Occasionally we receive email messages that we consider should be of interest to our readers for a longer period than their "shelf life" in our Mailbox section. When that happens we try to find a more permanent place for them at the website. Such was the case recently when we received a very thoughtful email from Michael Anisfeld, President of Globepharm, a health care consulting firm. He wrote initially to comment about risks consumers need to be aware of when purchasing drugs in Mexico. That led to a further question I posed about the issues, if any, related to purchasing drugs in Canada. And finally, to complete the story, Michael sent along some special notes pertaining to the purchase of generic drugs.
We thought each of his emails, while relatively short, contained extremely useful information for our readers. With his permission, we pubish below the the information he has provided to us:
First, on purchasing drugs in Mexico:
I read with interest your article on purchasing drugs in Mexico, and need to add some essential commentary.
I am a pharmacist and a member of the WHO Counterfeit-drug task force, and would advise you that everything is not as rosy as your article makes it appear with respect to counterfeit drugs. Our estimate of the Mexican counterfeit drug market puts the extent of counterfeiting at about 15% (perhaps more).
There are certainly significant savings to be made by purchasing drugs in Mexico, but your members should protect themselves by paying attention to:
a. always looking for the certificate of the pharmacist hanging on the wall, and then asking to speak specifically to that person. If there is no certificate visible, then you really do not want to be making purchases in that "farmacia" - some stores labeled as "farmacias" are really just sellers of cosmetics or herbal medicines.
b. purchasing drugs that have the tablets/capsules individual sealed in blister packages (much more prevalent that in the USA) aids in reducing the chances of getting a counterfeit, and as you mention always checking that the inner foil/blister is integral is absolutely essential.
c. check that the drug's batch number, printed on the inner foil exactly matches that printed on the carton. If it does not - walk out of the pharmacy - you are holding what is almost certainly a counterfeit.
d. ensure that the expiration date is at least 6 months (better 1 year) away from the date of purchase.
Also a correction to your article, the package insert is not a copy of the entry in the PDR. It is in fact the other way around. The package insert is what the US FDA has officially sanctioned as being permitted text to describe the drug. The PDR is a convenient reference book providing copies of all package inserts of drugs sold in the USA.
I hope that assists your members,
Michael Anisfeld
We then raised the question with Michael about the issue of drugs that are purchased from Canada, often via the internet. Here is the response he provided on that subject:
Dear Tom:
Purchasing drugs in Canada is a much safer, from the counterfeit perspective, than purchasing drugs in Mexico - Canada has much more effective, and stringent controls, over its pharmacies.
Going to Canada, or Mexico, is much different from purchasing on the internet. When purchasing on the internet you often never really know who exactly is behind the webpage. Many organizations whose WebPages tout themselves as "Canadian" pharmacies, are in fact located in other countries, and we have seen examples where the actual source can be India, China, Bangladesh, Argentina, and others.
If you are purchasing on the internet, assure yourself that the company is in fact Canadian, and under the control of the local provincial Board of Pharmacy. A simple and quick way to do this is to look for a phone number on the webpage. Then call the Canadian Provincial Board of Pharmacy (for a list go to http://www.nabp.net/vipps/consumer/links/stateboards.asp) , and:
a. ask for the phone number they have listed for the company - if they are the same, then the company is probably a real company and a legitimate operation.
b. ask if there are any complaints lodged against the pharmacy - and seriously consider anything you are told
Also, it helps if the pharmacy is certified as VIPPS - Verified Internet Pharmacy Practice Sites (VIPPS), a program established by the National Association of Boards of Pharmacy (NABP).
At WHO, it is estimated that about 50% of all internet drug sales world-wide are counterfeit;, and in some classes of drug, e.g. steroids, upwards from 80% are fake.
I hope this helps,
Michael Anisfeld
And finally, when Michael provided his permission to reprint his comments here for the benefit of our readers, he offered the following additional thoughts pertaining to generic drugs:
Tom:
It just occurs to me - one last thought.
When a drug goes off patent, it becomes generic; and anyone can manufacture the drug subject to their getting FDA approval. The generic company has to demonstrate to FDA equivalence in bioavailability, effectiveness, and quality of the generic to the original patented drug.
The prices of generic drugs in the United States are very often cheaper than the same generics available in Canada, Mexico and/or elsewhere. There is absolutely no point, from a pricing perspective, in your readers going outside the USA to source their drugs, when their drugs are generic.
To determine whether a drug is available in generic format, your readers should go to FDA's website, and check in the Electronic Orange Book (an FDA listing of Approved Drug Products with Therapeutic Equivalence) at http://www.fda.gov/cder/ob/default.htm - and enter the name of the active chemical present in their drug. If this list shows a generic equivalent, then first insist to their physician that he allows generic substitution on their prescription, and then phone two or three local pharmacies to get price quotations - yes, as well as shopping around for good prices in Mexico, the same rule applies in the USA.
I hope that does it,
Michael Anisfeld
Suffice it to say we are indebted to Michael and his firm, Globepharm, for providing this information. And we hope our readers will find it as useful as do we as we conteplate realistic options for the purchase of prescription medicines.