O Canada!

The current issue of The Medical Letter (May 22, 2017) leads off with a contentious topic: drug prices. I could think of a lot of good reasons for not publishing an article on this subject: not our usual thing, more questions than answers, everyone in the world has already written about this, etc. But many readers asked for it, so we did it, for better or worse. And now that we have, a reader commented that the one thing that jumps out of the article is the table comparing US and Canadian drug prices. Everyone knows that Canadian prices are lower, but seeing a substantial list of the actual differences is still stunning.

So why not just order drugs from a Canadian pharmacy? Well, apparently many people do just that. An article from the Canadian Medical Association Journal estimated that US customers purchase more than $1 billion in drugs per year from Canadian pharmacies. And that was in 2004 (S Morgan and J Hurley. Internet pharmacy: prices on the up and up. CMAJ 2004; 170:945). But importation of drugs from Canada (or any other country) for personal use is illegal, with a few exceptions that apply only to drugs that are not available in the US (www.fda.gov/ForIndustry/importProgram/ucm173751.htm).

The rationale for the illegality of importing drugs from other countries is that the FDA cannot assure their safety and quality. With regard to Canadian drugs, that concern may seem excessive, given that many Canadian and US drugs are manufactured in the same factory, so that, as Morgan and Hurley point out, people in the US who order Canadian drugs may just be reimporting American-made drugs in Canadian packaging. Of course, the Canadian packaging includes Canadian labeling, which may differ from the US FDA-approved labeling. And ordering online from Canadian pharmacies may not be straightforward because the pharmacies, even though they have a Canadian address, may not be in Canada at all, and the drugs they ship to the US may have originated in some other country where manufacturing quality is more of a concern.

Some observers have suggested that high US prices for drugs subsidize more moderate prices in the rest of the world. If that were true, it would certainly change the usual meaning of America First. It can’t go on like this, can it?

Enter your email address to follow this blog and receive notifications of new posts by email.


  1. Birendra huja says:

    It is obvious big pharma protectionism, most of agree but when will we rise. Many have reached the graves prematurely because of our silence, so will we.

    Let us rise for what is right, let us stop talking…..

    Birendra Huja

  2. Gordon Yanchyshyn, M.D. says:

    You omitted one key point — why is there such a dramatic price difference between Canadian and American medications? Does the Canadian government subsidize the pharmaceutical industry?

  3. James R. Chaillet, Jr., MD says:

    This is a example of discriminatory pricing, that is, charging different prices in different markets. Here, the market difference is a political one( different countries) but, really, a legal one. As the author noted, it is illegal to purchase drugs from Canada. Of note, an American can buy a car made in ( many American cars are) or purchased in Canada.

    Likewise, Americans can purchase Canadian made and sold toiletries, lumber, maple syrup and a myriad of other Canadian made and/or sold products and services.

    So why won’t the FDA act to allow the purchase of at least some drugs sold in Canada- say ones produced in the US. The FDA could vet the distribution process where US made drugs end up in Canadian pharmacies to assure the same quality as US sold drugs.

    A topic for an article: Why doesn’t the FDA allow this?

Leave a Reply:

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s