Canadian Pharmacies

Recently, I found myself in that clichéd American position of needing a medication that I could not afford at American health care prices.  I am usually pretty good at getting around these issues with a well crafted appeal.  But this time, no dice.  I attempted to contact the pharmaceutical company who said I might be able to get it free if I had a proper denial from my health insurance company.  I almost had a proper denial except they wanted me to try a number of drugs just to get the final “No” from them that I was going to get anyway, but that is another story.

The medicine I needed was going to be somewhere between 400 and 600 dollars per shot and I would need 6 shots total.  The spectre of Canadian Pharmacies loomed in the periphery, upon a brief investigation, I found it listed at about 200 per shot.

Easy, right?  Not so fast.  Looking online, I ended up seeing a lot of warnings that stated 97% of “Canadian” pharmacies were scam artists taking advantage of a vulnerable population.  A blog post from Consumer Reports suggests going through NABP approved pharmacies and attempt to look for deals through Costco, Walmart, Walgreens, etc.

NABP or the National Association of the Boards of Pharmacy created a system of verification called VIPPS or Verified Internet Pharmacy Practice Sites.  The concept is useful as the main problem with online pharmacies is verification.  Who am I really sending my money to?  And if only 3% of pharmacies are legit, then the odds aren’t in my favor.

Unfortunately, NABP accredits only 32 online pharmacies with VIPPS certification and all of these pharmacies are brick and mortar American institutions.   (Actually, according to their criteria, their accredited institutions have to be located in the US and registered with the DEA so no Canadian based pharmacy would be accredited anyway)  It is a Möbius strip of verification with all roads leading from and back to American pharma.  Even worse are the accusations that the NABP actively spam legitimate Canadian pharmacies on online forums to create a sense of danger from “rogue” pharmacies, posting up to 1000 times a day.

For due diligence, I check with NABP accredited pharmacies.  I try to look up my medication online and see the prices.  I get ready to break out my spreadsheet to compare and contrast and be a good consumer.  None of these sites are actually set up for a consumer comparison, because in America, there is no set price for these goods.  There is only your price.  The price based on who you are, what insurance you have, and how much they want to charge you.  Maybe if I wanted something more average they could give me an average price.  I even walked into Costco, waited at the prescription drop off counter and talked to the pharmacist who told me, “it’s not in the system, so I can’t tell you how much it would be” essentially putting me in a place of ordering it first and figuring out the price later.

Back to Canada, because it seems to be the only place to actually treat a person like a consumer, not a patient boxed in by the medical industrial complex.  Since the NABP won’t verify a Canadian pharmacy, how do the Canadian pharmacies verify themselves?  The answer to that is CIPA, the Canadian International Pharmacy Association.  To verify a pharmacy through CIPA, you can use their pharmacy verifier, where you enter in the URL of your intended pharmacy.

How does one verify CIPA itself?  The National Bureau of Economic Research (NBER), the largest economics research organization in the United States performed an audit of NABP pharmacies, CIPA pharmacies, and international unverified pharmacies and found that CIPA pharmacies had identical products as NBER pharmacies.  They found the only “rogue” pharmacies to be the third tier, unverified international pharmacies.  The NBER concluded that issuing a blanket warning against all international pharmacies would deny people the savings from certified CIPA pharmacies.  The report from the National Bureau of Economic Research can be purchased here.

The whole process of researching  online pharmacies is marked by obstruction after obstruction.  I spent an afternoon going through website after website trying to answer the question “who do I trust?”  And once I felt like I had an entity to trust, I had to verify why they were trustworthy.  All of this is probably more effort than the average person wants to put in.  The manufacture of fear is a very powerful market force, it makes me wonder how often people pay more for the illusion of safety and security.  And here I sit, prescription in hand and I still haven’t filled it yet.

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