PUTT: FOREIGN DRUG IMPORTATION WON’T FIX THE BROKEN PRESCRIPTION DRUG SYSTEM BUT WILL PUT FLORIDIANS’ LIVES AT STAKE

Florida Lawmakers Should Focus on the Real Issue: PBM “Middlemen” Profiting at Every Stage of the Prescription Drug Supply Chain

TALLAHASSEE, FL (March 29, 2019) – Following approval of the House Appropriations Committee for a bill that would allow the State of Florida and possibly individual citizens to import foreign drugs as an alternative to trying to afford the sky-high price of some prescription medications, Pharmacists United for Truth and Transparency is calling on lawmakers to reconsider this dangerous and risky proposition.

HB 19 would allow the state to establish the Canadian Drug Importation Program with the intention of enabling the purchasing of prescription drugs at a discount price. The idea has been hailed by some as a way to stimulate competition in hopes of bringing U.S. drug prices down. “You know what else the U.S, drug market has that Canada doesn’t have other than unaffordable prescription drugs, Pharmacy Benefit Manager middlemen”, said PUTT President Scott Newman. “Florida lawmakers are choosing to ignore the well-documented affect PBM middlemen have on prescription drug pricing. Importing foreign drugs sends a bizarre and dangerously tone-deaf message to the state’s patients and consumers. Florida is the only state with no PBM regulation bills on the docket this year. This legislation is playing Russian Roulette with people’s lives.”

These bad actors within the prescription drug supply chain, if addressed, would provide the people of Florida and the U.S. a clear view of how our drugs are priced and what percentage of the price consumers pay actually goes to pharmacy benefit middlemen positioned between the drugmaker, the patient and the pharmacy, Newman said.

But the complexities of prescription drug pricing aside, there are several other reasons PUTT opposes “Canadian” and other foreign drug importation:

● Patient and product safety and liability are not guaranteed. Several studies point to the danger and fallacy of importing drugs from “Canada”. The reality of so-called “Canadian” drug sites is that most are not Canadian, nor do they sell Health Canada-reviewed or approved medications. A 2017 review by the National Board of Pharmacies showed many of these sites do not require a valid prescription - a troublesome prospect in light of the nation’s opioid crisis. Worse, several were found to sell counterfeit medications. 1. (Can we take out this bullet? I know it makes the safety statement) ... Here - let’s try this:
Its not wise to expect another country to oversee and ensure the safety of medications as American consumers have come to expect with the FDA. (or something like that?) and then put in the sendense about patient importing. 

● Canada does not support this idea. One previous Canadian lawmaker told another house committee that it is ILLEGAL for licensed Canadian wholesalers to export prescriptions priced for consumption by Canaidan citizens. Operating outside of their license brings not only stiff penalties by also possibly jail time. Depending on Canada under these circumstances will create
a demand that cannot be supported and will ultimately disrupt their drug supply chain. It will lead to a “grey market” that only further calls into question the safety of these imported medications. We must remember that Canada’s population is only slightly larger than Florida’s -- and Florida, like Oregon and 14 other states, is seeking to implement a Canadian importation system.

● Importing drugs does not guarantee health plan savings. Pharmacy benefit managers (PBMs) have already limited the number of American wholesalers that pharmacies can use to purchase products for billing insurance plans. Even if safety could be guaranteed - which it can’t - opening the floodgates to importation, only to realize that PBMs have blocked use of Canadian wholesale medications for American insurance plans, is one more threat that will frustrate and break the hearts of Floridian patients.

● Temperature changes have been associated with reduced potency and diminished integrity of pharmaceutical products. There is no evidence to suggest importing from Canada to Florida will reduce the likelihood of medications damaged from extreme cold or heat.

● The savings that would be realized are not enough, even if the pharmacy were the “importer” of the drugs. While importing from another country could potentially reduce drug costs by 50 percent, for many patients, the discounted medication is still too high. What good is a $300 drug marked down to $150 if the patient has difficulty affording a $50 insurance copay? It
is the extremely high price of medications, even generic, at the heart of the nation’s drug pricing crisis.

● The opaque system that favors the middleman would still exist. The fact remains that much of the activity conducted by PBM middlemen takes place behind closed doors, with no regulation requiring transparency or accountability. Some 85% of Americans are enrolled in pharmacy benefits plans designed and administered by only three PBMs, each of which is a part of larger healthcare or health insurance companies, and each one still operating without licensure (they are “registered” in Florida) and with very minimal if any regulatory oversight.

● Canada does not support this idea. It is illegal for licensed wholesalers in Canada to export medications and will lead to the loss of licensure for any Canadian pharmacists who export medication. Depending on Canada under these circumstances will create a demand that cannot be supported and will ultimately disrupt their drug supply chain. It will lead to a “grey market” that only further calls into question the safety of these imported medications. We must remember that Canada’s population is only slightly larger than Florida’s -- and Florida, like Oregon and 14 other states, is seeking to implement a Canadian importation system. 

“Pharmacies and patients have a sacred relationship,” said Monique Whitney, PUTT Executive Director. “If something goes wrong in the foreign drug importation process, patients will turn to their pharmacies for help. It makes better sense to avoid the risk all together by focusing on the real driver of high prescription drug medications - the PBMs.” 

“We believe the simplest solution is the best solution. Importing medications is not simple - it is risky and adds one more layer of complexity. The simplest solution is to require transparency of prescription drug benefits programs and the PBMs who design and manage them,” said Ms. Whitney. “Throwing back the veil of secrecy allows everyone to know and understand how drugs are priced, including where and how price markups are determined, and what can be done to bring high prices back down to affordable levels.” 

“On behalf of Florida’s pharmacies, we are asking the State of Florida to do the right thing, to take the potentially more difficult path, and work with healthcare providers and healthcare business leaders to resolve the problem for Floridians and to hold the health insurers and their contracted benefits managers accountable for their significant role in the unnecessarily high cost of American prescription drugs,” said Newman.

Originally intended to process prescription claims, PBMs portray themselves as helping reduce costs. However, PBMs are nothing more than the “middlemen” in the pharmacy industry. The largest PBMs have been widely documented and fined for antitrust activities including questionable pricing, unfair practices and passing on costs that make it difficult for all, including the largest pharmacy chains, to do business. The result is an unlevel playing field that has forced hundreds of independent pharmacies, often serving small and/or rural communities, out of business.

1. Rhode Island Medical Society, “Is Importation of Drugs from Canada the Answer?” Oct. 2018
https://bit.ly/2V5MU5g

Pharmacists United for Truth and Transparency (PUTT) exists to unify, promote and preserve independent pharmacies through education and access; to monitor PBM and other industry practices which, when identified as abusive, are exposed in various manners in the interest of improving the quality, safety and cost of patient care.  For more information about the negative impact of Pharmacy Benefits Management company practices on the cost and accessibility of medications, or to learn more about PUTT, visit TruthRx.org or contact Monique Whitney, (505) 480-4150.