On one side, the American consumer. Sixty-six percent of us think that drug prices are too high, and 60 percent say there is too little government regulation of drug prices. On the other, Big Pharma, which fairly or not, finds its negative-opinion scores among the American public trolling the depths that were once the sole domain of Big Tobacco. In the middle, federal, state and local governments that are trying to balance the needs of their constituents against the safety of non-FDA certified, imported or reimported medications at half the price of the real thing.
Although two different pieces of federal legislation have set the groundwork for reimportation to be approved, and the President has indicated that he would consider doing so, it is, as of today, still illegal. That hasn’t stopped six states from establishing their own websites to enable the practice, with scores of other states and municipalities not far behind.
Many observers feel that the new year will see some form of reimportation approved. To call the situation a Pandora’s box doesn’t begin to describe it. The issues are international: Though Canada is often mentioned as the most likely savior, it’s just one of 30 or more different countries that may serve as sources for the new drug rush; the safety and purity of the drugs; the impact on prices and supply of flooding the relatively small Canadian market with American patients; the potential impact on pharmaceutical product development.
And the issues are personal: How might you treat a patient whose IOP remains uncontrolled after a year on a medication you prescribed, but was sourced from who knows where, containing who knows what ingredients?
No matter how this ultimately plays out in the coming months, a lot of information is going to be thrown at the American public. The pharmaceutical industry is gearing up to make its case, and one of its strongest arguments is that patients who truly can’t afford their medications do have a recourse in the form of patient assistance programs. These programs are underutilized, underpublicized and have been criticized for being too complicated.
As is common with complex problems, the focus on reimportation is easier than treating the much larger issue of runaway health-care costs. But if it forces the spotlight on improving the performance and raising the awareness of these programs, then let’s get to it.