1. Quality of prescription drugs
a. Health Canada responsible for efficacy and safety of drugs marketed in Canada
b. Health Canada operates under the Food and Drugs Act and regulatory mandate under the Food and Drug Regulations
c. Most drugs are not manufactured in Canada
d. There is no parity between drugs available without a prescription in US vs. Canada
2. Availability of prescription drugs
a. US Rx received in Canadian pharmacy must be approved by a Canadian physician prior to it being filled – cosigning
b. Canada Health Act – drugs administered in Canadian hospitals are approved at no cost to patients
c. Employers cover many Canadians and their families
d. Drug Shortages Canada –
i. Website for reporting drug shortages and discontinuations in Canada
ii. Drug sellers must report that they cannot meet demand
3. Cost considerations
a. Canada
i. Most prescription drugs are imported
ii. Government places price ceilings on Brand name medications imported into Canada
b. Canadian internet pharmacies are suspect
c. Bricks and mortar pharmacies are same as US
4. Opportunity Savings
a. HIS Markit study – Abilify costs 87% less and Xarelto costs 60% less
b. Concerns that manufacturers will increase prices for drugs in US and Canada
5. State Plans
a. Florida
b. Vermont
6. Trump’s Plan
a. States, individual pharmacies, wholesalers can write proposals and submit for federal approval
b. Exclusions – biologics, medications created from living organisms
c. FDA would work with manufacturers to bring drugs made in foreign factories to the US (e.g., insulin)
7. Arguments Against – PhRMA
a. Counterfeit, dangerous medications
b. Canada drug market too small
c. Canada doesn’t have an unlimited supply of medications
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