Why Americans Should Be Permitted to Buy Their Drugs from Reputable Foreign Pharmacies

Stephen Barrett, M.D.
August 24, 2011

I buy most of my brand-name medicines from pharmacies outside the U.S. and so should many other Americans. I get drugs made by U.S. companies but at 50% to 80% less than the price at stores in my community. My wife and I have purchased drugs from foreign online pharmacies for 10 years with only one problem: The U.S. Customs Service detained one of my wife’s shipments for several weeks before releasing it to us.

Although Americans can buy most other products from abroad, our government has declared it illegal to buy medicine from abroad, claiming that is unsafe. It can be unsafe, because there are rogue pharmacies whose products are dangerous or counterfeit. But well-informed shoppers can easily avoid the bad guys.

Drug companies oppose personal importation—not because of the quality of the drugs but to stifle competition. To cut costs, many companies buy their ingredients and make most of their drugs outside the U.S. Then they sell these drugs at very high prices in the U.S. and at lower prices in most of the rest of the world. They fund programs that advertise that buying drugs outside the U.S. is unsafe; and they lobby the government to keep Americans captive to their U.S. prices.

The U.S. Centers for Disease Control has reported that from 1997 to 2009 the number of Americans who can’t afford their medicine climbed from 4.8% to 8.4% [1]. That’s 25 million Americans skipping medication due to cost two years ago—and the number today is probably higher. A 2008 Harvard/Kaiser/USA Today report indicated that during the previous two years, 40% of Americans were struggling to afford their medication [2].

The White House has not helped. We are the only major developed country that does not negotiate drug prices for its citizens. It is widely believed that in return for support for its insurance reform legislation, the Obama administration agreed—at least temporarily—to take Medicare drug price negotiations and personal drug importation off the table. Making matters worse, the White House’s recently created Office of the Intellectual Property Enforcement Coordinator (the “IP czar”) has taken the drug companies’ side.

In a recent report to the President and Congress, IP czar Victoria A. Espinel cited vague “health and safety issues” as reason to pressure search engines, domain registrars, credit card companies and others to assist in its apparent crackdown on all non-U.S. online pharmacies that serve Americans [3]. This plan was hatched by a drug company-sponsored group and submitted to Espinel last year [4]. The truth is that independent research shows that properly credentialed international online pharmacies are just as safe as those in the U.S., and their drugs are just as authentic. The White House should focus on stopping real counterfeits.

Espinel appears to be targeting any pharmacy that is not on a “White List” developed by the National Association of Boards of Pharmacy, which excludes every non-U.S. online pharmacy, considering them all “rogue” regardless of their credentials or the authenticity of their products. A year ago, advertisements for Canadian pharmacies accompanied search results from the major search engines. Following government and pharmaceutical industry pressure, they are now blocked—an action Espinel applauded.

The nature of the pressure became clear today when the Justice Department announced that Google had agreed to pay $500 million that it earned by selling ads for online Canadian Pharmacies [5]. The news release indicated that the Department of Justice has been pressuring Google for several years and “will continue to hold accountable companies who in their bid for profits violate federal law and put at risk the health and safety of American consumers.” The agreement provided additional details, including the fact indicated that the National Association of Boards of Pharmacy advised Google that the importation of prescription drugs from foreign countries is illegal. The agreement also indicates that Google agreed to the Justice Department’s demands in order to avoid criminal prosecution [6].

Canada is not the only country that has lower prices for legitimate drugs. Authentic medicines can be obtained from licensed pharmacies in Australia, the United Kingdom, Israel, and several other countries. A free Web site, PharmacyChecker.com, maintains a database of trustworthy pharmacies and the prices they charge. In addition to verifying the legitimacy of these pharmacies it also tabulates feedback from thousands of people like me who use them. On the other hand, the United States is a great place to get generic drugs. Our prices are among the lowest in the developed world—particularly at Costco, CVS, Kmart, Kroger, Safeway, Target, Walmart, and many other supermarkets that sell hundreds of generic drugs for $10 to $20 for a 3-month supply. But for brand-name medicine, you need to go outside the U.S. for real savings. Reputable international online pharmacies that sell up to a three-month supply of medication for personal use based on a prescription are certainly not a threat to our domestic drug supply. And they are not relevant to Espinel’s claim that her actions are meant to “secure our supply chain.”

Reading about what happened to Google, I wonder why so little attention is paid to our government policies that wrongly exclude reputable foreign online pharmacies from marketing to Americans. Stopping rogue pharmacies is important, but our government should permit and encourage Americans to shop at reputable ones—and search engines should help facilitate the process. The likely effect: More people will get the medicine they need and U.S. drug prices will drop to attract back millions of customers who buy elsewhere.

  1. Health, United States, 2010. Hyattsville, MD: National Center for Health Statistics, 2011, table 76.
  2. The public on prescription drugs and pharmaceutical companies. USA Today/Kaiser Family Foundation/Harvard School of Public Health, March 2008, chart 20.
  3. 2010 U.S. Intellectual Property Enforcement Coordinator Annual Report on Intellectual Property Enforcement, Feb 2011.
  4. White House looks to block medicine from abroad. PharmacyChecker.com news release, April 5, 2011.
  5. Google forfeits $500 million generated by online ads & prescription drug sales by Canadian online pharmacies. USDOJ news release, Aug 24, 2011.
  6. Non-prosecution agreement between the United States Department of Justice and Google, Inc. Aug 19, 2011.

This article was revised on August 24, 2011.