Drugs from Canada

[audreyh1]

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Originally Posted by sengsational Interesting accusation. We'll probably never hear about the outcome of the charges, though. They were selling to doctors. After doing a quick search, I see that there were lots of warnings posted back in 2009-2012 about fake versions of this drug. I was going to look-up the price, but bevacizumab (Avastin / Altuzan) is provided by a doctor and is generally not available at a pharmacy, so doesn't show up on goodrx.com. Wikipedia said " the average price charged by hospitals for bevacizumab is approximately $9000 compared to approximately $2300 when administered in a doctor's office". Since a single dose of this drug (in this is super-high price range), would meet my annual deductible, I'd certainly not try to procure it via mail order. Instead, I'd pay for the first dose and get rest of the doses that year "for free".

Avastin is used for late state colon cancer. I don't think you want to need it!!!

[sengsational]

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Originally Posted by audreyh1 Wow - that was quite a read. But also a long time ago and things have really changed since then I would think.

What I found interesting was even as far back as that, the internet pharmacies were doing their own screening for counterfeit drugs. I had assumed it was just greed, but back then, they were apparently getting swindled, not making any more profit on the counterfeits than legit product.

It looks like internet pharmacies would not have encountered the counterfeit problem had it not been for the slimeball tactics that the big pharma companies; the article said that big pharma refused to sell to internet pharmacies and even shut-out non-internet pharmacies if any of their product got into the internet supply chain. So they went out on the world market and were the patsy at the poker table.

[Koolau]

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Originally Posted by Meadbh Now this: 6 Canadians arrested in U.S. extradition request for allegedly selling fake cancer drugs online - Manitoba - CBC News

Guess this is when someone stands up and states "I rest my case." But YMMV.

[Meadbh]

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Originally Posted by Koolau Actually, not surprising at all. This all started over 20 years ago in Ireland.

Actually, the history of the pharmaceutical industry in Ireland goes back much further than that, and precedes favourable tax policy. I'm 60 this year. When I was 12, I went on a school trip to one of the pharmaceutical factories around Cork Harbour, and there were already several at that time. So I would put it at 50 years.

[AllDone]

Quote:

Originally Posted by Koolau Guess this is when someone stands up and states "I rest my case." But YMMV.

And here's a link to a story about a pharmacist who was selling diluted chemotherapy drugs in Kansas:

Pharmacist Robert Courtney admits he diluted drugs | The Kansas City Star

[sengsational]

I'm not quite sure about resting one's case...we have a few examples of the labels not matching the product from US and non-US distribution points, and both stories are from five to ten or more years ago. Also, both of those examples were for super-high priced Rx's.

I think that of more concern to the readers of this forum might be cases where the non-US price of a prescription is five to twenty times less expensive than the price at a US pharmacy. I've seen scads of Rx's that fit this profile. So, for example, the US patient or their insurance is expected to pay $1000 per month but the same drug is available outside the US for $50 to $200 per month.

Can anyone find examples of cases of drugs that would fit the profile above where a mail order pharmacy that required a prescription was sending counterfeit, ineffective or dangerous products?

[MichaelB]

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Originally Posted by sengsational Can anyone find examples of cases of drugs that would fit the profile above where a mail order pharmacy that required a prescription was sending counterfeit, ineffective or dangerous products?

That's happened here in the US, and is well documented. A pharmacist intentionally diluting drugs in order to sell more and increase profits.

[sengsational]

So far in this thread I'm not sure we've discussed the relative difficulty of a bad guy making a counterfeit or doing a dilution or substitution based on the form of the medication.

The counterfeits in articles referenced so far were liquids in vials, so that would require just printing a box and re-labeling a saline vial. They'd probably copy a batch or lot number from the real drug. That makes me wonder if you emailed a picture of the packaging, with batch number, to the manufacturer, if they'd comment on authenticity. Probably not, because the lawyers would tell them not to. But they could probably spot a fake pretty easily.

But what if it were a tablet, especially one with a delayed release coating. It would seem that to produce a counterfeit of something like that would be much more difficult than a vial of liquid. You'd have all of the packaging details to manage, many are packaged in blister cards, and you'd have to get the tablet pressed and coated properly. Not impossible, of course, but unless you're talking about a super high priced Rx, the business case doesn't make sense...you'd just buy it from the real manufacturer and mark it up.

My experience is that, unlike getting meds from a US pharmacy, the mail order pharmacies send the Rx in the packaging they get from the manufacturer. In other words, they don't get a huge bottle of pills and manually count-out a subset to sell to customers. Instead, they sell you a whole container that came from the manufacturer.

[Skoach]

Quote:

Originally Posted by sengsational So far in this thread I'm not sure we've discussed the relative difficulty of a bad guy making a counterfeit or doing a dilution or substitution based on the form of the medication. The counterfeits in articles referenced so far were liquids in vials, so that would require just printing a box and re-labeling a saline vial. They'd probably copy a batch or lot number from the real drug. That makes me wonder if you emailed a picture of the packaging, with batch number, to the manufacturer, if they'd comment on authenticity. Probably not, because the lawyers would tell them not to. But they could probably spot a fake pretty easily. But what if it were a tablet, especially one with a delayed release coating. It would seem that to produce a counterfeit of something like that would be much more difficult than a vial of liquid. You'd have all of the packaging details to manage, many are packaged in blister cards, and you'd have to get the tablet pressed and coated properly. Not impossible, of course, but unless you're talking about a super high priced Rx, the business case doesn't make sense...you'd just buy it from the real manufacturer and mark it up. My experience is that, unlike getting meds from a US pharmacy, the mail order pharmacies send the Rx in the packaging they get from the manufacturer. In other words, they don't get a huge bottle of pills and manually count-out a subset to sell to customers. Instead, they sell you a whole container that came from the manufacturer.

+1, my experience exactly with a brand name drug. Not sure it is worth the trouble for the minor savings for generics.

[Koolau]

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Originally Posted by AllDone And here's a link to a story about a pharmacist who was selling diluted chemotherapy drugs in Kansas: Pharmacist Robert Courtney admits he diluted drugs | The Kansas City Star

Good point. Does anyone think such evil behavior is less likely or more likely to originate in other countries? Does anyone think such evil behavior would be more easily detected or less easily detected when the drug comes from outside the US and goes direct to customer? Does anyone think the evil person(s) involved in such behavior are more or less likely to be adequately punished when the behavior occurs outside the US? Just some musings on my part so YMMV.

[Koolau]

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Originally Posted by Meadbh Actually, the history of the pharmaceutical industry in Ireland goes back much further than that, and precedes favourable tax policy. I'm 60 this year. When I was 12, I went on a school trip to one of the pharmaceutical factories around Cork Harbour, and there were already several at that time. So I would put it at 50 years.

I suspect that is one reason US companies felt comfortable choosing Ireland (as opposed to, say Bangladesh) to ply their tax reduction strategies.

[pgiyer]

I am somewhat new to these forums, but have been following this thread closely.
DW has many expensive prescriptions and we have bought from outside USA with not a single bad experience.
There are entrenched opinions here that try to justify the US Pharma thievery by circuitous and straw man arguments despite lack of evidence. Each to his own.

[AllDone]

Quote:

Originally Posted by sengsational So far in this thread I'm not sure we've discussed the relative difficulty of a bad guy making a counterfeit or doing a dilution or substitution based on the form of the medication. The counterfeits in articles referenced so far were liquids in vials, so that would require just printing a box and re-labeling a saline vial. They'd probably copy a batch or lot number from the real drug. That makes me wonder if you emailed a picture of the packaging, with batch number, to the manufacturer, if they'd comment on authenticity. Probably not, because the lawyers would tell them not to. But they could probably spot a fake pretty easily. But what if it were a tablet, especially one with a delayed release coating. It would seem that to produce a counterfeit of something like that would be much more difficult than a vial of liquid. You'd have all of the packaging details to manage, many are packaged in blister cards, and you'd have to get the tablet pressed and coated properly. Not impossible, of course, but unless you're talking about a super high priced Rx, the business case doesn't make sense...you'd just buy it from the real manufacturer and mark it up.

Precisely. Fraud through dilution of parenteral drugs is a conpletely different matter and sadly can occur anywhere.

There are no real concerns about drugs from Canada.

[Koolau]

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Originally Posted by pgiyer I am somewhat new to these forums, but have been following this thread closely. DW has many expensive prescriptions and we have bought from outside USA with not a single bad experience. There are entrenched opinions here that try to justify the US Pharma thievery by circuitous and straw man arguments despite lack of evidence. Each to his own.

I'm no apologist for the drug companies. Some of the outrageous price increases of late make them look even more greedy than usual. Still, if one does not believe that ordering drugs from a pharmacy outside the US adds a separate layer of uncertainty beyond ordering from a pharmacy within the US, then I guess you should go ahead. I doubt that I will be doing so but I wish you well and I mean that most sincerely.

My other point (made back in post #39): For ALL the drug price issues (and I agree that there are many) no company will risk investing in new drugs if they don't think they can make back those costs (and a whole bunch of profit.) It's not so much right or wrong as "the nature of the beast" The other option is probably to (in some fashion) let the gummint do it when it comes to new drugs. That might have its own issues, so YMMV

[AllDone]

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Originally Posted by Koolau My other point (made back in post #39): For ALL the drug price issues (and I agree that there are many) no company will risk investing in new drugs if they don't think they can make back those costs (and a whole bunch of profit.) It's not so much right or wrong as "the nature of the beast" The other option is probably to (in some fashion) let the gummint do it when it comes to new drugs. That might have its own issues, so YMMV

Basic drug research is almost entirely done on the government's dime right now (although the NIH's funding is currently on the chopping block). The pharmaceutical companies buy promising drug discoveries and run the later drug trials, workout formulation, and identify additional marketing possibilities for the drug. It's a high-profit, high-marketing, low competition industry with lots and lots of barriers to entry for competitors.

[Koolau]

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Originally Posted by AllDone Basic drug research is almost entirely done on the government's dime right now (although the NIH's funding is currently on the chopping block). The pharmaceutical companies buy promising drug discoveries and run the later drug trials, workout formulation, and identify additional marketing possibilities for the drug. It's a high-profit, high-marketing, low competition industry with lots and lots of barriers to entry for competitors.

I really don't disagree with any of this. Is this a bad model or just not what you would consider ideal? It's been the model for a very long time. I certainly see issues with the model but I've never heard of a good replacement. The universities love it, the drug companies love it, the end user for which a new drug therapy is needed love it. The gummint obviously loves it (or it wouldn't exist since they have the power to change it.) Again, not saying I think it's ideal. Changing it to something "better" could be problematic.

By the way, regarding barriers to entry: Development costs of over $billion per new drug might be a barrier as well. YMMV