Ins, outs of getting meds from overseas

Buying prescription drugs overseas is back on the national agenda. Maine recently allowed residents to buy drugs from pharmacies in Canada, England, New Zealand, and Australia, triggering a lawsuit from the pharmaceutical industry. And a bill introduced last month in Congress would let people buy drugs from countries with safety rules similar to our own.

Prescription drug prices here are generally higher than anywhere else in the world. While it is technically illegal for U.S. citizens to import drugs manufactured here and exported, it is a fact of today's world. There are risks in doing this and ways to minimize them. Here, we talk about both.

Q: How common is buying prescription drugs from overseas?

A: More common than you might think. According to a study of 2011 data by the National Center for Health Statistics (NCHS), about 2 percent of U.S. adults bought prescription drugs from another country that year. This wasn't the most common strategy consumers used to hold down drug costs. About 20 percent asked the doctor for a lower-cost drug, and others used "alternative therapies" involving different drugs from those originally prescribed or did not take the medication as required, skipping or cutting doses.

Q: What's driving this?

A. It's the high cost of prescription drugs coupled with lack of insurance coverage. According to the Commonwealth Fund, a private foundation that works in health care, 46 percent of adults with chronic health problems who were underinsured - those spending 10 percent or more of their income on out-of-pocket health costs - skipped doses or didn't fill prescriptions. Also, the United States is one of the few industrialized nations where the government doesn't negotiate with the pharmaceutical industry to keep down drug prices.

Albert Wertheimer, a professor at the Temple University School of Pharmacy, says that "employers want to pay less for health care, so they put more on the patient side."

David Becker, a Flourtown cardiologist, says that copays for patients using the same drug can vary wildly, depending on what plan they have. When patients ask him to give them a written prescription rather than sending the scripts electronically to a pharmacy, he says he assumes they're buying overseas from a reputable pharmacy, and "I have no problem with that." What concerns him more, he says, are the patients who come to him and say they've been neglecting their medications for months.

While cardiologists usually have a wide range of generic drug choices, Becker says, cancer patients face more serious problems. A recent study in the Journal of Clinical Oncology showed that 38 percent of patients receiving chemotherapy for colorectal cancer were suffering from "severe financial hardship."

Q: Isn't buying drugs overseas on the Internet illegal and dangerous?

A: Illegal? Technically, yes. Dangerous? That depends on whom you ask.

Unless you live in a state bordering Canada or Mexico, buying drugs overseas usually means buying over the Internet, and Temple's Wertheimer says, "I tell everyone not to use a Web-based pharmacy. It could be in Botswana or Zimbabwe, you have no idea. It could be counterfeit, substandard, or have failed batch tests." But not all websites selling cut-rate pharmaceuticals are equal. We'll get to that.

While the FDA sometimes confiscates drugs sent from overseas, its policy has been not to prosecute individuals who buy small quantities this way for their own use. It's rather like Pennsylvania residents going to New Jersey or Delaware to buy liquor, although, of course, you have to do that in person. But there is some danger of seizure of the shipments.

The FDA did act in June against websites selling "potentially dangerous, unapproved prescription medicines," working with the Department of Justice to shut down U.S. operations of 1,677 websites, some of which used web addresses similar to those of major U.S. chains.

Q: If I want to buy online from overseas, what's the best and safest way?

A: Probably to go through a site that is vetted by a consumer organization, such as pharmacychecker.com, based in Westchester County, N.Y., or the Canadian International Pharmacy Association, www.cipa.com., based in Winnipeg.

Gabriel Levitt, vice president of Pharmacychecker.com, says his group verifies that the websites are owned and operated by licensed pharmacies, require prescriptions, and have real physical addresses. Most are in Canada, Great Britain, India, or Turkey.

Tim Smith, general manager of the international pharmacy association, says his 11 members have similar requirements and also ask patients to provide profiles detailing all drugs they are taking so the pharmacist can be alert to possible interactions. He says more than a million U.S. citizens a year buy from member pharmacies, mostly maintenance drugs such as Nexium, Crestor, and Celebrex, "and that's been pretty steady."

Since deliveries can take three or four weeks, Smith cautions against buying a drug overseas if your physician may be considering adjusting the dose, because "we can't respond to that."

Q: If I go that way, how much can I save?

A: A pharmacychecker.com survey found that brand-name drugs manufactured in the United States but purchased overseas on the Internet were about 75 percent cheaper.

Examples:

Cymbalta, used for depression and sometimes for osteoarthritis or musculoskeletal pain, was available in 60mg strength for $116 for 90 pills; it was $879 in a New York City Rite Aid.

Crestor, a cholesterol-lowering medication, was available in 40mg strength at $140 for 90 pills; it was $680 at that Rite Aid.

Tarceva, an anticancer drug, was available in 100mg strength at $1,949 for 30 pills; it was $6,531 at that New York City store.

Q: If I don't want to buy overseas, what are some online domestic options?

A: The National Association of Boards of Pharmacy website www.nabp.net, lists 34 approved online pharmacy sites. Major drug chains may also offer online discounts, particularly if you are buying larger quantities, such as a three-month supply.

Q: What are some other options?

A: The industry-funded Partnership for Prescription Assistance (www.pparx.org, 1-888-477-2669) offers a single access point to more than 475 public and private patient assistance programs. Individual drug companies also have patient-assistance programs for patients with no or insufficient insurance. Try their individual websites.

Q: Can my physician help?

A: Not unless you ask. They might be more comfortable with a brand-name drug than a generic, but not if it's unaffordable.

And Keerthi Gogineni, a hematologist at the University of Pennsylvania's Abramson Cancer Center, says that physicians should also be more sensitive to drug-cost issues even if patients don't raise them. For example, she says that a physician treating a cancer patient might not realize he or she is on multiple medications for unrelated conditions.

But Gogineni and colleagues said in a paper released in June that the prices of some cancer drugs were soaring because drug companies were deemphasizing production of cheaper generics for economic reasons.