The Toronto Star by Kelly Grindrod 6 Aug 2019
There is only one upside to the Trump administration’s plan to allow American pharmacies to buy cheaper drugs from Canada — it is finally drawing much needed attention to our drug shortage crisis.
Canadians are living through one of the worst drug shortages in modern history. Of the roughly 7,000 prescription drug products available in Canada, over 1,800 are shorted. Anecdotally, Canadian pharmacists are complaining that up to half of the drugs they order are unavailable.
Recent drug shortages have ranged from cancer and surgical drugs to drugs for blood pressure, seizure, heartburn, and acne. In some cases, there are similar products that can easily be substituted.
For many others, clinicians must choose an entirely different drug with different risks and benefits. Challenges include finding an equivalent dose or knowing how to switch from one drug to another.
The most frustrating aspect of the drug shortages is that there is almost no transparency around the true causes. Many of the shorted drugs have been around for years, are inexpensive, and have become cornerstones of care, such as the antidepressant bupropion or the heart medication diltiazem.
Pharmacists are given vague explanations such as “disruption of manufacturing” and “delay in shipping,” but there are no explanations of why there are disruptions or delays.
For U.S. politicians, the proposed policy is a meagre attempt to reduce drug costs. Unlike other developed countries, the U.S. government does not regulate drug pricing. Instead, they support a free market where pharmaceutical companies can charge whatever the market is willing to pay. As a result, pharmaceutical companies make the bulk of their global profits from U.S. consumers.
Currently, insulin is the poster child of drug pricing run amok. For years, highly publicized caravans of Americans have come to Canada to buy insulin. With each trip, the caravans draw attention to the stark contrast where a $300 vial of insulin in the U.S. only costs $30 in Canada.
Ultimately, Americans need to regulate their own drug prices. With a population of over 325 million, they cannot rely on a country of 37 million to solve their pricing problems.
In theory, if there is a greater demand for Canadian drugs, then drug manufacturers can make more to meet the demand. However, given the current drug shortage crisis and the profitability of the U.S. market, drug manufacturers may not be so willing to comply.
Where does this leave Canadians? The drug shortage crisis needs to be a federal election issue this fall. All parties need a plan for how they will address drug shortages. The Canadian government also needs to establish a regulatory framework that provides more transparency and protection for the Canadian drug supply — both for manufacturing issues and export to the U.S. market.
At the end of the day, the U.S. proposal is nothing more than lazy policy making but it is a chance to focus on what really matters to Canadians.
Kelly Grindod is an assistant professor in the School of Pharmacy at the University of Waterloo.