(This commentary was submitted by the same organization that purchased the advertisement on page 9 of the October 2003 Allegro.)

Some Local 802 members work enough union jobs to get on the union’s health plan. But for those who don’t have prescription drug coverage, the option to buy drugs from Canada – at a substantial savings off U.S. retail prices – warrants a closer look.

In light of a recent House bill (H.R. 2427) that was passed allowing the reimportation of U.S. manufactured prescription drugs from Canada, and the controversy surrounding the risk and safety to American consumers, it’s become critical to help Americans make an informed decision.

The recent proliferation of Canadian mail order pharmacies offering significantly lower prices for brand-name prescriptions is due to the fact that the Patented Medications Price Review Board (a Canadian governmental agency) maintains strict price controls on drugs.

Add that to the favorable exchange rate and Americans can realize a savings of between 30 to 80 percent on their medications.

For instance, 100 tabs (10 mg each) of Prozac can cost $361.28 in the U.S.; the same amount can cost $115.93 in Canada.

Similarly, 60 tabs (10 mg each) of Tamoxifen can cost $142.44 in the U.S., which can be as cheap as $7.05 in Canada. (These figures are from the United Health Alliance and are expressed in U.S. currency.)

Today, there are an estimated two million Americans purchasing their prescriptions from Canadian mail order pharmacies.

At issue is whether this practice is legal and safe. Understandably, the FDA is concerned with the lack of oversight in cross-border drug sales. Although the drugs may be manufactured in the U.S. under the authority of the FDA, once they are exported to another country, they no longer fall under the FDA’s watchful eye.

In Canada, drugs are regulated by Health Canada, the equivalent of the FDA. The Canadian health ministry states that all imported drugs must be equally safe and effective whether they are for use by Canadians or for export.

The FDA has not identified any cases in the U.S. where individuals getting their medications from Canada have been harmed. In practice, the FDA and U.S. Customs have chosen not to enforce restrictions on individual consumers who import their prescriptions for “personal use.” Although the FDA says it reserves the right to go after individuals, it also states that their highest enforcement priority would not be actions against individual consumers.

Of course, the issue of patient safety is paramount. More importantly for consumers is how to distinguish quality providers from unscrupulous ones. Considering the risk involved in purchasing drugs over the Internet, your research here is critical.

Here are some suggested guidelines for utilizing a mail order pharmacy via the Internet:

• The pharmacy should require you to complete a medical questionnaire signed by your physician and obtain an annual exam from your personal doctor. Beware of pharmacies that say you don’t need your personal physician involved nor a valid prescription.
• Check to see if the pharmacy has been accredited by a U.S. body such as the Internet and Mail-Order Accreditation Commission (IMPAC) or the Verified Internet Pharmacy Provider (VIPPS). The consumer should be able to identify what the standards are that have been met under the accreditation. Confirmation should be available that a site visit to the mail order pharmacy was completed as part of the accreditation process.
• The pharmacy should require a written prescription from the patient’s doctor and a listing of all medications that the individual is currently taking, including over-the-counter and herbal medicine.
• The pharmacy must show evidence of licensing, certification and credentials of professionals and any accreditation on their Web site.
• A physical location for the pharmacy should be listed with all contact information.
• The patient or their physician should be able to get in touch directly with the staff pharmacist or physician.
• There should be a dedicated customer service department available to answer your questions and track your orders.
• All prescriptions must be provided in the manufacturer’s original sealed container.
• The pharmacy should provide clearly stated privacy and security policies to protect the patient’s personal information.

If the mail order pharmacy you are considering doesn’t address the items listed here at a minimum, find one that does.

A prudent consumer should take the extra precautions when accessing medications via the Web. Lower pricing can be achieved without sacrificing quality and safety. Remember, the Internet is only a marketing tool.

Dr. Elizabeth Wennar is a principal with HealthInova, a consulting firm specializing in health resources management and acquisition and development for health systems and provider organizations.