One of the Trump Administration’s big drug pricing policy proposals was to allow for states to import prescription drugs from Canada and other nations. The logic is that Canada has much cheaper drugs and importing drugs will lead to both lower US prices through both direct channels and indirect, competition channels.
Canada has a say.
Canada has always been willing to look aside at retail level importation schemes such as a bus leaving Boston at 0400 to go to Montreal for lunch and a pharmacy run before returning to Boston at midnight. But the big question is would Canada allow for massive importation and immediate re-exportation of prescription drugs on a population level instead of an individual level.
On Friday, Canada moved to block the export of drugs intended for the Canadian market citing the risk of drug shortages….
“Canada is a small market, representing 2% of global drug sales, that sources 68% of its drugs internationally,” a statement from Health Canada said. “The need for vigilance in maintaining the national drug supply continues.”
On Monday, the Food and Drug Administration‘s final rule went into effect, allowing Canadian drugs to be imported for sale by states, Indian tribes, pharmacists and wholesalers after President Donald Trump pushed the measure forward in a July executive order. But Canadian health officials said they would prohibit drug exports without paperwork showing that sending drugs to the United States wouldn’t cause a shortage.
Canada, and most of the rest of the OECD get significantly lower drug prices for a simple reason; they have credible systems of “NO” or more often “NO, NOT AT THIS PRICE!”
The United States barely has national scale systems of no. Instead, it is a patchwork of formularies, pre-authorizations and politics.
The drug importation rule is basically an attempt to import other countries’ “Systems of No” to the United States.
The problem is that other countries, including Canada can and will likely say No to the US free-riding off of their work.
SiubhanDuinne
People were worrying about you in the open thread downstairs :-)
Enhanced Voting Techniques
Plundering other countries to pay for your own internal negligence is classic faschim.
Barbara
The sheer duplicity of wide scale importation schemes never ceases to amaze me. Consider Florida. Trump apparently used the threat of socialism as a way to peel voters away from Biden. And if you were to propose an actual regulatory regime for imposing rational limits on drug pricing, the usual suspects (beginning with Rick Scott and Ron DeSantis) would be bellowing about socialism until their lungs gave out. But their constituents — many of the same people who can be riled up about the big S — are unhappy about the price of drugs. And the solution of their elected leaders is to import the drugs from Canada. So, basically, it’s okay to import someone else’s socialist solution, just not to implement anything actually tailored to our own domestic market for drugs. The people who propose importation are worse than brain dead. They are spending actual state resources, in Florida’s case, millions of dollars, to pursue a completely stupid and dishonest policy. I am glad Canada took a hard pass. We should solve our own Goddamned problems without burdening other countries with them. Even without Canada, no U.S. distributor was willing to respond to Florida’s RFP for importation. For one thing, they would jeopardize all their other business relationships with, you know, manufacturers of drugs in the U.S.! It cannot be said enough: these people are stupid and they don’t give a flying fuck whether you have to decide whether to eat or take your medicines on a month to month basis.
bbleh
At least from what I can tell, this alleged effort by Trump is far more scam than substance, for which of course both Trump loyalists and much of the US media are duly falling.
Look, almost every other country in the world has some form of drug price control, mostly (though not all) via “cost-effectiveness” analysis (basically “bang for the buck” for drugs, or more specifically improvement in quality of life vs. increase in price, compared to the standard of care), and US and global pharma firms (and academic institutions and payers and others) routinely carry out those analyses. That is, the work is already done. What is lacking in the US is the political will to impose a similar regime and thereby limit the profits of pharma manufacturers and pharma benefit managers, and this of course is because US politicians — mostly but not exclusively Republican — put the financial interests of those companies ahead of the interests of the people.
Wag
I hope that Biden is able to rectify the huge problem of American drug prices. For far too long we have supported the profit margins for the global pharmaceutical industry, while paying outlandish and ever increasing prices for our medications.
One of the goals for the Biden administration should be building consensus around issues. High drug prices is one of the few areas of agreement by voters (but NOT politicians) across the political spectrum. By working to seriously address this issue, Biden has an opportunity to build a coalition that he might be able to leverage to address other issues as well.
The Moar You Know
Additionally, the Canadian government subsidizes drugs for Canada’s consumers, on top of their already rigorous price controls. I think Canadians might lose 100% of their famed politeness if they find out their tax dollars are going to subsidize America’s failed pharma policy.
Yarrow
It’s my understanding that these sorts of trips have been curtailed by the pandemic. Also Mexico border crossings for pharmacy stock ups and dental work have been halted. Definitely makes things more difficult and expensive for people who depend on those sorts of trips to get medications they need at a price they can afford.
Speaking of medications, I’ve seen a lot of “pharmacy clubs,” for lack of a better way of describing it, springing up recently. Like GoodRx. Is there some reason for that? If I need a medication I look around for those kinds of things and compare it to what my health insurance plan has. A lot of times those are cheaper.
So my question is, why are so many of those “pharmacy clubs” springing up at the moment?
Booger
@bbleh: Yes, but do those countries have all those commercials on mid-day teevee featuring all those beautiful silver foxes and silver vixens living their best lives because their doctor prescribed coxafloppin or whatever?
I think not. Checkmate, libs!
Note: I had to break up your single line because that breaks the site margins and makes the thread unreadable for folks on phones and tablets. ~WateerGirl
Yarrow
@The Moar You Know: Canada’s gonna build that wall and we’ll pay for it. Can’t really blame them.
Yarrow
@Booger: Can you please edit your long word so there are spaces. It totally messes up the margins. Thanks.
Ken
@Booger: Please break up the long lines, they break some devices.
I’m in complete agreement with the sentiment, of course. My favorites (for lack of a better word) are the ones for some relatively trivial condition, like dry skin, where possible side effects include something horrible like kidney damage or stroke.
Ramalama
@Yarrow: We watch American tv up here in Canadiaville. When we first saw the GoodRx commercials, my partner asked me, “Why does one company offer better deals on medications than … other ones?” It literally made no sense to her. This made me, an American, see yet another example of complete folly, one of many, in the US healthcare system.
bbleh
@Booger: Lol, advertising — of all kinds, direct and indirect, and to prescribers as well as consumers — for prescription drugs is another gigantic can of worms, but in my experience it’s largely separate from cost-effectiveness controls and from market access generally. And I’d add that I half-suspect that pharmacos would actually welcome the reimposition of the effective (though not legal) ban on direct-to-consumer advertising that existed before the Reagan years, if only because it’s turned into a hugely expensive arms race that probably doesn’t change market share much in the end.
Ramalama
@The Moar You Know:
Canadians know better. Americans thinking about Canadians need to remember that Quebec is also part of Canada. There is nothing famed about their politeness. Désolée!
Yarrow
@Ramalama: Health coverage and treatment being a “competitive market” is immoral, imo. It leads to a few people having excellent care because they can afford it and a lot of people having none because they can’t. Pretty much where we are now.
Doug R
With Canada at about 12% of the USA population, we don’t mind helping a neighbour out, especially ones that sell us cheap gas, milk, cheese and eggs.
BUT we won’t let a huge population scoop up all our cheap drugs at the expense of our own population.
Interrobang
@Doug R: Yes, exactly what you said. Speaking as a Canadian, I’m glad Health Canada said no to this, because it’s not fair to us at all. The US shouldn’t be free-riding off our price controls and buying power; the US needs to fix its own damn problems.
It would probably make prices go up for us and create artificial scarcities, and that’s really not fair for us.
Yarrow
When a friend’s pharmacy plan would only cover generic of a medication he needed, and that medication had been in the news for the generics having problems and not working, his doctor actually told him to order the brand name version from Canada. Gave him the name of a website to use. It was something like a third the price of what the brand name one would have been had he bought it in the US and paid cash at the pharmacy.
Yarrow
@Doug R: @Interrobang:
As Canada should! Can’t blame you guys at all. It’s one thing to have a few individuals come over the border and buy medications. It’s another thing entirely to have the US create shortages for Canadians. The Canadian government is standing up for its citizens, which is its obligation and the right thing to do.
burnspbesq
The story has always been that Americans should suck it up and accept high prices for on-patent prescription drugs because we’re paying for all the R&D that all those selfish countries shirk paying their fair share of through evil schemes like price controls and compulsory licensing. Having turned in my economist card when I got my bar card, I have no idea whether that’s truth or propaganda—but it seems like an empirically testable hypothesis.
burnspbesq
@Yarrow:
You might be surprised at how quickly Canadian distributors would adjust their order quantities.
burnspbesq
@Ken:
‘I’ve had a front-row seat for legal review of food advertising. I can only imagine what it’s like for prescription drugs.
J R in WV
Imagine that — someone told Trump “NO!” and can make it stick!!
I agree with other posters who think making health care in general a for-profit industry is highly immoral.
I have occasional Irritable Bowel Syndrome. It is apparently sometimes caused by genetic influences as my cousin also has it and my mom apparently had it, although she never talked about it directly. My family doc prescribed a medication that helped a great deal.
It was a very inexpensive generic medication, a blend of two other common generic medications. Like $5.00 copay for a 3 month supply inexpensive. Then one day it was no longer “On the formulary” my insurance published. So I asked the pharmacy tech how much it would cost as a straight cash purchase. How about $3,000 !?!?!???
Some MBA wealthy person did a Pharma Boy stunt like Martin Shkreli, only on my IBS drug. Bought up the rights for a song, since no one was making much money from it, and boosted the price by a boatload. So now I take a similar drug that doesn’t work quite as well, but only costs $9.37 copay for a 3 month supply.
Teach me how this is not immoral?!!?!!!
When I needed joint replacement surgery on both shoulders, no one could tell me what my out-of-pocket cost would be for any part of the months-long process would be. How is that acceptable? You need an MRI. OK, how much will that cost? No one knows… WHUT??? How can that be? I can get a detailed price list at the Ford garage for work on the truck, or at Mazda for work on the car…
But for work my my body, no one knows?
I’m glad Canada told Trump to piss up a rope. Hope they stick to that policy. If it happens enough, maybe D J Trump will learn a lesson?
Gravenstone
@Booger: Don’t break the page with run on words, por favor.
Yarrow
@burnspbesq: From the article above:
If Canada imports enough so they can cover American export needs without shortages in Canada then problem solved.
Wag
@burnspbesq: We are subsidizing the world wide profits for the industry, not the R+D costs. If we begin to play hardball, other country’s prices may rise a bit, but it will just reflect a much needed leveling of worldwide prices.
scav
@burnspbesq: While I’m sure there are economists that will not only believe in empirically derived data but respect what it demonstrates, they’re certainly not the ones with the loudest tongues and the firmest grip on the lapels of the American infrastructure. All hail theory! and the necessarily maximizing man! is the usual cry.
Gravenstone
At a guess they work like store loyalty cards, where the customer data is sold back to various parties (in this case, probably the pharma companies) who fund the discounts while getting reams of customer data to massage and manipulate for greater gains.
Booger
Hey, can’t seem to edit my comment. Can a front pager delete it? Sorry.
Yarrow
@J R in WV: Sorry about your medication struggles. It is immoral, imo. Have you checked into pricing on places like GoodRx, etc.? Sometimes worth a double check just in case something has changed.
Yep. It’s immoral, again. I once spent the better part of two full days trying to find out how much a CT scan would cost. I spoke to everyone. The office business manager was in tears by the time I was had spend half an hour on the phone with her asking her how she would feel if she were in my position not knowing if this procedure would bankrupt me. I tracked down the radiology outfit that was supposed to read the results. No way of knowing anything ahead of time. I spoke with the mediation people at the insurance company. Again, no idea. Could have been $5, could have been $50,000. Not even a range of, “it’ll be between this and this.” Just no idea at all. Absolutely immoral.
scav
@Yarrow: And yet the economic norm is still to assume the perfectly informed consumer.
Yarrow
@Gravenstone: Could be. I recently had to pick up a prescription for someone. They had insurance and various pharmacy clubs on file. The insurance didn’t cover it and the pharmacist literally ran though all the various options to “find the best deal,” she told me. I was kind of impressed. So one “pharmacy club” won’t necessarily have all the info because people use different ones at different pharmacies to get the best price. I guess they could share the info.
Kent
That is the most humorous suggestion I’ve seen all morning.
Yarrow
@scav: It’s maddening beyond belief. You simply CANNOT be informed. It’s not possible. The people at the various offices or companies do not have the information so cannot give it to you.
I sometimes see articles on this issue – reporters trying to find out how much something will cost. And they’re always the same as what I and JR experienced. Can’t get the info until the procedure is done, no or an extremely wide range for cost, no way of knowing if your radiologist or other doctor is in-network. And yet the prevailing story is that consumers can be well-informed if they’re just willing to do the work to find the info. Total BS.
Roger Moore
@Wag:
Everyone agrees we want lower drug prices; they just don’t agree on how we should achieve low prices. Even the drug companies would be happy with low consumer prices as long as they’re achieved by some kind of subsidy rather than restricting profits.
Enhanced Voting Techniques
There is two obvious problems with Plan Trump here;
1) all the money will be going to Canada and Canadian companies. While I suppose it minimizes the Trump’s own circle from emebelezzing it, still,…
2) For the Canadian deal to work it would require the Trump admin to file the correct paper work, presumably predicting American demand under the program and showing why it wouldn’t result in a shortage in Canada. Forecasting is something Trump admin been utterly incapable of even trying to do for the last four years.
Matt McIrvin
Reminds me a little of the conversation I got into around the time of the debates over the ACA, in which one participant explained that all health insurance is a scam and everyone should just do what he did, which was to pop over to Mexico for all his health care.
Cheryl from Maryland
@Yarrow: Our local CVS does that, which is amazing considering CVS. But none of that is the appropriate, political solution to have the government set prices rather than have individual consumers on their own.
barbequebob
I seem to recall that when prescription drug coverage under medicare (Medicare D) was established during the W Bush administration, the law establishing it specifically prohibited negotiating with pharmaceutical companies over prices? Can someone more knowledgeable than I on this subject comment as to whether this is, and remains true, and what the impact on prices today would be if we had the bargaining power of Medicare exerting downward pressure on drug prices.?
Villago Delenda Est
The VA strongarms big pharma to lower prices. They should do that for all, and let the pharma execs suffer in penury.
patrick II
@bbleh:
Drugs are what we are talking about here and now, but I will say the whole medical system is out of wack because we are overly applying capitalism/free-market solutions to something that is a condition, not a commodity. You have a choice not to buy a new tv, not a choice if you need chemo. This data is a few years old, but I had an MRI about 10 years ago, it was $1,700. In Japan it would have cost $160, with similarly low prices in France and Germany. (I looked them up at the time).
Ronald Reagan campaigned against Medicare, calling it socialism. Not many over the age of 65 would give it up to go on an unregulated market today. Somehow making sure regular people get a larger share of the wealth is “socialism” and bad, and making sure very rich people get a larger share is called capitalism and “good”. That has to change.
Villago Delenda Est
@Roger Moore: Big Pharma execs need tumbrel rides. Stat.
Villago Delenda Est
@bbleh: So much that is totally wrong, immoral and decidedly in opposition to the teachings of Jesus of Nazareth got started under Ronald Reagan.
bbleh
@Villago Delenda Est: or perhaps at least, received validation and came to flower under him. I still think that Reagan, like Trump, was far more symptom than cause, or at most served as a catalyst for something that was already long primed to happen.
As with Trump, the problem is Republicans.
dnfree
@Booger: I take two of the medications you see on TV. I’m lucky I can afford them and lucky Part D exists. Drug cost this year was over $6000, my share over $2000. I’m also lucky that Crestor, which you no longer see on TV, is now a generic, rosuvastatin.
Roger Moore
@Yarrow:
The real problem is not the competitive market; its the immense inequality behind the competitive market. The best expression of this I’ve seen comes from Matt Yglesias of all people. He said that when people are relatively equal, markets are great at allocating resources efficiently, but when they’re unequal markets are great at allocating resources to what rich people want.
This is as true in healthcare as in any other area. If people were relatively equal, healthcare competition would result in providers fighting to offer healthcare anyone could pay for, because that would be the best way of maximizing profits. Instead, providers are fighting to provide care for the richest people (or people with the best insurance) because providing expensive cures for the pampered few is more profitable than providing basic care for everyone.
Ruckus
@bbleh:
It is after all about the almighty fucking dollar – and who’s bank account it ends up in. That’s far, far more important than life or any of that other unimportant crap, that’s written on some old piece of paper, somewhere. //
Barbara
@burnspbesq: It won’t work like that. Manufacturers will begin limiting the amount that is distributed into the Canadian market. Florida (the state trying hardest to implement this) has a population that is slightly more than half of the entire population of Canada, with no doubt a higher average age.
Roger Moore
@burnspbesq:
The idea that we’re paying to develop those new therapies is a bunch of BS. There are all kinds of non-patent regulatory restrictions in the system that unscrupulous drug companies can take advantage of to drive up prices. That was the basic thing that pharma bro Martin Shkreli was doing, for instance, or what Mylanta has done with EpiPens.
More generally, I’m not convinced that spending tons of money on new drugs is such a good idea in the first place. I think we’d get much better bang for our buck by improving access to basic care than we do by developing a lot of these new drugs. Let’s make sure people aren’t dying because they can’t get insulin before we spend a ton of money developing yet another ED medication.
Barbara
@Roger Moore: I come out somewhere in between. The hepatitis C drugs are truly an innovation, and what’s more they are an actual cure for a disease that has been escalating in burden over the last decade. In the long run, they probably do pay for themselves by lowering other much more costly care or staving off disability and death. However, many other drugs are either just slightly better than placebos or help people manage chronic conditions. The latter category is important, especially for a condition like diabetes, but it is a real question how many more drugs we need — for example — to help reduce blood pressure when we already have 8, and the most recent is always the most expensive whether it is better or not. Other countries account for these types of differences when they set prices. We simply lack political will. We should be looking to Canada to import its regulatory framework not actual prescription drug products.
JAFD
Yours truly has very good prescript plan, and even tho ‘retail price’ on month’s supply of two heart and blood pills that I picked up last week was about $1,200, not painful to me.
What gets me is ‘retail price’ of $693.99 a bottle – why ye heck don’t they just say $700 and make it simple?
davecb
@Yarrow wrote:
The requirement is that the US importer ensure the above is true, such as making a deal with the Canadian importer. Though why they wouldn’t go straight to the manufacturer we buy the drugs from is beyond me.
Robert Sneddon
I had two MRIs last year, they cost me nothing. No co-pay, no insurance, nothing. Period. Nada. Zip.
I’m on a couple of low-cost medications to manage a chronic condition. When they run low I email my GP office, they send a prescription request to a local (two hundred yards from my door) pharmacy, they text me when it’s ready to collect. They cost me nothing. No co-pay, no insurance, nothing. Period. Nada. Zip.
You Yanks should think about coming into the 21st century with the rest of the world.
Roger Moore
@J R in WV:
If you want really crazy, I have a coworker who had to get cancer surgery. She obviously couldn’t get an estimate before her surgery, but she did get a bill afterward. I can kind of understand that. Surgery is unpredictable, and the surgeon didn’t know for sure exactly what they were going to do before the surgery started. The hospital certainly didn’t know exactly what her stay after the treatment was going to be like. It’s unfair that the patient has to deal with that uncertainty rather than the provider, but it’s at least comprehensible.
The thing that really seems crazy is that she got a second bill a year later for the same surgery. It seems that the hospital decided their charges weren’t quite right, so they decided to bill her for the difference. Then she got another bill another year later. If the hospital can’t know how much something really cost until a year or two later, how in hell is a patient supposed to have a chance? How can we count on markets to set prices if nobody knows what the price is until well after the service is completed?
sab
@Cheryl from Maryland: When they built our local CVS they bought out the neighborhood pharmacist and then hired him as head pharmacist in that store. So he runs it like he always did.
sdhays
@Roger Moore: High drug prices aren’t financing new AIDS medication or cures for cancer – charities and our tax dollars are doing that. Like you, I’m pretty skeptical that the medications that actually are being developed by Big Pharma’s profits are anywhere close to beneficial enough to justify the cost.
Ruckus
@Yarrow:
I used to buy my migraine med from Canada. Still expensive, but far cheaper than anywhere in the US.
BTW Now that it’s off patient it is far, far cheaper. To me the drug patient program is crap. Pfizer paid out billions in fines and lawsuit settlements and is still quite profitable. They are making huge profits while many people have little or no healthcare – something is wrong with this picture.
Ruckus
@Robert Sneddon:
I’ve had MRIs that cost my insurance company $1500 or more, so my doc would only do one when absolutely necessary, while at the VA, it’s like what you get, you need one, it’s no big deal, because it’s not a profit center for someone, it’s a tool to be used as necessary. The VA hospital I use has at least 5 machines, I know because that’s how many different ones I’ve been in. One has to be about 20 years old but the rest are not close to that. And they get used a lot, I’ve had to wait in line.
Ruckus
@Robert Sneddon:
Can we at least try the 20th century, that has to be a bit better?
J R in WV
@Matt McIrvin:
Now that both the northern and southern borders are CLOSED, how’s that “pop over to Mexico” for health care working out for him?
The one time we visited Mexico, I stopped by a fairly good looking Pharmicia in Cabo, and the pharmacist was dispensing medications to his patients, no doctor involved. Antibiotics mostly, for little kids in mom’s arms. He seemed very professional, but didn’t have what I was looking for. Should have tried Walmart I guess.
Visiting a cousin who lived near the Mexican border, and who used to go shopping in Mexico. She gave us a big jar of moisturizing cream, told us to use it all while in the high desert country.
That night I was slathering up, and noticed the price tag, which was for $47.95. So we asked and learned the next morning that the price tag was in Pesos, and it really cost about three dollars American.
Roger Moore
@sdhays:
This is a bit of an exaggeration. A lot of basic research is funded by taxes and charitable foundations, but that’s a surprisingly small part of the cost of drug development. Turning the leads from basic research into usable drugs is a long and expensive process, and that part of things generally is funded by drug companies.
Roger Moore
@Ruckus:
Kaiser is the same way. If your doctor orders an MRI, you get an MRI. There’s a behind-the-scenes system keeping the doctors from prescribing them willy-nilly- my doctor made me get some other tests before I could get an MRI- but once the doctor decides it’s needed, you as the patient don’t have any further problems getting one. The MRIs are booked solid, so unless it’s an emergency you have to schedule well in advance, but that’s the only restriction you as a patient see.
Brachiator
I call bullshit. People should be able to buy Canadian drugs. Health plans and states should be able to buy Canadian drugs. Medicare should be able to provide cheaper Canadian drugs. The market would adjust.
Glidwrith
@sdhays: I will let you in on the dirty pharma secret: NONE of Big Pharma actually create new drugs. Us little biotechs create them, then Big Pharma buys us out if we get something usable.