By Susan Martinuk
Frontier Centre for Public Policy
When U.S. presidential candidate Bernie Sanders joined a caravan of diabetics for a cross-border shopping trip to buy Canadian insulin, it was a deliberate attempt to publicize his proposed policies to reform health care. He likely had no idea that the media coverage of his actions would set off alarm bells among Canadians and even motivate Canadians to take a stand against the very reforms that Sanders is promoting.
Insulin caravans have become commonplace in border cities. Canada doesn’t require a prescription to purchase the drug, it can be bought at one-10th of the cost it’s sold in the U.S., and common practice allows Americans to import a 90-day supply of drugs for their own use.
Canada has no laws to prevent such ‘pharmaceutical tourism’ and even though our tax dollars are used to purchase and subsidize the costs of our ‘cheaper’ drugs, we may not be averse to providing lifesaving drugs to our southern neighbours.
But just days after Sanders started the conversation, President Donald Trump jumped onto the drug affordability bandwagon. The U.S. Department of Health and Human Services revealed its plan to create legislation that would allow states, pharmacies, wholesalers and distributors to legally import bulk quantities of drugs from Canada. Ten states already have such legislation and are just waiting for federal approval to begin.
That one word ‘bulk’ provokes a very different response from Canadians. It shifts our mental picture from children who need a hand to one of greedy Americans raiding Canada’s medicine chest.
Our drug supply is meant to supply 37 million Canadians, not 370 million Americans. If Americans could import bulk quantities, we would very soon run out of medicine and the U.S. would still not have resolved its problem of having to pay top dollar for prescription drugs.
Discussions about the U.S. importing cheap drugs from Canada have been around for awhile. In January, Sanders tabled a health-care reform bill that’s languishing in the Senate and will likely never be passed.
In Canada, pharmacists and other groups have warned Ottawa for months about the dangers of allowing the U.S. to dip its hand into our drug supply. Diabetics in Canada have already had to deal with insulin shortages and now three significant cancer drugs are in short supply.
Patient advocacy groups, pharmacist associations, physicians (oncologists, in particular) and organizations representing the pharmaceutical industry have all called on the federal government to do what’s necessary to protect our somewhat fragile drug supply.
The U.S. says a pilot program could be underway soon and given its potential for disrupting Canadians’ access to their own drug supply, it seems it would be prudent for the federal government to take proactive steps.
Yet Ottawa seems to be taking a very laissez-faire approach to these developments, considering only reactive measures. Health Canada admits it was not consulted by the U.S. prior to its announcement.
Despite the warnings and calls for action, including a demand to Parliament to deal with this, Health Minister Ginette Petitpas Taylor says they will be working closely with experts to “ensure there are no adverse effects” on Canada.
The primary concern is shortages. Prime Minister Justin Trudeau has responded by stating he believes that Health Canada ensures “a steady and solid supply” of medications for Canadians – regardless of internal or external pressure.
But that statement is more spin than reality. University of Waterloo pharmacy professor Kelly Grindrod says we are already in “one of the worst drug shortages in modern history.” Of the 7,000 prescription drugs available in Canada, more than 1,800 are in short supply.
Canada has a website designated to track drug shortages and, according to Grindrod, anecdotal evidence from pharmacists suggests as many as one-half of the drugs they order are unavailable. Additionally, a Canadian Pharmacists Association survey found dealing with drug shortages can consume as much as 20 per cent of a pharmacist’s typical shift.
The problem is complex and involves a lot of stakeholders. But this is a time when the Canadian market can’t protect itself and is in dire need of political leadership, government action and a long-term solution.
Susan Martinuk is a research associate with the Frontier Centre for Public Policy.