May 6, 2021

Drugs from Canada

 

Every employer is looking for ways to save on prescription drugs. One way that has recently received more buzz is to save costs via personal drug importation from Canada.

Since former HHS Secretary Alex Azar certified the 2003 Medicare Modernization Act (MMA) and personal importation drug law before leaving office last year—making it legal for personal drug importation from Canada—employer health plans are asking about importing drugs from Canada.

While some individuals and their employers have obtained medications through personal importation that appear to reduce the drug’s cost, the savings results are not universal and there are other considerations that as a pharmacist I think every employer and their employees should consider.  In fact, one of my paramount concerns is that this practice could be dangerous.

Before adding Canadian Drug Importation to your voluntary benefit program:

Drug Importation from Canada: Considerations

  1. Technically, some therapies still cannot legally be imported – under the MMA 2003 Act, the only therapies that may fall under the personal importation law are drugs (including insulin under this particular law). Higher dollar biologicals like high dollar anti-inflammatory drugs and controlled substances may not be legally imported under this Act. That leaves brand name drugs that are not biologicals that may potentially be legally imported.
  2. Drugs can never truly be certified as “safe” when coming from Canada or outside of the US – The Food and Drug Administration has no control over pharmacies outside of the US. Here in the US, the FDA is implementing the DSCSA – or the Drug Supply Chain Security Act – a 10-year rollout to keep our drug supplies safe, through tracking and tracing their origins. Canada only controls 2% of the legitimate world’s drug supply and does not manufacture the majority of its drug supply. That is a perfect recipe for drug counterfeiting or fake medications entering the US from our northern border. Every week in the US, according to the Partnership for Safe Medicines, over 25,000 drugs are seized at borders as counterfeit, potentially entering the US drug supply. There is no way to ensure that drugs imported from Canada are legitimate, let alone safe.
  3. Plans lose drug rebates – One of the larger plan ways to save are through drug rebates, particularly on brand drugs. Generic drugs in the US for the most part are already affordable, either through PBMs’ negotiated discounts; brand name drugs have rebates. However, if you purchase from Canada, there are no drug rebates on brand drugs anymore for plans. We conducted an independent analysis of a high dollar drug, popular as imported here at Apex Benefits, and learned that it was actually cheaper to obtain the drug through US drug channels, rather than importing the drug from Canada.
  4. Plans and Members lose copayment assistance – Drugs imported personally from Canada do not qualify for most copayment assistance. When a member uses a voluntary program to import drugs from Canada they are operating outside of their core benefit.  As a result, employers often waive or significantly reduce copayments so the loss of assistance doesn’t affect the member.  However, if plans are using variable copayment or copayment maximization designs, this can mean the loss of hundreds or thousands of dollars of cost-savings.
  5. Plans who tried Canadian importation failed due to lack of savings – The State of Illinois in the early 2000s set up an importation plan, dumping money and resources into the program, only to find that it did not work through its I-SaveRx Program.1
  6. The Canadian Government is against exportation of drugs – Canada has opposed exportation of drugs to the US several times – in 2019,2 and again recently with President Trump and Sect. Azar’s certification of the 2003 MMA personal importation law.3
  7. Drugs may be and are often seized at the border – Drugs may be seized at the border at any time, and often are by the US Border Patrol. If the patient needs the drug but it is held up at the border, will they receive it in time for the next dose?

As a pharmacist, I want every patient to know, like, and trust his or her pharmacist. And, I want to ensure that patients at a minimum are safe. After all, “First, do no harm” is a mantra that all healthcare professionals take; we take that seriously. Canadian drug importation for all the reasons outlined above and more is simply not in the best interest of patients and their safety, which should be first.

If you are a plan benefits administrator and you’re struggling to find ways to save, please contact us. We have several solutions and ways to save that are safer and likely more cost effective than drug importation. We are here and happy to help.

  1. http://www.safemedicines.org/wp-content/uploads/2015/11/FY06-Flu-Vaccine-ISaveRX-MGMT-digest.pdf
  2. https://www.reuters.com/article/us-canada-pharmaceuticals-exports-exclus/exclusive-canada-warns-u-s-against-drug-import-plans-citing-shortage-concerns-idUSKCN1UD2LN
  3. https://www.safemedicines.org/policymakers-media

Contact Erin
Erin L. Albert

Authored By

Erin L. Albert, MBA, PharmD, JD, PAHM

Kinetiq Health Pharmacy Benefit Practice Leader
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