As US Prescription Drug Costs Rise, International Pharmacies Beckon

Christina M. Sorenson, OD


March 08, 2017

Remember when you spoke of doughnut holes and were just referring to those sugary treats you could pop into your mouth? Twenty doughnut holes later you were in a sugar coma.

Today the conversation is very different. "Doughnut hole" is now the term used to describe the coverage gap for medications.

All patients covered by Medicare Part D start the year with a deductible dollar amount which, once used, sets off insurance coverage for medications. The medication coverage is designed to keep the cost to the patient stable over the course of the year—that is, until the deductible and the insurance coverage are depleted. Once the coverage amount is gone, patients begin to pay for the medications at retail cost. This is the doughnut hole. Patients see the cost of their medications skyrocket five to 10 times the covered cost. What we see in the office is a sharp climb in requests for samples and substitute medications.

More and more of the patients in my practice are obtaining medications from Mexico and Canada. Patients are finding international pharmacies online. There are even organized bus trips across the border for drug purchases—sounds nefarious, doesn't it? I have gotten reports from my patients of incredible savings on a brand-name product in the same packaging and same manufacturing plant. Why the costs to the American consumer are consistently at such an outrageously inflated rate compared with other countries is not well explained from any source I have found.

I don't know what to expect for our patients. Healthcare is now approximately 18% of the gross domestic product (GDP) and is expected to rise to over 20% by 2025.[1] This is a whopping amount of money spent on healthcare, and yet our system is no longer considered the premier model of patient care. The United States ranked 11th out of 11 countries on measures of healthcare system quality in the Commonwealth Fund's 2014 list[2] and 37th out of 191 countries ranked by the World Health Organization in 2016.[3]'s annual Global Retirement Index 2017 reported that Malaysia, Costa Rica, Colombia, and Mexico provide the best and most affordable healthcare in the world.[4] Items considered in the healthcare category include cost of care, quality of care, number of people per doctor, number of hospital beds per 1000 people, percentage of the population with access to safe water, infant mortality rate, life expectancy, and public health expenditure as a percentage of a country's GDP.

In the United States, the near future carries the threat that the Affordable Care Act will be repealed with no clear outline of any replacement system. I find myself alternately frustrated and anxious, but wouldn't it be nice if we could develop and maintain a system of healthcare that met or exceeded that of other countries?


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