UF study: 2 million Americans buy prescription drugs outside the country

Buying prescription drugs from other countries is one way some Americans have coped with rising drug prices. A new University of Florida study, published today in JAMA Network Open, finds that 1.5% percent of adults, or more than 2 million Americans, purchase their prescription drugs from outside the U.S. to save money.

The UF researchers caution that with the rapid growth in unemployment related to the COVID-19 pandemic and subsequent loss of health insurance, the number of Americans searching for cheaper prescription drugs is likely to rise. Their findings may actually be an underestimation.

“With the economic and health consequences of COVID-19 disproportionately impacting minority and low-income populations, more people in those groups may be seeking an alternative way to meet their medication needs,” said the study’s lead author Young-Rock Hong, Ph.D., M.P.H., an assistant professor of health services research, management and policy at the UF College of Public Health and Health Professions and a member of the UF Health Cancer Center.

In recent years, a number of proposals have been discussed as strategies to counteract increases in drug pricing, Hong said.

Last year, the Trump administration announced plans to allow importation of drugs from Canada in an effort to stimulate price competition. The U.S. Food and Drug Administration introduced the Safe Importation Action Plan, with proposed pathways to allow for the safe importation of drugs originally intended for foreign markets. If finalized, the plan would permit U.S. consumers to purchase certain drugs from Canada.

Safety is a real concern with purchases of international drugs, UF researchers say. The World Health Organization conservatively estimates that 1 in 10 medications sold in the world are substandard or falsified.

“Patients might not be getting what they think they are getting,” said co-author Juan Hincapie-Castillo, Pharm.D., Ph.D., an assistant professor of pharmaceutical outcomes and policy in the UF College of Pharmacy. “This is particularly dangerous to patients needing medications with a narrow therapeutic index. In other words, a medication for which a small dose deviation can result in severe adverse events.”

For the study, researchers analyzed data from the 2015-2017 National Health Interview Survey, a nationally representative study conducted by the National Center for Health Statistics in order to track health status and health services use. Participants were asked if they had purchased prescription drugs from countries outside the U.S. to save money. Those who had were more likely to be older, be an immigrant, and have inadequate insurance coverage and financial constraints that impact their ability to refill prescriptions. They were also more likely to use the internet for health care information.

With more Americans anticipated to purchase prescriptions outside the U.S., patient education and stringent quality control measures are more important than ever, Hong said.

“Patients should be informed of these potential risks they can encounter,” Hong said, “and policies that seek to pursue drug importation should reinforce quality assurance and strict monitoring processes to promote safe administration of imported medication in the U.S. market.”

In addition to Hong and Hincapie-Castillo, the UF research team included Zhigang Xie, a doctoral student in health services research; Richard Segal, Ph.D., a professor of pharmaceutical outcomes & policy at the College of Pharmacy; and Arch Mainous III, Ph.D., a professor in the department of health services research, management and policy.