As prescription prices in the US continue to skyrocket, the idea of importing cheaper drugs from Canada has gained popularity, favored by politicians as diverse as Bernie Sanders and Donald Trump.
Between 2 and 8 percent of Americans already turn to foreign pharmacies to save on the cost of their medications. (The practice is currently illegal, but enforcement is patchy.) And polls have long found that a majority of Americans would support legalizing drug importation from the Great White North.
Last week, a proposal, co-sponsored by Sanders (I-VT) and Minnesota Democrat Amy Klobuchar, tried to do just that. The Senate Democrats pushed forward an amendment to a budget resolution aimed at lowering prescription drug prices by allowing American pharmacists, wholesalers, and individuals to bring in cheaper drugs from Canada. As Sanders said in a statement:
The American people pay, by far, the highest prices in the world for prescription drugs. ... But while the drug companies and their executives do phenomenally well, nearly 1 in 5 Americans are unable to afford the medicine that their doctors prescribe.
But the measure, which would have been non-binding, failed by a 52-46 vote. And Cory Booker, in particular, drew fire for joining a dozen Democrats who opposed the amendment, citing concerns about the safety of medicines coming in from Canada. Here’s Booker:
I support the importation of prescription drugs as a key part of a strategy to help control the skyrocketing cost of medications. Any plan to allow the importation of prescription medications should also include consumer protections that ensure foreign drugs meet American safety standards. I opposed an amendment put forward last night that didn’t meet this test.
So this raised a question: Are there actually safety concerns about Canada’s drug supply?
Are drugs from Canada really more dangerous?
To find out, I emailed some of the leading drug safety researchers in Canada and the US. They said they knew of no good evidence suggesting drugs regulated by Health Canada (the Canadian equivalent of the US Food and Drug Administration) were any riskier than the FDA-regulated drugs sold down here.
"There is nothing whatsoever ‘unsafe’ about drugs approved by Health Canada or most Western European countries, or Japan, or Australia," said Jerry Avorn, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston, in an email. "There isn't any evidence that citizens of these countries are having any problems with the purity or effectiveness of their medications."
Joel Lexchin, a professor of health policy at York University in Toronto, called the idea that Canadian drugs are any less safe than US ones "absurd." He added: "Some of the drugs sold in Canada come from the US, and many of the drugs sold in both the US and Canada come from the same manufacturing plants overseas."
I also dug into the research on this question — and didn’t see any red flags. Researchers have done studies comparing the quality of drugs purchased online from Canadian pharmacies with their US equivalents, and found they’re pretty much the same. Some studies have raised concerns about drugs from pharmacies that aren’t certified by groups like the Canadian International Pharmacy Association or PharmacyChecker — but you’d run into the same issue buying drugs online from sketchy sources anywhere.
In other words, the research doesn’t suggest that Canada’s drug supply is particularly problematic.
If safety isn’t a serious concern, why would Booker and other Democrats kill the measure? The pharmaceutical industry has long lobbied against importation measures, including by citing safety concerns. And as Ellie Shechet at the Slot pointed out, the Senate Democrats who opposed the measure happen to be cozy with the pharmaceutical industry:
Between 2010 and 2016, a handful of the Democratic senators who voted "nay" [to the amendment] were amongst the top Senate recipients funded by pharmaceutical companies: Sen. Booker received $267,338; Sen. Patty Murray (D-WA) received $254,649; Robert Casey (D-PA) received $250,730; Michael Bennet (D-CO) received $222,000.
Vox’s Jeff Stein also noted one other possible explanation: Booker was voting to protect his state’s interests. New Jersey is home to a large number of pharma companies, Stein writes, and "Booker was following the predictable, longstanding pattern of elected officials to try to protect the jobs and industries that dominate their home states."
Bringing in drugs from Canada won’t fix the problem of skyrocketing drug prices
There are other reasons not to like importation bills, however. "Going around FDA removes a layer of protection for American consumers," said Josh Sharfstein, an associate dean at the Johns Hopkins School of Public Health and former deputy commissioner of the FDA. Indeed, when I asked Booker’s office for comment, they pointed out that previous FDA commissioners have pushed against such efforts since the agency doesn’t have authority over other countries’ drug distribution systems.
The potential solution is that the FDA could take the lead on developing a system for importing products safely. "[They already do this] to facilitate the importation of products from other countries to address drug shortages," said Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who researches the drug approval process.
But even if that happens, there’s one other thing to keep in mind: Legalizing importation won’t actually fix America’s drug pricing system — the cause of the skyrocketing drug prices here and the reason we’re talking about drugs from Canada in the first place.
In countries with single-payer systems, like Canada, governments exert much more influence over the entire health care process. That allows them to negotiate directly with drugmakers. The government sets a maximum price that it will pay for a drug, and if the company doesn't agree, it simply loses out on the entire market. This puts pharmaceutical companies at a disadvantage, driving down the price of drugs.
"Canadian drug costs are lower explicitly because the Canadian government makes the hard decision of deciding whether or not to cover a newly approved therapy, and Canada bases that decision on the drug’s value to its citizens," said Joseph Ross, a professor of medicine at Yale University.
The United States, by contrast, has long taken more of a free market approach to drugs. Pharmaceutical companies can haggle over prices with a variety of private insurers as well as selling to the government. What's more, Medicare, the government program that is the nation's largest buyer of drugs, is actually barred from negotiating drug prices. That gives Pharma much more leverage.
So drug companies here do what any other profit-maximizing company does — they try to get the highest prices possible without going so high that no one will buy them. And they do this because they can. There is no government regulator pushing back.
Instead of ushering in a new drug pricing system for Americans, importation bills allow Americans to access cheaper Canadian drugs and introduce a measure of competition to the drug market, which may incentivize drug companies to lower prices. But these bills are more of a temporary workaround than a sustainable, system-wide fix. "The US government needs to take action to lower its own prices," Lexchin added, "pie-in-the-sky wish though that is."