IPABC - Questions & Answers

We are the International Pharmacy Association of British Columbia (IPABC), a coalition of distance-based heath care providers located in the province of BC. Our mandate is to promote the growth of BC-based International Pharmacies, to inform the public about what we do, and to dispel some of the myths about our industry.

First off, we're not "internet" pharmacies, although the internet is one way a client can get in touch with us - a first step, only, to having their prescription filled. We are fully functional pharmacies that utilize all the checks and balances of a normal dispensary. We have permanent addresses, and employ real, not "virtual," people - pharmacists, pharmacy technicians, managers and support staff. The only difference is that the clients we serve require their drugs to be shipped to them. Primarily, the patients we supply live beyond our borders. And so a more accurate term would be "International Pharmacies" - which is what we call ourselves.

The International Pharmacy trade in Canada started when U.S. patients started taking bus trips up to Canada in order to buy patented medicines at reasonable prices. In the early 2000’s, as Internet usage began to grow rapidly, the industry realized that e-commerce would soon replace the bus trips. Today, the industry has grown to serve millions of patients in need.

We serve approximately 1 million American patients.

Our members significantly contribute to the BC economy, and the demand for our industry is growing. We directly employ a range of full time staff, including pharmacists, pharmacy technicians, call centre staff, IT technicians, shipping clerks, administrative staff.

While some in the popular media have assumed that it’s not legal to dispense drugs from outside of their country, there is little support for this in U.S. law. The FDA has a policy of allowing into the U.S. up to a 90-day supply of approved medication for personal use.

There is also enormous grassroots pressure not to enforce the limited restrictions on drug re-importation. Many of the individuals who are currently getting their medicines from Canadian International Pharmacies are senior citizens on fixed incomes. The optics of trying to stop them from re-importing U.S.-made drugs would be difficult. It is also evident to most of the stakeholders that the price of patented medicines in the U.S. is a critical problem.

The U.S. Government also knows that drugs from Canadian pharmacies are, simply put, totally safe.

Yes, there are many bills currently being considered by the US Congress, including the Safe and Affordable Drugs from Canada Act of 2015, sponsored by Senator John McCain (R-Arizona).

This act would permit individuals to import a prescription drug purchased from an approved Canadian pharmacy provided it is:

• dispensed through a pharmacist licensed in Canada
• purchased for personal use, with the quantity not greater than a 90-day supply filled using a valid prescription issued by a physician licensed to practice in the US
• a FFDCA-approved drug

Canadian International Pharmacies have extremely stringent controls and standards. These controls are stricter than any other nation, including IPs based in the United States.

Unlike some international pharmacies, Canadian IPs do not provide narcotics and controlled substances. The overwhelming majority of drugs that are shipped to the United States are so-called "maintenance medications" designed to treat chronic conditions like, for example, high cholesterol and heart disease. In other words, we supply drugs designed to keep an existing condition under control. Since these drugs are not candidates for fraud and abuse, this potential is simply not part of the equation for IPs located in Canada.

To protect a status quo that has served (and continues to serve) them exceedingly well. The pharmaceutical industry is ranked as one of the most profitable industries in America, with an average 17% return on revenue. And some individual companies are doing even better. In 2001, Pfizer earned a 28.4% return on revenues, followed closely by Eli Lily & Co., which earned 24.4%. Contrast this with Intel (11.6%) and GE (10.7%).

Primarily, the reason drug prices in the U.S. are so high is that America is the only Western country that allows a completely unregulated approach to drug pricing. In other words, there are no price controls on pharmaceuticals. In this regard, among all other Western countries, the United States stands alone. The result has been that drugs in the U.S. are routinely 50-80% more expensive than in Canada.

In Canada, the system operates much differently. In 1987 the Canadian government created the Patented Medicine Prices Review Board, the mandate of which is to ensure that the price of patented drugs in Canada is not excessive. In exchange for increased patent protection, the pharmaceutical manufacturers agreed that (among other things) drugs which are new to the market would not be priced significantly above the cost of its closest related treatment, and that any increases would be tied to the Consumer Price Index. Furthermore, Canadian provinces, such as BC, have been very aggressive in regulating and driving down the costs of pharmaceuticals.

The U.S. has no similar price constraints. As a result, compared to every other Western nation, costs have spiralled dramatically. The U.S. currently accounts for about half the worldwide revenue of drug makers.

This is largely a myth. Evidence shows that, in the United States, the development of new pharmaceuticals is largely funded by the National Institutes of Health, a federal government organization. But it is the biotechnology firms that usually lead the way in R&D; Big Pharma often only comes into the picture during Phase II or Phase III trials, purchasing the rights for drugs that look promising after much of the real research and development (and the associated risk) has already taken place.

And even when they do come into the picture, the amount of money the drug manufacturers spend on R&D is dwarfed by other expenditures. For example, out of every $100 Big Pharma spends, approximately $30-$35 goes to marketing costs. By comparison, only about $20 is allocated to R&D. And with profit margins at all-time highs, the costs are, once again, passed on to the consumer. The major pharmaceutical companies like to present themselves as almost selflessly charitable, even altruistic. The truth is they are big, robust and very profitable corporations.

The drug companies are certainly part of the process. But with regard to R&D, many of the drugs Big Pharma "develop" are not, in fact, new at all. A common industry practice is "Evergreening." Often, when a patent is about to run its course and is a candidate for generic manufacture, instead of continuing to market the drug with an expensive high-profile campaign, the manufacturer dramatically reduces the marketing support for their own product. Subsequently the demand trails off. As the demand for the old drug fades, a new drug - with a full-length patent - is positioned to take its place. And often the "new" drug is only a minor variation on the old; a molecule is "tweaked" (slightly altering the molecular structure), thereby rendering it technically "new." Sometimes, the main difference is that the dosage is upped. The drug is then declared more efficacious - not surprisingly, since the patient is now taking more of it.

Evergreening has two purposes. One, to undercut the generic drug suppliers, who now have the right to reproduce a drug - but one whose luster has been intentionally faded, and is no longer the darling of the physician-prescriber. And two, to ensure that the manufacturer continues to dominate a market for which they have developed marketing expertise. While that may be good business, it's not necessarily good for patients and the medical systems that support them.

In a word, no. But don't take our word for it. Take the word of Health Canada, the federal agency in charge of ensuring the integrity of the Canadian drug supply. Since these baseless claims of IP-related drug shortages were first levelled, Health Canada has investigated every one that has been reported to them. At no time have they ever - ever - found anything to substantiate that the practices of the Canadian International Pharmacy industry has caused even a short-term disruption in Canada's drug supply.

No. Again, because of the Patented Medicine Prices Review Board (PMPRB) process, any price increases that would be acceptable under the agreement would be tied to the Consumer Price Index. Any suggestion that there are exceptions to this rule are baseless. In addition, Canadian provinces are continuing to drive down prices themselves.

In a nutshell, that would constitute a 'scorched earth' approach that no rational pharmaceutical manufacturer would entertain. The public relations nightmare that would ensue would be more than enough to render this approach absurd. (Plus, it would be financially suicidal for public companies whose eyes have historically been fixed on the bottom line.) Also, it would mean their patent protection guaranteed by their participation in the PMPRB price controls would be null and void. In such an extreme case - and it hardly bears thinking about - the Canadian government would likely give the go ahead to generic drug companies to duplicate the formula, thereby ensuring that Canadians would continue to get the drugs they need. (Our own generic drug manufacturing companies are more than capable of stepping in and picking up the slack.) But this scenario is as farfetched as any science fiction film.

Our pharmacies have a perfect safety record.

We require:

• Valid prescription
• Patient’s demographic and medical information
• Licensed pharmacist on staff to supervise dispensing of medications and be available for patient consultation
• All our members to have procedures in place to ensure patent privacy and confidentiality.

IPABC pharmacies are thoroughly vetted and certified by the Canadian International Pharmacy Association (CIPA)

All our pharmacies display the CIPA red oval seal that denotes integrity, quality and trust. CIPA is aggressive in pursuing fraudulent online pharmacies.

Our members significantly contribute to the BC economy, and the demand for our industry is growing. We directly employ a range of full time staff, including pharmacists, pharmacy technicians, call centre staff, IT technicians, shipping clerks, administrative staff.

We are distance-based health care professionals. We are knowledgeable, ethical and experienced. We are, we believe, the future.