18 Jun 2019
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In its April 2019 piece entitled “Importing Bad Ideas on Drug Prices,“ the Editorial Board of The Wall Street Journal showcases several of the flawed arguments and propaganda techniques employed by the big pharma lobby to undermine the fair, safe and pragmatic practice of importing prescription drugs from Canada. Fortunately, Florida Governor Ron DeSantis and state lawmakers weren’t swayed, and have passed a new law to create a state-based drug importation program.

Prescription Justice applauds this decisive action – and the similar laws passed in Vermont and Colorado. We firmly believe that importation is a critical piece of the puzzle to ending the crisis of high drug prices in America. Other states weighing the option should take note.

High drug prices affect Americans from all states, regions, and walks of life. Importation has immense bi-partisan support as a solution to the crisis of high drug prices: 76% of Republicans and 78% of Democrats – 80% overall – support importation from Canada. The state drug importation laws require cooperation from the federal government, and the Trump administration has voiced strong support for Florida’s new law. As we await federal approval of the new Florida plan, and as other states follow suit, Prescription Justice offers the following points of view in response to the WSJ Editorial Board and other opponents of drug importation plans.

YES, DRUG PRICES ARE, IN FACT, REALLY HIGH

The WSJ Editorial Board questions whether drug prices are even high. Attacking the premise of whether drugs are – in fact – high is a common trope in pharma-lobby funded media and literature. Prices for brand-name prescription medicines are exorbitantly higher in the U.S. than in Canada and other high-income countries; often multiple times the price for the same drug. Americans have experienced skyrocketing price increases for prescription drugs over the past decade, and millions have been forced to choose between food, rent, and medicine. Questioning this fact reflects a level of hostility towards both reality and tens of millions of lower and middle-income Americans.

THE MARKET FOR DRUGS IN THE UNITED STATES IS NEITHER FREE NOR FAIR.

The WSJ Editorial Board invokes the socialist specter of “price controls,” when describing drug importation plans. However, they do not touch the fact that the market for pharmaceutical drugs in America is neither free nor fair to begin with. In a competitive marketplace, consumer prices are forced down to cost plus a fair profit. In the U.S., drug patents give pharmaceutical companies carte blanche to charge extraordinary sums for life-saving medications. Patent protection effectively grants the pharmaceutical industry a monopoly, regardless of the human consequences.

Some argue that skyrocketing costs are the price of being a leader in drug innovation. However, fully a third of our national investment in new drugs is underwritten by American taxpayers through the National Institutes of Health. That public investment, which is dedicated to basic biomedical research, has laid the groundwork for many of today’s miracle drugs. Yet, the same taxpayers who funded the research are getting charged far more than patients in any other part of the world.

That’s why tens of millions of Americans have already imported medicines for private use, despite federal prohibitions. With approximately 30% of Americans not properly filling prescriptions because of cost, it’s not surprising that importation is a lifeline of affordable medicine.

WHAT ABOUT STATES’ RIGHTS?

The WSJ Editorial Board goes after Republican Gov. Ron DeSantis for promoting a bill, which he signed this month, allowing Florida to create a drug importation program. It is similarly critical of importation programs in Vermont and Utah. They claim the state importation plans are “impractical, unsafe, and unlikely to reduce prices at the pharmacy.”

While conservatives often celebrate states’ rights and the free marketplace of ideas, somehow in the eyes of the WSJ Editorial Board these virtues do not extend to allowing states to respond to an issue that affects the health and wellbeing of its employees and residents. States shoulder the burden of 25-30% of their residents’ pharmacy bill. State governments are tired of waiting for the federal government to act on high drug prices and are increasingly looking to Canada and other countries as part of their toolbox of solutions. Prescription Justice applauds Gov. DeSantis and like-minded leaders who are taking purposeful action to lower drug prices rather merely providing lip service.

MOST PHARMACEUTICALS ARE ACTUALLY IMPORTED FROM ABROAD ALREADY

Importation of prescription drugs is not impractical or unsafe. In fact, it is how the United States currently procures most of its pharmaceuticals. According to the FDA, 80% of the active pharmaceutical ingredients that make up drugs sold in U.S. pharmacies are imported. As recognized by the Florida bill’s sponsors, 71 of the 100 top-selling brand name drugs were also foreign made, much higher than the FDA estimate of 40%, a stat that is almost a decade old.

Pharmaceutical companies sell the same products to Canadian and American pharmacies at radically different prices. Laws like the one passed in Florida would mean the state could source prescription drugs from regulated Canadian pharmacy wholesalers. Eligible Canadian pharmacy wholesalers would be inspected, and the imported medicines tested, as part of their registration with the Florida Board of Pharmacy. The medications would have to be labeled in accordance with FDA regulations. Section 804 of the Food, Drug and Cosmetic Act allows for this type of program if the Secretary of Health and Human Services agrees that it would pose no additional safety risks and would achieve significant savings. In other words, the proposed Florida program would only proceed if it is deemed safe by the federal government.

PHARMA WHATABOUTISM

Whataboutism refers to the practice of deflecting criticism by pointing to an opponent’s failures without directly refuting or disproving the argument at hand.

The WSJ Editorial Board warns that Canada, with its population of 33 million, can’t handle every Floridian’s (21 million) prescription needs. This is a non sequitur, of course, because the Florida bill merely provides the option to purchase select prescriptions from Canada – not all prescriptions. Florida will not be raiding pharmacy shelves in Canada. The vast majority of Florida’s prescriptions will continue to be purchased domestically as generic drugs that usually cost less than in Canada, and comprise 90% of all prescriptions filled.

ABOUT THAT FDA LETTER …

The WSJ Editorial Board contends that because four past FDA Commissioners published a joint letter in 2017 against importation proposals, it really can’t be a good idea. While opponents of importation have leaned on this letter, few have taken time to highlight its weaknesses.

The former FDA commissioners take aim at the dangers of the Internet as the primary threat. Focusing exclusively on rogue pharmacy sites, counterfeit drugs, and online scams, they fail to note the positive benefits of the Internet, which include pricing transparency and access to real, licensed foreign pharmacies that require valid prescriptions and charge much less than U.S. pharmacies.

Secondly, new state drug importation proposals only relate to wholesale drug importation. People who now import medicines by ordering it online would have less incentive to do so if the prices were lower at their local pharmacies.

The FDA commissioners also imply that pharmacy shelves are currently stocked with American-made pharmaceuticals. Bizarrely, they state “Routine importation from foreign countries is not the right approach.” Yet the FDA already regulates importation of pharmaceuticals, which make up the majority of our nation’s drug supply, as noted above.

The WSJ Editorial Board also cites the FDA’s recent warning letter to a company called CanaRx as an example of the dangers of importing lower-cost drugs. As covered in Kaiser Health News, CanaRx works with hundreds of self-insured cities, counties, schools and other organizations by connecting them with licensed pharmacies in Australia, Canada and the UK from which employees and retirees import brand name medicine for personal use. Those programs, including one in Albany, NY, have not reported any safety issues – only lots of savings. As Prescription Justice founder Gabriel Levitt wrote in The Nation, CanaRx is a good example of why importation works.

BOTTOM LINE:

Prescription drug importation is practical and safe – and, it is proven to help people access lower drug prices. Making it legal can help Americans get access to lower cost drugs and offer a check on pharmaceutical industry greed.

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