On Sunday, U.S. Senator Bernie Sanders travelled to Windsor, Ont., accompanying a group of American patients with Type 1 diabetes who crossed the border to purchase insulin.
The presidential hopeful used the occasion to denounce the “greed” of Big Pharma and promote the idea that Americans should import “cheap” drugs from Canada, an idea he has been touting for two decades.
Since Mr. Sanders first took a busload of Vermont seniors to Montreal in 1999 to fill their prescriptions at a fraction of the price they would pay at home, this cross-border idea has gained momentum.
There are now 27 different legislative initiatives in the U.S. Congress and state legislatures that would allow the importation of prescription drugs from Canada. At least 10 states, as well as U.S. President Donald Trump, have embraced the approach.
But let’s be clear. It’s a ridiculously simplistic idea that is untenable both politically and practically; it needs to be killed and buried, and quickly.
There is one reason that Canada’s drug prices are lower than those in the U.S.: Canada (like almost every developed country) regulates and caps prices, while the United States has a free market free-for-all that encourages price gouging.
If Americans want lower drug prices, their politicians need to put on their big boy pants and regulate, not try to shamelessly raid and pillage the neighbour’s medicine cabinet.
The politicians and advocates who have embraced the idea that Canada is an easy source of cheap drugs are fooling themselves. They clearly do not understand either the complexity of the global drug market, or U.S. or Canadian law.
Very few prescription drugs are actually manufactured in Canada. Our drug supply is largely imported from the United States, Europe and Asia.
Prices of brand-name drugs here are set by the Patented Medicine Prices Review Board; they examine prices in seven comparator countries – Italy, France, Germany, Sweden, Switzerland, Britain and the U.S. to ensure the Canadian list price of drugs are not “excessive.” (The PMPRB does not regulate the price of generics.)
The result is that we have the fourth-highest brand-name drug prices and the 11th-highest generic drug prices in the OECD.
Manufacturers whose drugs are approved for sale in Canada have a “duty to supply” the market. The quid pro quo is that we forbid re-export, although perhaps the law is not as explicit as it should be on this point.
The U.S. also bans the importation of medications, a rule the proposed laws would like to circumvent.
Both Canada and the U.S., however, tolerate the export-import of small quantities of drugs for personal use. Technically, Americans need to purchase these drugs in person, and can carry a 90-day supply, except for narcotics and biologics.
In recent months, caravans of parents of children with Type 1 diabetes have been advertising their trip to Canada to purchase insulin, largely to pressure U.S. manufacturers to lower prices. But they are sensible enough to realize buying lifesaving medication in Canada is not a long-term solution.
But let’s not forget that insulin is not a prescription drug in Canada.
For Americans to purchase prescription drugs in Canada, they would require a prescription from a Canadian physician.
There are currently a small number of physicians in Canada who hold dual provincial-state licences to cater to cross-border shoppers.
But what the U.S. legislative initiatives seem to suggest is that Americans should be able to buy Canadian drugs online, presumably with a U.S. prescription, or no prescription.
If you know your history, you know that’s not going to happen. (And, as an aside, if the U.S. truly wants cheap drugs, why doesn’t it import from Mexico or India?)
The U.S. Food and Drug Administration has spent more than a decade prosecuting and shutting down online pharmacies, including those based in Canada (or pretending to be based in Canada), because they are a haven for counterfeit and unsafe drugs.
Finally, exporting prescription drugs from Canada to the U.S. would harm Canadian patients because it would almost certainly result in more drug shortages. (However, the causes of drug shortages are complex.)
As a coalition of pharmacists, physicians, nurses and patient groups said in a letter to federal Health Minister Ginette Petitpas Taylor, pharmacies in Canada “are not equipped to support the needs of a country 10 times its size without creating important access and quality issues.”
As self-deluding excitement builds in the U.S. around plans to import cheap Canadian drugs, Ottawa has to stand up and unequivocally throw cold water on this half-baked idea.
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Editor’s note: Aug. 2, 2019: A previous version of this column incorrectly said Canada has the second-highest generic drug prices in the world. They are actually the 11th-highest in the OECD.