politics, anarchists and free market fanatics, you might find some support for quitting the federal government! But no, we need those government entities to protect and improve our health as a nation. There are many areas of public health, however, that we can’t deal with effectively alone as one country, and that’s where the WHO is really needed. Say, for things like… um, er, let me think… global pandemics.
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Generally, I strongly support the World Health Organization (WHO) and its unambiguously important work to save lives through its public health efforts. The backlash against it in the U.S. is simultaneously misguided and politically motivated. I know why. It detracts from our failures in the U.S. to save lives, but there is more to the story. Republicans generally have a greater hostility to international organizations because they view them as tying our hands and/or taking our money to help people in poorer countries. The argument is that U.S. foreign policy must be about U.S. national interests not some idealistic notion of global cooperation.
But here’s the thing. The WHO plays critical roles in polio eradication, vaccines for preventable diseases, providing essential healthcare services, public health surveillance, emergency operations, and, yes, preventing and controlling outbreaks. Here’s a great fact-check document about WHO, specifically its efforts to bring the world together to combat Covid-19. Those efforts do protect and promote our national interests by bringing greater global political stability.
Using very similar talking points to Big Pharma-funded experts, in its quest to “educate” the public about the dangers of internet pharmacies and personal medicine imports, the National Association of Boards of Pharmacy (NABP) appears to have ignored the greatest pharmacy-related public health travesty happening right under its nose. Since the beginning of this century, billions of prescription opioid pills were wrongly, and in many cases unlawfully, pushed on and distributed to Americans. The result is about 500,000 deaths since 1999. The main culprits in sowing this drug epidemic are usually identified as big pharmaceutical companies and distributors.
Citing the case of the Rochester Drug Cooperative, I have asked before where the NABP was in tackling this opioid crisis. I was mostly referring to its quasi-regulatory role in certifying wholesale pharmacies through its Verified-Accredited Wholesale Distributors (VAWD) program because all major distributors accredited through VAWD – AmerisourceBergen, McKesson, and Cardinal Health – have been implicated in the opioid epidemic. As reported in the New York Times last week, a new court filing provides details showing how major U.S. pharmacy retail giants – including Walgreens, CVS, Rite Aid, and Walmart – were “as complicit in perpetuating the crisis as the manufacturers and distributors of the addictive drugs.”
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Americans without health insurance are four times more likely to buy a prescription drug from another country due to cost. That’s from an analysis by the U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, published in 2015. Not surprisingly, more comprehensive health insurance generally leads to greater prescription adherence, meaning people properly taking prescription medication. Due to the coronavirus pandemic, and a very uncertain healthcare system response in the U.S., 27 million Americans stand to lose their health insurance, according to a new survey and analysis by the Kaiser Family Foundation. More than I have ever meant it in the history of this blog, safe personal importation of prescription drugs can and should be a lifeline for Americans.
Further to the above, I implore those in government and the pharma-funded organizations who have say over this matter to take the requisite actions to make sure Americans have security in their access to more affordable medicines available online at international pharmacies. Last month, incredibly, the FDA was increasing personal drug import seizures, medicines that Americans had ordered because the prices are too high domestically.
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