Lee Higman, a 71-year-old artist from Bellevue, Idaho, who considers herself a law-abiding citizen, was shocked last month when she got a notice from the Food and Drug Administration telling her: “A mail shipment addressed to you from a foreign country is being held.”
The 90 tablets of Vagifem she had ordered from a Canadian pharmacy that her physician prescribed had been impounded as an illegal drug at Los Angeles International Airport.
First marketed in 1988, Vagifem estrogen tablets are used by millions of women to relieve symptoms of menopause. There is no generic version available in the United States, and brand-name drugs are pricey here. So about five years ago, Higman started ordering the tablets from Canada, where a year’s supply that would cost about $1,000 in the United States sells for under $100.
“The price went up. And we’d lost a lot on the stock market, and we’re living on fixed incomes,” Higman said in an interview. She and her husband, a writer, are covered by Medicare. In an email to the Food and Drug Administration, she sought the release of the package, explaining: “When it became economically imperative I ordered it from Canada, a country with strict drug requirements.”
Many strategies for obtaining meds
The high price of many prescription drugs in the United States has left millions of Americans telling white lies and committing fraud and other crimes to get their medicines. In response to a New York Times article about the costs, hundreds of readers shared their strategies, from having a physician prescribe twice the needed dose and cutting pills in half, to “borrowing” medicines from a friend or relative with better insurance coverage. But an increasingly popular — though generally illegal — route is buying the drugs from overseas.
The Canadian International Pharmacy Association, a 10-year-old pharmacy group, said its members fill prescriptions for 1 million Americans each year. “It’s the Americans who are seeking us out,” said Tim Smith, the group’s general manager. “Clearly there’s a need.”
In surveys from 2011 by the Centers for Disease Control and Prevention, about 2 percent of adults and about 5 percent of the uninsured said they had bought prescription drugs from other countries. The figures likely underestimated the practice because people may be reluctant to admit to doing something illegal, even though the law is rarely enforced in such cases.
The FDA says on its website that “in most circumstances it is illegal to import drugs into the U.S. for personal use” because the agency cannot guarantee they are safe and effective. The government also prohibits “reimportation” of drugs made in the United States because it cannot guarantee the medications were not tampered with or stored improperly.
The agency said it does not track the volume of such imports. However, it “typically does not object” to people buying imported medicine for personal use “under certain circumstances,” the agency said. Those include using the drug to treat a serious condition for which an effective alternative is unavailable in the United States and purchasing less than a three-month supply. But those ambiguous edicts have left patients wary.
Dr. Stephen Barrett, a retired psychiatrist and health care advocate in North Carolina, said he has saved thousands of dollars buying medicines from overseas in the past decade. “It may be technically illegal, but I don’t think anyone would ever get prosecuted,” he said, adding that such laws reflected “protectionism” for drugmakers. Although the Obama administration initially proposed allowing some importation of drugs, the idea was dropped from the Affordable Care Act after intense opposition from the pharmaceutical industry.
Some purchases from overseas pharmacies are identical to products sold in the United States. When an FDA compliance officer told Higman that her order of Vagifem was held because it was an “unapproved” drug, she responded: “This drug might come from Turkey, however, it is in the same box, the same packaging, the same labels, the same manufacturer, Nordisk, as the outrageously priced Vagifem in the United States.”
Identical drugs sold in other countries may have different package inserts, slight variations in dose or different brand names. But that is frequently a function of patent law and business decisions by drugmakers, rather than medical efficacy.
Diana Simonson, 42, a freelance computer programmer in Glens Falls, N.Y., said she started ordering her inhalers from Canada after she nearly died of an asthma attack in the United States, where she cannot afford her preventive treatments.
The process is simpler for patients who live near the border. Joshua Kalish, 70, of Silver City, N.M., said that before he was eligible for Medicare, he drove to Mexico to fill all his prescriptions, calling it a “common practice.”
Higman said she is also heading for the border. Despite her pleas, the FDA told her that her Vagifem tablets would be returned to Canada or destroyed.
To tide her over, she has spent $233 for two months of Vagifem at a local pharmacy. “Fortunately my children and grandchildren live in Seattle, so the next time we go over there, I’ll take a little trip up to Vancouver, British Columbia, to buy my medicine,” she said. “I’ll save enough money to get room service in a five-star hotel there and still have enough left to claim I saved a couple of bucks.”