[Ip-health] When medication prices are unaffordable, patients travel abroad for a better deal

Gabriel Levitt gabriel.levitt at gmail.com
Fri Jul 27 08:16:54 PDT 2018


Every three months, Jon Yeagley sets out from his Berwyn home at 5:30 a.m.
for the six-hour journey to Canada.

He crosses the border at Buffalo, stops at a Walmart a couple miles into
Canada, and turns around 30 minutes later with a small paper bag on the
seat next to him.

He’s home by bedtime and can sleep easier, knowing his 20-year-old son has
a medication that is helping restore the hair and the confidence the young
man lost after being diagnosed with the skin condition alopecia areata as a

The drug, Xeljanz, would cost the family almost $50,000 a year at home, in
part because it isn’t covered by their insurance plan. In Canada, a year’s
supply costs $15,000.

As drug prices soar and patients with high-deductible health plans must lay
out more cash, this kind of medication tourism is enticing.

Importing prescription medication is prohibited by the U.S. Food and Drug
Administration, but the rules are not enforced for individuals buying small
amounts of drugs for personal use. In a 2016 survey of 1,202 adults by
Kaiser Family Foundation, 8 percent of people said they or someone in their
household had traveled to another country for medications or used an
international online pharmacy to skirt exorbitant U.S. prices.

“The reason so many people feel compelled to engage in personal importation
is because the prices of many of these drugs are unsustainable — and
unaffordable for many patients,” said Rachel Sachs, an associate professor
of law at Washington University in St. Louis, who specializes in drug

For a while, the Yeagleys bought Xeljanz in the U.S. Though the drug is FDA
approved for rheumatoid arthritis, it was prescribed to Yeagley’s son,
Jonathan, by a Yale University-affiliated doctor who has published medical
research about its effectiveness in stimulating hair growth. But when the
cost became too burdensome, (a year’s supply cost closer to $37,000 in
2016, when Jonathan started taking the medication) Yeagley arranged a video
consultation with a Canadian doctor, who wrote a prescription that could be
filled at a pharmacy minutes from the border.

He was nervous the first time he faced the security checkpoint, and he
considered claiming he was sightseeing.

“The pharmacist said, ‘Just tell them what you’re doing.’ I’ve done that
every time since,” Yeagley said.

The family uses a $15,000 rebate card from Xeljanz maker Pfizer to pay for
three months of the medication in the U.S. To cover the rest of the year,
Yeagley makes three trips to Canada, each time spending about $3,700 for a
three-month supply.

The FDA has not enforced rules banning such purchases in part because it’s
too hard to keep track of it all, experts say, especially as the number of
online pharmacies has grown.

The FDA estimates that just under 22,000 FDA-regulated products, primarily
drugs, were intercepted at international mail facilities in the past nine
months. That’s up 62 percent from about 13,500 such packages blocked in the
prior 12 months.

The FDA does not prosecute Americans who order medications from foreign
pharmacies, but when packages are intercepted, will return them to the
sender or destroy them.

“There’s no way for the FDA or any federal agency to truly know the scope
of the problem,” said Jeremy Kahn, a spokesman for the FDA, in an email.
The agency staffs international mail facilities (IMFs) to provide a
“front-line defense against illegal, illicit, unapproved, counterfeit and
potentially dangerous drugs entering the U.S.,” he said. “However, the
sheer volume of drugs that are being shipped through the IMFs far exceeds
our interdiction capabilities.”

The FDA recommends sticking with American pharmacies because the agency
can’t vouch for the safety or efficacy of foreign medications it has not

Even medications that have FDA approval shouldn’t be bought from foreign
countries, the agency says, because they may have been manufactured in a
facility that’s not inspected by the FDA. So consumers are putting their
trust in the regulatory authority of another country.

But as prices in the U.S. continue to rise, widening the chasm between
prices in Canada and Europe, patients are willing to overlook such cautions.

“As long as the drug price discrepancies between the U.S., Canada and other
countries remain as high as they are, people will do what they need to do
to afford medicine that helps them stay healthy — or even to live,” said
Gabriel Levitt, president of PharmacyChecker.com, a website that vets
international pharmacies for American consumers.

Even doctors are raising the possibility with patients.

“I ask all my patients, when I’m pretty sure that they’re struggling to pay
for their insulin, I ask them, ‘Are you planning to take any trips?’” said
Mark Schutta, the director of the Rodebaugh Center for Diabetes at Penn
Medicine. “For people who are paying these maximum prices for insulin, it
makes sense.”

That’s how Catherine Price, an author who lives in Philadelphia, wound up
filling her insulin prescription in the Netherlands, while on a business
trip to promote her latest book in June.

After talking to her doctor about rising insulin prices, Price, 39, said
her doctor, a colleague of Schutta’s, asked if she had any upcoming trips

Price, who has type 1 diabetes, paid $100 for three vials of insulin at a
little pharmacy in Amsterdam, plus $450 for her round-trip plane ticket,
which in her case was already paid for. At home, a local pharmacy quoted
her $645 for a single vial  — with her insurance coverage – which would
come to nearly $2,000 for three.

“If you’re going to pay that much for your medicine, you might as well get
a weekend in Europe out of it and come out ahead,” she said.

How to safely buy medications online

People considering buying medications in another country must be cautious,
especially if shopping online.

Canada, the United Kingdom and European countries have their own systems
for regulating pharmaceutical companies and ensuring patient safety, so
purchases from brick-and-mortar stores there do have that layer of safety.
But it’s harder to verify the origin of medications purchased online.

Independent organizations, such as PharmacyChecker.com, vet international
pharmacies, but the group is not sanctioned by the federal government or
the National Association of Boards of Pharmacy, which represents state
pharmacy regulators.

“We in America take things somewhat for granted, in that all the
protections the FDA puts in place are followed. We can’t say that’s
necessarily the case in other countries,” said Patricia Epple, CEO of the
Pennsylvania Pharmacists Association.

Levitt, of PharmacyChecker, admits there are risks to buying medications
online, but thinks the government’s and pharmacy association’s warnings are
a scare tactic.

Pharmacies vetted by PharmacyChecker are licensed with their applicable
pharmacy board or licensing authority, do not sell controlled substances
(which international pharmacies cannot ship into the U.S.), require a valid
prescription and encrypt personal financial information, he said.

Yeagley isn’t worried about the safety of the drug he buys in Canada.
Rather, he’s relieved to have found a way to provide his son the medication
he needs — without it costing the equivalent of a year’s college tuition.

“This is such a big deal for him,” Yeagley said. “We’ll do whatever we can
to make sure he gets the drug.”

Share your own experience — and what you paid — at Philly Price Check or by
emailing healthcosts at philly.com. Or leave a voicemail message at
215-854-2500 describing the billing issue you would like to share.

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