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| The Basics | Save big at Canada's online pharmacies
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U.S. residents can pay less than half for some prescription drugs across the border -- with just a click of a mouse. But be aware of legal and safety considerations.
By Jennifer Mulrean
Have you caught wind of those "drug tours" to Canada and Mexico? Seniors who need expensive drugs take bus trips, fill their prescriptions and come home. They're not alone. Many consumers, sick of choking down high U.S. prices, are also hunting online for more affordable prescriptions.
Dave Robertson, co-owner of CrossBorderPharmacy.com in Calgary, Alberta, says his site's clientele is "almost exclusively" from the United States. And though he won't release the number of prescriptions they fill each month or the number of clients, he says the site has grown exponentially each month since its founding in January.
How much can you save? Sometimes more than half. But you must be willing to brave a disapproving U.S. Food and Drug Administration and do the homework necessary to make sure your foreign pharmacy is legitimate.
Currently, the majority of prescriptions being filled by Net-only pharmacies are for what Forrester Research analyst Liz Boehm calls "lifestyle drugs." These include drugs such as Viagra, for treating male erectile dysfunction, and Propecia, for treating hair loss. And because insurance often doesn't cover them, there's added incentive to get them cheap.
Where the deals are
Some foreign pharmacy sites seem to market to "Xfiles" fans rather than conscientious penny-pinchers (you'll find a proliferation of blurbs on "What the Government Doesn't Want You to Know"). But beyond the conspiracy theories lay some very real price discrepancies -- and thus, savings potential for U.S. consumers.
Though these sites span the globe, we've chosen to focus on Canadian pharmacies, in particular, because their quality assurance and approval laws are most similar to the FDA's.
Sixty tablets (100 mg. each) of arthritis drug Celebrex will cost you $84.95 at drugstore.com (about $1.42 per pill). But for roughly $20 less at CrossBorderPharmacy.com, you can buy 100 Celebrex tablets at the same dosage level (for a per-pill cost of roughly 66 cents). You'd be saving roughly 76 cents per pill -- or about 54%.
Shopping around at other U.S. sites yields prices similar to drugstore.com's: Eckerd's will charge you $1.50 per pill when you buy 100 tablets; FamilyMeds.com will charge about $1.58 per pill ( $141.87 for 90 tablets). Searches for several other drugs, such as Propecia, yielded similar results. (See the table at the end of this column for more price comparisons.)
Why so cheap? Robertson says that the provincial governments in Canada negotiate competitive deals with drug companies. Sites such as his and insurance companies then try to get comparable deals to what the government is paying. Also, he claims that because drug companies don't market directly to consumers in Canada, fewer costs are passed on to the consumer. To top it off, U.S. consumers should benefit from favorable exchange rates on the dollar. (The Canadian dollar is now worth 64 cents in the United States.)
This doesn't mean every drug you order from a foreign site is guaranteed to be cheaper. I found that Viagra, in particular, is worth checking against U.S.-based sites. Some Canadian sites didn't have it at all, and the ones that did weren't all that price-competitive with sources such as drugstore.com and Eckerd's. Four pills cost $33.82 at Canadian site Mydrugs.ca., or $8.46 per pill. Stateside, you can buy 10 pills for $83.70 -- $8.37 each -- at drugstore.com.
You'll also still need a prescription for many sites -- usually from a Canadian doctor for pharmacies domiciled in Canada. You can get these in a couple of ways: either by faxing your U.S. prescription to the pharmacy, where it is then reviewed, or by filling out an online questionnaire.
"We absolutely require a U.S. prescription," says Robertson of CrossBorderPharmacy.com. And that's not just to fill the order. A copy of the prescription is included in the package that's sent to customers to satisfy customs rules. Robertson also notes that he cannot send orders to commercial properties and can't send more than a 90-day supply to any individual.
Some sites, such as CrossBorderPharmacy.com and TheCanadianDrugstore.com of Toronto, may also have you fill out a medical history and release form, since their pharmacists will not be seeing you in person.
Illegal or not?
Finding the best price and getting a prescription aren't the only hurdles. Ordering from foreign sites is problematic for a couple of reasons. Foremost, it can be illegal. And the line for what's legal is blurry at best, though it largely depends on what you're ordering, says Tom McGinnis, the Food and Drug Administration's director of pharmacy affairs. In particular, U.S. customs keeps an eye out for the following items:
- Packages from pharmacies, particularly those on an FDA alert list (These are mostly sites that sell prescription drugs without the prescriptions.)
- Non-FDA-approved drugs
- Controlled substances
- Undeclared/mislabeled drugs
Should your package fit one of these criteria, it could be refused entry by U.S. Customs, wiping out your potential cost savings quicker than you can say "FDA." There are, however, some compassionate-use rules that the FDA uses that can allow treatments for serious illnesses for which there aren't any FDA-approved options.
But what makes some of these sites illegal does not necessarily make them unsafe.
Some of the time, "the medications are manufactured in FDA-approved plants but shipped to different countries," says Carmen Catizone, the executive director for the National Association of Boards of Pharmacies (NABP). Once the drugs leave the U.S. distribution system, the FDA can't give them its approval.
The result for U.S. consumers is that they're often coughing up more money in this country for FDA-approved drugs with the same ingredients, in the same amounts and with the same recognized brand names as those that you can buy outside the country. It's also true that some foreign versions of medications differ slightly from U.S. counterparts. Robertson cites some asthma medications on his site that differ from the U.S. version by a few milligrams per dose, but he also points out that it can be simply a matter of a drug that comes in a capsule in one country and a tablet in the other.
McGinnis acknowledges that ordering FDA-approved products would be legal, but notes, "it would have to be the exact FDA-approved product," something he says is difficult, if not impossible, to determine online.
Seal of approval for foreign sites?
But is this really any different than the usual risks facing consumers ordering from U.S.-based pharmacies? Not really. So-called "rogue sites" can be based either in the United States or outside its borders. These include the sites that don't require prescriptions. McGinnis also noted that the sale of expired drugs is a problem -- something that's not always discovered until the FDA inspects a package at customs' request.
But the main difference is in how the FDA and other U.S. regulatory agencies can respond to any wrongdoing by pharmacies. If you were to be ripped off by a foreign site -- you were sent, say, expired drugs -- the FDA would have no recourse for helping you get your money back. The best the agency can do is to report the pharmacy to the FDA equivalent in the country where the pharmacy is based and add the company to its alert list.
For these reasons, the FDA and NABP say the trick to ordering safely online is to identify legitimate pharmacies. The FDA posts guidelines on how to do so on its site (see the link at left), including checking the pharmacy's contact information, such as a physical address and phone number. Though the FDA specifically recommends looking for a U.S. phone number and address, I was able to easily reach customer service representatives at both foreign sites I called -- TheCanadianDrugstore.com and CrossBorderPharmacy.com, the latter of which now has a 24-hour help line for questions on prescriptions and order-filling.
Another key FDA recommendation is to look for the NABP's seal of approval, which it issues through its Verified Internet Pharmacy Practices Sites (VIPPS) program. A site with the VIPPS seal verifies that the pharmacy board has checked its licenses and completed physical inspections of their pharmacies, among other things. (The program is voluntary and costs between $1,000 and $5,000 for participating pharmacies.)
Problems with VIPPS
Forrester's Boehm, for one, is not convinced of VIPPS' relevance, if only because of the role that insurance companies continue to play. "If I get a prescription, I'm going to go where my insurance company says I can, and I'm not even going to realize if it's a VIPPS pharmacy or not." And, she notes, the main drawback so far is that the program has failed to market itself heavily enough that consumers really know to look for the seal.
Furthermore, only 12 pharmacies are listed as VIPPS-qualified sites and all are U.S.-based something Catizone hopes to change within the year as NABP is working to extend its VIPPS program to Canada and Europe. He also notes that the 12 listed sites include such giant drug chains at Eckerd and CVS and actually represent 10,000 to 12,000 pharmacies around the United States.
For now, probably the best strategies for protecting your wallet and your health are to buy prescription drugs online from sites that require prescriptions and that have either customer support or pharmacists you can easily reach by phone. Robertson also recommends looking for a site's pharmacy license number on the homepage.
With drug costs rising and the population aging, business should continue to thrive at these sites. Research by Jupiter Media Metrix finds the online shopper of tomorrow will be older and less affluent, making it likely that cheap foreign pharmacies will only become more popular.
"This isn't an issue that's going to go away," says Catizone.
| How popular prescription drugs fare on domestic and Canadian pharmacy | | Site | Celebrex (100 mg) (Arthritis drug) | Viagra (male erectile dysfunction)** | Propecia (hair loss treatment), (1mg) | Xenical (for weight loss), (120 mg ) | | US sites with VIPPS logo | | | | | | drugstore.com | $1.42 each (60 tablets for $84.95) | $8.37each when you buy 10 tablets for $83.70 (50 mg) or $7.87 each when you buy 30 tablets for $236.10 | $1.41 each (90 tablets for $126.90) | $1.18 each when you buy 90 capsules for $106.47 or $1.13 each when you order 270 capsules for $304.29 | | | | | | | Eckerd.com | $1.50 each (100 tablets for $150.31) | $8.56 each (100 tablets for $855.95) (25 mg) | $1.39 each (90 tablets for $125.20) | $1.17 each (100 capsules for $116.63) | | Familymeds.com | $1.58 each (90tablets for $141.87) | $9.20 each (90 tablets for $827.87) (25mg-100 mg) | $1.63 each (90 tablets for $146.87) | $1.33 each (90 capsules for $119.87) | | CVS | $1.59 each (30 tablets for $47.79) | $8.90 each (10 tablets for $88.99) (50 mg) | $1.57each ($90 tablets for $140.99) | $1.26 each (90 capsules for $112.99) | | | | | | | Canadian sites | | | | | | TheCanadianDrugstore.com | 89 cents each (30 tablets for $26.67) | NA | NA | NA | | CrossBorderPharmacy.com*** | 66 cents each (100 tablets for $65.70) | NA | $1.41 each (28 tablets for $39.37) | $1.30 each (84 capsules for $109.38) | | CanadianMeds.com*** | 66 cents each (100 tablets for $65.70) | NA | $1.41 each (28 tablets for $39.37) | $1.30 each (84 capsules for $109.38) | | Mydrugs.ca | 68 cents each (100 capsules for $67.87) | $8.46 each (4 tablets for $33.82) (50mg) | $1.17 each (28 tablets for $32.82) | $1.14 each (84 capsules for $95.89) |
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*All prices in U.S. dollars
**Viagra prices didnt seem to vary by pill strength within each site
***Price list pages look suspiciously alike
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