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Conference explores pros and cons of drug reimportation

Buying prescription drugs outside the United States is illegal, but that's not stopping Americans faced with skyrocketing health care costs from considering it as a way to get costly medications for less.

About 100 people participated in a U-M conference Oct. 30-31 on the pros and cons of the practice.

Drug reimportation involves people in this country buying American-made prescription drugs from countries to which U.S. pharmaceutical companies export their products, either by traveling there to buy drugs or purchasing them through the mail.

"I've never seen a more thorough gathering of information on this issue."
—Chris Ward, a Canadian health policy consultant

It is a complex and emotional issue. Senior citizens frequently are in the news for taking buses to Canada to buy medications at a fraction of what they cost back home. But in doing so, they could buy unsafe counterfeit or black-market drugs, and they undermine the economic motives of U.S. companies to invest in developing new drugs, opponents say.

Pat McKercher, director of the Center for Medication Use, Policy and Economics at the College of Pharmacy, and U-M colleagues organized the event to foster dialogue.

Toward that end, the participants ranged from a representative of AARP, which supports limited reimportation as a way of putting downward pressure on drug prices, to a delegate from the Pharmaceutical Research and Manufacturers of America, which says cost savings from reimportation are exaggerated and the practice puts at risk the integrity of the U.S. drug supply.

Chris Ward, a Canadian health policy consultant who served as a cabinet minister in Ontario government from 1987-90, said he recently has been to Illinois and Minnesota, among other places, to talk to officials there about their interest in importing drugs from Canada. "I've never seen a more thorough gathering of information on this issue," he said of the U-M event.

Ward said in the last three months, reimportation has created a Canadian health crisis that includes drug shortages as Americans siphon off the Canadian supply, and a pharmacist shortage, with pharmacists seeing the potential to make huge profits selling drugs to people in the United States on the Internet.

"It has just gotten completely out of hand," Ward said.

Canadian price controls keep many drugs cheaper than in the United States, and Ward said any state or federal endorsement of buying drugs from Canada is "a copout" that sidesteps the question of how the United States can supply its own citizens with affordable prescription medications. Reimportation isn't the solution, he said; instead, the United States should move toward broader prescription drug benefits through Medicare or Medicaid.

But Paul Saatsoglou of IMS Consulting said a survey conducted in April showed about half of Americans buying drugs abroad have medical coverage, so even those with insurance are tempted by cheaper medication.

Ilisa Bernstein, a senior advisor for regulatory policy at the U.S. Food and Drug Administration (FDA), said the FDA simply lacks the resources and authority to stop the flood of foreign drugs coming in through the mail. So while the FDA regulates everything from the formulation of drugs to their manufacturing and labeling when made and sold in the United States, it is helpless outside of that closed system, Bernstein said.

The FDA and U.S. Customs participated in spot inspections during the summer of thousands of mail packages suspected to contain medications. Bernstein said 88 percent were found to be drugs not sold according to FDA rules, including some pulled from the U.S. market for safety concerns, animal drugs not approved for use in humans and drugs with no English labeling.

Additionally, increased interest in buying foreign medications allows opportunists to sell counterfeit drugs or drugs diverted out of legal channels and on to the black market, said Marv Shepherd, director of the Pharmacoeconomics Center at the University of Texas College of Pharmacy.

"It's organized crime—big organized crime," Shepherd said.

That's part of the reason the AARP's position on drug reimportation supports buying drugs only from licensed Canadian pharmacies and wholesalers, aiming for a system that provides confidence in the safety and integrity of reimported medicines, said David Gross, an advisor at AARP's Public Policy Institute.

McKercher said several people approached him about taking the program to other cities, including Washington, D.C. He's considering that, as well as putting on another conference soon, possibly focusing on Medicaid legislation.

The Center for Medication Use, Policy and Economics hosted the conference with sponsorship from AstraZeneca, and support from Aventis and the Michigan Pharmacists Association.

For more information about the conference, visit

The conference was videotaped and organizers hope to have it both on that Web site and on UMTV soon.

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