Buying brand-name prescription drugs from Canadian Internet pharmacies can result in an average savings of about 24% for 41 of the 44 most popular medications, according to a report in the current issue of the Annals of Internal Medicine.
Researchers with McGill University in Montreal compared the prices of 44 brand name medications listed on 12 Canadian Internet sites to those found on the Web sites of three large U.S. pharmacy chains (CVS, Rite Aid and Walgreens) and found that -- except for three erectile dysfunction drugs -- even the most expensive Canadian site offered a cheaper alternative 80% of the time.
The researchers used the evaluation tool of Pharmacychecker.com, a White Plains, N.Y.-based organization that tracks Internet pharmacy drug prices. It also evaluates these pharmacies on whether they are licensed, ensure security of online personal financial information, ensure security of personal medical information, provide a contact address and phone number and require an original prescription. The study included only pharmacies that received a five-out-of-five rating using these criteria.
"I think this has major implications for the U.S. healthcare system," said one of the report's authors, Mark Eisenberg, M.D., an associate professor of medicine at McGill. "It's quite impressive; a 24% savings is huge when you think of the amount of money that's spent on prescription drugs in the U.S."
The largest annual average savings were found for the anti-psychotic medication Zyprexa ($1,159), the anti-hyperglycemic agent Actos ($852) and the heartburn drug Nexium ($772). Based on the use of four pills per month, the cost of the erectile dysfunction drugs Cialis, Levitra and Viagra averaged $74 more from the Canadian pharmacies than from those in the U.S. ($550 annually compared with $476).
The report cites previous studies that found Americans spent an estimated $750 million on cross-border prescription drug purchases in 2003, which amounted to 0.5% of the total $156 billion U.S. retail pharmaceutical market. And of that amount, about 64% was obtained through Internet pharmacies. Most of the remaining balance of those sales was made to consumers who physically crossed the border to purchase the allowable 90-day supply of prescription medicines.
Eisenberg admitted to contributing to these statistics. "I'm from Rochester, N.Y., so I buy medications for my parents up here and they save a lot of money," he said, adding that the study's findings were certainly not unexpected.
"I think the big news is that what everyone perceives, but no one had documented, is true: that brand-name prescription drugs are much cheaper in Canada than in the United States," Eisenberg said. "I was sort of neutral on this issue before the study, but now I can't believe it. It's like throwing money down the toilet. Any consumer would question 'Why should I spend more money for the same thing?' "
Jeff Trewhitt, spokesman for Pharmaceutical Research and Manufacturers of America in Washington, supplied some reasons.
He said up to one-third of Internet pharmacies posing as Canadian are actually from other countries, so consumers who use them have no idea if they are getting what they paid for.
"Sure there can be some above-board Internet drug sellers, but there are many that are unscrupulous," Trewhitt said. "Importation involves serious patient-safety risks. Using Internet drug sellers could be like playing Russian roulette."
Eisenberg, however, noted that all the Canadian Internet pharmacies studied were licensed and believed to be reputable. But he also warned that prices are subject to fluctuations.
He said the prices included in the report which listed savings of 24% were all posted on Dec. 4, 2004. The same prices were studied five months later, and there was only a 20% savings.
"I think it goes up and down, but 20% is still a lot of money," Eisenberg said. "I don't see how lawmakers can ignore this. I would be very upset if I was a consumer in the U.S."
Trewhitt also said there were better ways to make prescription drugs more affordable, including wider use of generic alternatives to brand-name medications, better use and promotion of patient-assistance programs for prescription drugs and more aggressive comparison shopping by consumers. Ultimately, however, he said the best solution would to reduce the number of Americans who are uninsured or underinsured.
"We need more and better drug coverage in this country," Trewhitt said, adding that cost controls such as those in Canada, Japan and the European Union are not the answer because they stifle innovation.
Read the study abstract.