Citing ethical, safety, and supply concerns, Canadian health officials have begun to draft a proposal that would ban the export of prescription drugs into the United States by retail sales through the Internet and the mail.
According to David MacKay, executive director of the Canadian International Pharmacy Association, in a statement to the Associated Press released on January 6, “Exporting mail-order drugs from Canada is about to become illegal in Canada.”
Canadian Health Minister Ujjal Dosanjh, in a December interview on Canadian television, stated, “I want to make sure that we don’t have 250 million Americans buying drugs in Canada.” In an earlier speech to a Harvard University audience, Dosanjh said, “Canada cannot be the drugstore for the United States.”
Dosanjh said he might pass new regulations forbidding Canadian physicians to co-sign or originate prescriptions for U.S. residents whom they have not personally examined. That rule, said MacKay, might “prevent non-Canadian citizens from acquiring Canadian medications unless they physically come to Canada and get examined by a Canadian physician.”
Existing Canadian law requires that all prescriptions filled in Canada be signed by Canadian physicians. Under current practice, a prescription from a U.S. doctor is faxed to a Canadian doctor who reviews the patient’s health history. The Canadian doctor then signs and faxes the prescription to a so-called Internet pharmacy, which ships the drug.
New regulations would also ban the export of certain drugs widely used by Canadians.
Reimportation Called Unethical
Ken Polk, spokesperson for Dosanjh, confirmed to the Boston Globe on January 5 that Canadian health officials might prohibit pharmacies in Canada from filling prescriptions for U.S. residents unless patients are present, and the authorities may establish a list of prescriptions on which the Canadian government could restrict sales in the event of a shortage.
According to a January 5 Associated Press report, Polk commented, “Dosanjh has made it pretty clear that he wants that unethical practice [of reimportation] to stop.” While Polk says Canadian health officials don’t necessarily want to ban Internet pharmacies, they have an overriding responsibility to assure an adequate supply of drugs for Canada’s citizens.
News reports from the Canadian media indicate health officials there were likely to present the Dosanjh proposal to the cabinet by January 31. In order to pass such legislation, the proposal would require support from opposition parties and the minority government of Canadian Prime Minister Paul Martin (Liberal Party). Revisions to current regulations would not require such political support.
Laws Not Enforced
The issue is a prickly pear for President George W. Bush.
Bush administration officials have argued against importing U.S.-made drugs from Canada, claiming the practice puts American consumers at risk. The federal Department of Health and Human Services and the Food and Drug Administration consistently say they cannot guarantee the purity and safety of imported pharmaceuticals.
Four presidential administrations before Bush also refused to sign off on importation. Yet advocates of importation accuse Bush of having put pressure on Martin when the president visited Canada last fall. In a televised news conference, White House Press Secretary Scott McClellan said, “Any assertion that we made a request of Canada is nonsense.”
Importing drugs is prohibited by federal law in the United States, but the laws are not strictly enforced. Ten million illegal shipments of prescription drugs entered the United States in 2003, half of them from Canada. FDA sting operations have found the other half to be from China, Indonesia, Iran, Japan, Lebanon, Mexico, Pakistan, Syria, and some unidentifiable sources.
Supply Is Insufficient
Banning Canadian imports is likely to have broad implications for state-based Internet buying plans tied into the Illinois I-SaveRx Web site established last year by Governor Rod Blagojevich (D).
Polk noted Dosanjh is displeased by efforts like the one spearheaded by Blagojevich to organize the purchase of drugs from Canada.
Canada has a population of 33 million–not much larger than the combined population of Illinois, Kansas, Missouri, and Wisconsin, the states currently participating in I-SaveRx.
The Chicago Tribune reported on January 6 that U.S. supporters of importation fear a decision by the Canadian government has already been made but not formalized. They warned that U.S. citizens wanting to continue buying drugs from Canada might have to show up in person at pharmacies across the border rather than ordering online, by mail, or through local storefront operations.
Prices Are Rising
PharmacyChecker.com, a Web site that tracks Internet pharmacy prices, issued a report on January 4 showing savings through reimportation were less for brand-name drugs by the end of 2004 than they were in 2003. The average savings dropped to 29 percent from 38 percent at the beginning of 2003, according to the study. A Health and Human Services task force on drug importation also recently confirmed the savings are not what they used to be and don’t justify the safety risk. (See “HHS and Commerce Dept. Reports Oppose Drug Importation,” page 5.)
The rise of drug importation into the United States has Americans and Canadians competing for the same limited supply of drugs.
Robert Goldberg, director of the Manhattan Institute’s Center for Medical Progress, writing in National Review Online on December 23, 2004, pointed out, “Importation proponents want us to believe that somehow the laws of supply and demand don’t apply to prescription drugs. Do they really believe that private companies can provide all the drugs we want, now and in the future, at half the price they do right now? That’s a market miracle I would like to see.”
The Wall Street Journal noted in a January 5 editorial, “Now that drug importation is turning out to be a politically inspired mirage, maybe we can concentrate on finding real solutions that work.”
Conrad F. Meier ([email protected]) is senior fellow in health policy at The Heartland Institute and editor emeritus of Health Care News.