The price difference would be even higher if prices at Canadian internet sites were compared to walk-in U.S. pharmacies, said Dr. Mark Eisenberg, senior author of the study, appearing in the Sept. 20 issue of the Annals of Internal Medicine.
"There's a huge, huge outlay for pharmaceuticals in the U.S, and prices are artificially high," said Eisenberg, an associate professor of medicine at McGill University in Montreal. "The same exact drug manufactured by the same exact company costs much less in Canada, so people in the U.S. are paying higher prices than they have to."
The findings were hailed by some activists in the field.
"On a drug-by-drug basis, someone could save well over $1,000 a year. For someone who is not covered by the soon-to-be-rolled out Medicare program and isn't elderly and doesn't have any coverage, $1,000 is huge," said Sharon Treat, executive director of the National Legislative Association on Prescription Drug Prices in Hallowell, Maine. "It explains why some people are doing this. It explains why at least 22 states this year looked at legislation addressing importation." The association acts as a clearinghouse for information for legislators interested in this issue.
"While there is a widespread perception that prescription drugs are less expensive in Canada, there has not been much research to back this up. Everybody says it's cheaper in Canada and no one knows if it is and, if so, by how much," Eisenberg said.
In the United States, soaring prescription drug costs and the growth of the Internet have fueled cross-border drug sales in recent years, with one U.S. Department of Heath and Human Services study estimating that more than 12 million prescriptions destined for American patients were filled by Canadian pharmacies in 2003 alone, for a total $700 million in sales.
The U.S. Government Accountability Office recently reported a 25 percent overall increase in U.S. retail drug prices from 2000 to 2004. Price hikes for two brand-name drugs from Pfizer Inc., Lipitor and Celebrex, had the most impact on that increase.
While the Bush administration has firmly opposed legalizing drug imports, government leaders in various U.S. states and cities have set up programs to help cash-strapped residents buy their pharmaceuticals from Canada.
The U.S. Congress is expected to pass legislation to ease Internet drug sales. But in a new twist, the Ottawa government, concerned that pharmacy sales to the U.S. may cause domestic shortages in Canada, is drafting legislation to restrict bulk exports of Canadian drugs, although the legislation is not likely to be as severe as once feared. Any changes would probably not happen till later this year.
The authors of this study compared prices on 44 common brand-name medications at 12 highly ranked Canadian internet pharmacies and three major online U.S. chain pharmacies: CVS, Rite Aid and Walgreen's.
The survey, conducted at the end of 2004, found that 41 of 44 medications were less expensive on Internet sites north of the border.
The medications with the largest mean yearly savings were Zyprexa (for schizophrenia and bipolar disorder) with annual savings of $1,159, Actos (for control of diabetes), with savings of $852, and Nexium (for heartburn), with savings of $772.
Only three medications, all of them for erectile dysfunction, were more expensive in Canada. This is because so-called lifestyle drugs do not have the same price controls as drugs that are considered "vital," Eisenberg explained.
The mean savings at Canadian internet pharmacies was 24 percent per dose.
Canadian price savings apparently extend beyond medications, Eisenberg added.
"The same stent here costs much less than it does 30 or 40 miles away in northern New York State," Eisenberg said. "I published a paper a few months ago comparing the cost of bypass in Canada and the U.S., and it was half as much here with the same outcomes."
Why the difference?
"Companies will charge as much as the traffic will bear, and the traffic will bear much more cost in the U.S. than in Canada, and that keeps driving up costs," Eisenberg stated. In addition, Canada has placed price-control measures on brand-name prescription drugs.
Some thought the findings might spur the U.S. government to modify its stance on imported drugs.
"Maybe this is one way to move the federal government," Treat said. "It's a ridiculous way to be addressing the problem to go state by state, receiving threats from the government saying it's illegal, and yet states are doing it anyway. It just shows how desperate they are to come up with anything to reduce drug prices for their citizens."
More information
AARP has an article on assessing Canadian pharmacies on the Internet.
The causes of eating disorders, such as anorexia nervosa and bulimia, are often multi-faceted, which can make the conditions difficult to treat.
The best cure is prevention, says the U.S. Naval Hospital in Camp Pendleton, Cal. Here are five ways to help combat eating disorders:
- Talk to your kids about natural differences in body shapes and sizes.
- Avoid negative attitudes or conversations about weight.
- Don't discourage activities, such as swimming or dancing, just because they draw attention to weight or body shape.
- Talk to your kids about the misguided way in which appearance is linked to success.
- Be a good role model by eating nutritious meals and exercising regularly.
