Nova Scotia

Quiet resurgence: Americans coming north to fill prescriptions on the rise again

How Americans are able to get a valid Canadian prescription varies. But right now, it isn't impacting Canada's health-care system or supply.

'There's always potential for disruption of the Canadian supply'

While crossing the border to buy prescription drugs is nothing new, pharmacists are seeing a resurgence of the practice in recent years. (Shutterstock)

It was Tara Saunders's dermatologist who suggested she drive across the border to Canada to buy her medication.

The dermatologist called in the prescription to Mark's Marine Pharmacy in Vancouver. The 20-minute drive from her home in Blaine, Wash., saved Saunders $300 US a month.

"It's ridiculous what they charge for medications down here," Saunders said.

She isn't the only one making the trek north.

A type of insulin called NovoLog costs roughly $300 US for one vial. The Canadian equivalent, NovoRapid, is one-tenth of the price. (Quinn Nystrom)

Earlier this month, a group from Minnesota, calling themselves the Caravan to Canada, made a trip to Ontario to buy insulin at a tenth of the U.S. price.

The reason prescription drugs cost less in Canada is because a federal agency sets the maximum price a company can charge for patented drugs. In the U.S., drug companies are allowed to decide.

While Americans crossing the border to buy prescription drugs in Canada is nothing new, pharmacists are seeing a quiet resurgence of the practice in recent years.

Right now, the cross-border traffic isn't impacting Canada's health-care system or our supply of pharmaceuticals. 

But more and more U.S. politicians are pushing to import lower-priced drugs from Canada at a commercial level. Presidential hopeful Bernie Sanders has been promoting the idea for years, in the hopes of forcing American drugmakers to lower their costs.

A similar measure is gaining steam in the Florida Senate, and other states may follow suit. 

But pharmacists on both sides of the border worry that will only create more problems. 

Pharmacists worry about patient safety when it comes to buying prescription drugs in another country. (Regis Duvignau/Reuters)

"There's always potential for disruption of the Canadian supply, and that would be most acutely felt by Canadians who are trying to access medications that were earmarked for Canada," said Barry Power, a director with the Canadian Pharmacists Association.

"So without sounding alarmist, it's something that we need to consider."

Geoffroy Legault-Thivierge, spokesperson for Health Canada, said in an email that the department is monitoring the situation in the U.S.

Legault-Thivierge said "collaborative efforts" among involved parties would be important in addressing "any potential adverse impacts on the drug supply in Canada that may arise from increased cross-border trade."

"Canada has one of the most stringent drug approval systems in the world, which is focused on the quality and safety of products destined for the Canadian market.

"Health Canada is not, however, responsible for ensuring the quality and safety of prescription drugs exported to the U.S."

How do Americans buy cheaper Canadian drugs?

Currently, Americans need a prescription from a physician licensed in Canada to buy Canadian pharmaceuticals. 

They can visit a walk-in clinic in Canada, and pay out-of-pocket for the visit. Or some living near the border may even have a family doctor in Canada.

There are also doctors who hold dual medical licences, like Dr. Carl Flynn in Caribou, Maine, which is located on the New Brunswick border.

Flynn, a Canadian-trained physician, said he uses his dual licence every day.

"It's kind of waxed and waned over the years how much people have requested to get prescriptions in Canada," Flynn said. "But definitely in the last five years it's increased."

Most of his patients are elderly and many have never crossed the border.

U.S. citizens can get prescriptions by seeing a Canadian doctor in person, having a doctor with a dual medical licence or having an American prescription co-signed in Canada. (Shutterstock)

"It's a foreign country to them and it's not something they've ever even fathomed," he said.

"And then there's another portion of people that are staunchly patriotic and feel that they're American and they should be getting their prescriptions here."

But he said usually when they explore the cost difference, they decide it's worthwhile to make the trip.

Prescriptions can be co-signed by Canadian physician

The College of Physicians and Surgeons of New Brunswick offers a border-area licence for doctors in Quebec, Nova Scotia, P.E.I. and Maine. It must be renewed every year.

The Canadian Pharmacists Association does not know for certain exactly how many Americans are crossing the border to buy prescription drugs. (Shutterstock)

Ed Schollenberg, the college's registrar, said it has about 40 physicians who are licensed in New Brunswick practising in Maine.

He said he doesn't know how many Americans are crossing into New Brunswick to buy prescription drugs.

But the most common way Americans can get a valid prescription is by getting it from a U.S. doctor and having it co-signed by a Canadian physician.

Co-signing has been deemed unethical by some regulatory bodies because, in some cases, the Canadian doctors weren't seeing or even speaking to these patients.

Jordan Rosenblatt works with Mark's Marine Pharmacy in Vancouver, roughly 40 kilometres from the U.S. border. He said there are a number of doctors who work with them to serve American patients.

"They check the medical profile to ensure that it's the right medication, there's no interactions with other medications, that it's properly suited and, assuming it is, they will rewrite them a new prescription," he said.

At Mark's Marine Pharmacy, none of this is done online. Rosenblatt said it's either over the phone or in person, and he understands why Americans come north.

"The [U.S.] prices are absurd," he said. "Quite frankly, when we hear the prices, I often wonder how people would really afford it if it wasn't for options like us."

But online pharmacies do exist in Canada, and so do their illegitimate counterparts posing as a Canadian pharmacy.

"There are reports in nearly every state of somebody receiving a counterfeit drug," said Norman Tomaka, spokesperson for the American Pharmacists Association.

The concern for patients isn't just about the legitimacy of the drugs. It's also about drug interactions and the overall picture of a patient that gets lost when another physician, who doesn't know the patient, gets involved.

"It's unsafe because it's fragmented," Tomaka said. 

He said he also has concerns about commercial imports of Canadian drugs into the U.S.

"Allowing for open drug importation to our northern neighbour would increase the likelihood of patient safety lapses and reduce the patient-pharmacist connection in helping patients properly use their medicines."

In February, the American Pharmacists Association and Canadian Pharmacists Association issued a joint statement opposing federal legislation allowing for importation of Canadian prescription drugs into the U.S.

While there are different ways Americans are able to obtain Canadian prescriptions, experts say it's not having an impact on the health-care system or the drug supply. (The Associated Press)

Tomaka, who is also a clinical consultant pharmacist in Florida, said he once had an elderly person come into his pharmacy in tears. She was unable to afford her antidepressants, so she sent away to Canada to purchase them.

She failed to tell the online pharmacy about another drug she was taking for pain management. They sent her a slightly different version of the drug she was on, which lowers a person's seizure threshold — something her pain-management drug also did.

"She told me that three nights prior to that she had a seizure she went to the emergency room," Tomaka said.

He was then able to work with her and her physician to bring down her dosage of the pain medication and switch to a more affordable drug in the U.S.

"All that work I did, I loved doing," he said.

"But that process could never, ever have taken place by her taking a piece of paper and mailing it to the Canadian pharmacy."

The U.S. Federal Drug Administration allows for a three-month supply of prescription drugs to be brought into the U.S. for personal use. (Elaine Thompson/The Associated Press)

He said if it was mostly doctors with dual licences writing the prescriptions, that would alleviate many of the pharmacists' concerns.

"Is that common? Heck no. I would venture to guess that that is so uncommon that it's a border-state phenomena," he said.

"I don't think you see a lot of dual-citizen physicians wanting, out of the kindness of their heart, to add more work."

But this, Tomaka said, would not deal with the bigger issue.

"We've got a drug-pricing problem in United States and we are not addressing it at all."

We've got a drug-pricing problem in United States and we are not addressing it at all.- Norman Tomaka, clinical consultant pharmacist

With no solution in sight, the flow of Americans is likely to continue to Canadian pharmacies.

"It really speaks to the desperation that people are facing in the U.S. trying to deal with the cost of health care," said Barry Power of the Canadian Pharmacists Association.

"I think there needs to be some movement from the federal government to make sure that the drug supply chain for Canadians is not disrupted through these mechanisms."

For now, Flynn will continue sending his desperate patients in Maine over the border.

"I don't think necessarily that the Canadian government is all that happy with a lot of Americans going across the border," he said.

"So I expect at some point there's going to be some roadblock or red tape put in place for Americans to get across, but in the last 25 years it hasn't happened yet."