Will Canadian mail-order pharmacies negatively affect American pharmacies?

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Mar 23, 2003
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Canadian mail-order pharmacies can provide prescription drugs to Americans for a low price. Won't this negatively affect American pharmacies?

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Check this thread out: http://www.studentdoctor.net/forums/showthread.php?s=&threadid=64509

I really don't know...domestic mail order pharmacy operations have been around for some time and have since taken a small bite from the pharmacy pie. It could potentially affect pharmacy by taking away some of the patients who purchase a large number of prescriptions to manage their disease states, especially if they need to purchase brand-name Rx's (since the Canadian gov't puts a cap on how those brand-names are priced).

But what can the federal gov't do? Pharmaceutical companies have something like seven years after approval to recoup the losses they've incurred in the "drug discovery" process. Americans subsidize the "drug discovery" process by paying up the wazoo for those brand-names. But the companies still rake in a large profit...guess it's gonna depend who wins the lobbying/campaign contribution tug-of-war....big pharma vs. AARP.

On another level, getting scripts filled in a foreign country could mean that the patient won't be getting properly counselled on the use of the medication, and their entire drug therapy regimen won't be properly monitored for drug-drug interactions.
There was an article in our paper two weeks ago about some people who have set up shop selling Canadian drugs. Anyone can come into their store with a prescription and then they order it from Canada. The person picks it up, just like it was from their local Wags. The main problem is that these stores are run by businessmen, not pharmacists.

I wrote an editorial to the paper, that patiients won't get properly counseled, that errors in scripts won't be caught, etc. Of course, they didn't print it.
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I know that in the province of Ontario, pharmacies cannot dispense medication overseas (including the States) unless the patient provides a prescription written by a doctor who is actually licensed in Canada. So, technically, it is completely legal---at least in Ontario, for Americans to order prescriptions from Canadian pharmacies as long as they can find a Canadian licensed doctor living and practicing in the USA.

The Canadian pharmacy I work for gets a lot of emails from "enterprising non-pharmacist" Americans who propose to act as 'distributors' to the drugs ordered by our pharmacy. Of course, we delete all those emails and don't respond because it would be unethical to service these people. It makes me really mad how these people can actually try to make money off of pharmaceuticals when they don't know a thing about drugs and moreimportantly, didn't shed all the blood,sweat, and tears that come with going through pharm school (from undergrad admissions to graduation).
Anyhow, these kind of proposals that we get, to supply medication to entrpreneurs in the USA, Russia, & India makes me realize how valuable and important the PharmD. degree is worth. The pharmD. degree is so coveted.... So many people wish that they too could be licensed to sell drugs legally....not just anyone can sell pharmaceuticals like anyone can sell cars, candies, and other goods. It's just another reminder to all those who are working hard in school in order to get their pharmacy degree, that it's all worth it. Of course, being an ethical and responsible pharmacist with integrity is the biggest honour of all! ;)
Well, guess what became a topic in my "Pharmacy Communications" class today? The professor had learned of one of these Canadian pharmacy "storefronts" opening up on the west side of Las Vegas and decided to give them a list of about 8 meds to check the costs and see how they would be able to fill them. The storefront is operated by a non-pharmacist, and all new scripts need a $10 "physician referral fee" whereby a licensed Canadian physician will review the script and ok it. Shipping would cost about $18. The cost was below the cash price at Walgreens (that's where the prof works on occasion).

The bottom line is: where is the pharmacist? Isn't this an "illegal pharmacy" that should be shut down by the state board of pharmacy for distributing meds without a licensed pharmacist? There is NO ONE to insure the patient's safety. If something goes wrong, and the patient's meds are misfilled, there will be no way to sue the establishment located in Canada (at least, easily), and no pharmacist who is accountable to the state board or to the courts. All risk is assumed by the patient; not shared, as is usually the case.
Yeah, how is that legal? Can't you contact the NV state board of pharmacy and ask them about this? I'm sure they can't be pleased about it for several reasons.

I'm kinda confused too. How can that little shack be selling the drugs for less than cash price? Does this mean they're just buying the drugs from the pharm co's and then just marking it up less than the walgreens?
Yes, the markup is less, because the price of brands are (I believe) capped by the Canadian gov't to a certain amount (don't remember what)...and this is for brand name, not generic. The Canadian route would seem to offer savings to individuals on meds that are still on patent and are not available as generics yet. In any case, this "cap" is what allows Canadian pharmacies to undercut domestic retailers.

I think U.S. retailers have a lower profit margin on brands since they are so expensive already...the market wouldn't be able to bear a higher markup. They make up for this low profit margin on brands with higher markups on generic. Example: one of our Henderson Wags will sell a 30 day supply of Fluoxetine generic for ~$160. Costco, which operates on lower profit margins on all their stuff, will sell the same 30 day supply for ~$20. Quite the markup! (about 8x)

So yeah, cash price for brands are already high here in the U.S. not so much due to the retailers, but to the manufacturers.

I heard that Oklahoma SBOP has filed lawsuits against some of these storefronts for running illegal pharmacies (or it could be just one establishment, don't remember). The FDA has taken some sort of action against them as well. I'll bet you other state's BOPs are paying attention to Oklahoma...and will base their actions on what happens there.

Oh, and that new Canadian pharm storefront here in Vegas? It was in the LV review journal the other day....it's in the news. It's just a matter of time before I'll see it on the agenda for upcoming NVSBOP meetings. We'll see.
this is all semi-illegal and FDA is starting to crackdown, but this is another one of those things that could put many retail pharmacies out of business.
the lesson for the pharmacist is that one had better be prepared to do something other than retail if this whole drug distribution thing we have now starts to collapse.
btw, mail order pharmacies also employ pharmacists heh. if you happen to live close to one of the giant distro centers, might be something to consider.
I live within walking distance of Merck-Medco, the big mail-order operation. I think it's one of the largest pharmacies anywhere in the world, in a very large, but non-descript building...there are no signs anywhere to indicate that it is Medco Health (just the corporate flag underneath the US flag). The school had tours of this facility, but I was unable to go. I hear it is quite difficult to get an internship there, but it is a good way to get your "foot in the door". They have plenty of part-time positions for pharmacists, but full-time positions are harder to come by. I know a pharmacist who works there part time, and works hospital full time.