Americans travel to Mexico and Canada for their medication

In its effort to moderate the very high prices that Americans pay for many vital medicines, the Trump administration introduced last month a plan which would legalize the import of prescription drugs selected from countries where they are sold for much less. But the plan addresses imports only at the wholesale level; It says nothing about the transactions of millions of Americans who already buy their medications outside the United States.

US citizens routinely bypass federal law by crossing to Canada and Mexico, or by using online pharmacies abroad to buy prescription drugs at a fraction of the price they would pay at home.

In certain cases, they do it out of desperation. It is the only way they can pay for the medications they need to stay healthy, or alive. And they buy them despite the warnings from the Food and Drug Administration (FDA), something repeated by the pharmaceutical industry, about the risk of contaminated or counterfeit products.

"The reality is that every year, literally millions of people get their medicines this way, and they are saving a lot of money or receiving a medicine they could not buy here because prices are too high," said Gabriel Levitt, president of PharmacyChecker.com, a digital company that allows you to compare prices of prescription drugs between international and US pharmacies.

For people with diabetes, the inability to pay insulin prices in the United States can be a matter of life and death, so they go to Canada or Mexico to meet their needs.

Robin Cressman, who was diagnosed with type 1 diabetes in 2012 and has become an advocate for the lowest drug prices, said that, even with insurance, he paid $ 7,000 a year out of pocket for the two insulin medications he needs : Lantus and Humalog. At one point, his credit card debt reached $ 30,000, said Cressman, 34, who lives in Thousand Oaks, California.

During a trip to Tijuana, Mexico, last year, he visited some pharmacies to see if they stored their medications. He said that with little fanfare he could buy both drugs at the counter for less than 10% of what they cost north of the border.

"That day, I left Tijuana literally shaking because I couldn't believe how easy it had been to get my insulin," he said, "but also how little it cost and how bad it had been to extort me in the United States."

If you plan to cross the border to buy your medications, or get them through an online pharmacy abroad, there are two things you should know. First: it is technically illegal. Second: it is unlikely that you will be prosecuted.

Despite the official ban, FDA guidelines they allow federal agents to refrain from enforcing the law "when the amount and purpose are clearly for personal use, and the product does not present an unreasonable risk to the user."

Personal use generally means no more than a 90-day supply. You should think twice before bringing larger amounts because, if the authorities suspect that you have commercial intentions, it could enter a swampy legal ground, and lose medications.

People familiar with the practice say that you can usually go through customs without much hassle, if you do not have a supply of more than three months, you declare it to the customs agents and show them a medical prescription or a personal note that proves that it is for your own use, along with your doctor's contact information.

Even in the worst case, an unfriendly agent could confiscate drugs, but not arrest you.

Ordering medications online at foreign pharmacies also tends to be largely undisputed. Legally, the FDA may refuse to enter the package in an international mail facility. "That happens occasionally," but not often, Levitt said.

It is more common for passing shipments to stop for several days pending FDA inspection. Therefore, if you need to take your medication every day, make sure you have enough room for possible delays.

If you are buying medicines abroad, a possible risk is that you do not receive the product you paid for, or that it is not safe. "There is a lot of garbage in the pharmaceutical world," said Dr. Ken Croen, a primary care physician at Scarsdale Medical Group in Westchester County, New York, who advises many of his patients on how to buy medications safely in Canada.

And there are many dishonest operators, especially in the world of online pharmacies. You will have to investigate a little.

Before doing business with an online pharmacy, he confirms that he is licensed in his home country and that the country has strong regulations on pharmaceutical products, advised Dr. Aaron S. Kesselheim, professor of medicine at Brigham & Women Hospital at the School of Harvard Medicine.

Countries with well-regulated pharmacies include Canada, New Zealand, Australia, much of Western Europe and Turkey.

Also, verify that the pharmacy publishes an address and a phone number on its website. Experts advise against using online pharmacies that do not require a prescription: if they are informal with this, they may be in other aspects.

A couple of websites investigate for you, using these and other criteria.

The Canadian International Pharmacy Association administers a site (cipa.com) which allows you to compare the prices of medicines among dozens of pharmacies whose legitimacy you have certified. Their clients "tend to be people who live in the United States, have fixed incomes or low incomes and cannot afford the medications where they live," said Tim Smith, general manager of the association.

To buy through one of CIPA's certified pharmacies, you must have a valid prescription and present a medical profile to help protect against adverse drug interactions. The site also maintains a list of “dishonest” online pharmacies.

PharmacyChecker.com offers a similar service, which links customers to a wider range of online pharmacies abroad and in the United States.

Levitt points out that, while importing medications is a “vital line” for many people, it is still possible to buy many medications affordable in the United States. He and others suggest that you take the time to compare prices in the country, because these can vary significantly from one pharmacy to another.

GoodRx, based in Santa Monica, California, keeps track of the prices of prescription drugs at more than 70,000 pharmacies in the country and offers coupons.

Levitt also recommends asking your doctor if there is a viable therapeutic alternative or a lower cost generic medication. Recent PharmacyChecker research shows that 88% of the most commonly prescribed generic drugs can be bought cheaper here than in Canadian pharmacies.

"Many times there is no reason to become international," says Levitt. "In fact, the drug will be cheaper here."

Article courtesy of California Healthline