The United States pays the highest prices in the world for prescription medications, and the majority of Americans (72 percent) believe these costs are unreasonable. According to the International Federation of Health Plans, Americans pay two to six times more than the rest of the world for brand-name prescription drugs. Specialty and cancer drugs tend to be the most expensive, but commonly used medications also carry sky-high prices.

With the globalization of the drug industry, 40 percent of generic and brand-name prescription drugs consumed in the United States are manufactured in other countries. Eighty percent of the active ingredients in medications consumed in the United States also come from abroad. Many millions of Americans already order prescription medications abroad. Expatriates utilize overseas health care providers and pharmacies without hesitation. Americans who travel widely are confident in the safety of purchasing medications abroad.

In 2013, Maine became the first state in the nation to pass legislation allowing its citizens to buy mail order drugs from certain foreign countries, including Canada. However, in 2015 Maine’s U.S. District Court overturned the law, stating the federal government has jurisdiction over importation.

According to PhRMA, a U.S. pharmaceutical trade group, high prices reflect the research, development and time it costs to bring a drug to market. In Germany, however, nonprofit health care insurers bargain directly with pharmaceutical companies and health providers to get the best price. Countries such as Canada and England also negotiate prices with pharmaceutical companies. These countries and groups exert greater purchasing power since they buy in bulk at lower costs. This is not the case in the United States; Medicare does not negotiate costs with drug companies. Drug review boards could lower costs if we had them in place.

Currently, American law prohibits large groups and health care systems from negotiating prices with drug companies. The Veterans Health Administration, the largest closed health care system in the country, does fix drug prices to keep costs down so they can care for all their patients; however, the VHA also maintains a single national formulary physicians must follow, often restricting which drugs are available to patients.

The U.S. Food and Drug Administration objects to the purchase of medications abroad that have not received its approval, believing many drugs sold in developing countries contain impure or toxic ingredients, applying the same precautions for purchasing prescription medications over the Internet or when traveling in a foreign country. The agency warns buying drugs from non-U.S.-based websites can be risky since these drugs have not met FDA standards for safety and effectiveness. It is also difficult to know whether you are dealing with a reputable website.

Reputable U.S. online pharmacies receive a Verified Internet Pharmacy Practice Sites seal of approval from the National Association of Boards of Pharmacy. The seal indicates the online pharmacy complies with state licensing and inspection requirements. The FDA believes we should be wary of U.S. or foreign websites not approved by the NABP since they may sell questionable products, may not be licensed and may not protect the personal information you share.

For some time, many Americans looked to Canada for purchasing less expensive prescription drugs. But according to the FDA, some drugs entering the country from Canada actually originate in other countries. Canada has its own federal agency similar to the FDA responsible for regulating drugs within Canada, but there is no guarantee it regulates drugs exported to the United States. This means some Canadian medications may be foreign counterfeits or may not meet U.S. or Canadian safety standards.

Globalization of the pharmaceutical industry presents regulatory challenges for the FDA. The clinical trials of all medical products required for FDA approval are increasingly conducted abroad, adding complexity to the drug review process. Since consumer products come from many locations around the world, the FDA has gone global, opening new posts in key locations such as China, India, the Middle East, Europe and Latin America. These new areas help the FDA build strong relationships with officials overseas and observe firsthand how foreign-based facilities operate.

There are many legitimate online pharmacies. Others are not licensed in the United States or abroad, and some aren’t pharmacies at all. When buying prescriptions online, save your time and money and be selective about which sites you use.

Buy safe medications

• Consult your doctor.
• Use a licensed pharmacy.
• Insist on access to a registered pharmacist.
• Read the privacy and security policies.
• Be alert for counterfeits and report problems to the FDA.
• Do not use a website that bypasses prescriptions.
• Steer clear of sites that don’t provide a street address and phone number.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.