Facing High Drug Costs, Some US Cancer Survivors Buy Prescriptions Abroad

By Carolyn Crist

January 19, 2021

NEW YORK (Reuters Health) - U.S. cancer survivors who face difficulties in finding a doctor and affording their medications are more likely to purchase their prescriptions outside of the country, according to a new analysis.

Federal officials should monitor imported prescription drugs for safety and create new strategies to address the rising costs of cancer care, researchers write in the American Journal of Preventive Medicine.

"The costs of medical care impose substantial financial hardship on patients, especially those with cancer, and their families in the U.S.," said lead author Dr. Young-Rock Hong of the University of Florida College of Public Health and Health Professions in Gainesville, Florida.

Some cancer drugs routinely exceed $100,000 per year of treatment, he said, and more patients are reporting financial concerns around affording their medications. Patients and their families are often forced to make tough decisions about treatment and prescriptions to manage the financial burden.

"Drug importation or purchasing prescription medications outside of the U.S. has emerged as a means of reducing healthcare costs in the current administration," he told Reuters Health by email. "More patients and their families are expected to choose this option to lower medical expenses, not only for those with financial hardship."

Dr. Hong and colleagues analyzed data from the National Health Interview Survey between 2011 to 2018 to understand the factors behind cancer survivors' decisions to purchase abroad, including access to prescribers, financial strain and use of online pharmacies. They also looked at sociodemographic factors such as health-insurance status, education levels, immigration status and race and ethnicity.

Among the 17,672 cancer survivors included in the analysis, 288 - or 1.6% - reported prescription medication purchases outside of the U.S., which didn't change much between 2011 and 2018.

Cancer survivors who were Hispanic, immigrants, uninsured, married, had a graduate degree or higher and had 10 or more years since their cancer diagnosis were more likely to purchase their drugs outside of the U.S. Age, geographic location, family income and the type of cancer didn't seem to affect whether patients purchased abroad.

However, cancer survivors who had difficulties with finding a prescribing doctor or affording prescribed medications were three times more likely to purchase medications abroad. Extrapolating this to the overall population of U.S. cancer survivors, the research team estimated that about 120,000 cancer survivors in the U.S. likely purchase medications abroad each year to save money.

"The volume of medication purchase abroad could be increased during this pandemic (financial constraint, loss of insurance, difficulties in access to care)," Dr. Hong said. "Further work is needed to evaluate the pattern of imported prescription drug use and its consequences, especially treatment adherence and regarding drug safety."

People who used online pharmacies and filled prescriptions online were also three times more likely to purchase abroad. This practice will likely persist and grow, even if the increasing cost of medication in the U.S. slows.

While most prescriptions are still filled at brick-and-mortar pharmacies, "given the projected prevalence of cancer patients in the coming years, the wider use of e-prescribing and access to the Internet will serve as external forces to spur the purchasing of medicines abroad by cancer survivors," said Dr. Pricivel Carrera of HealtEmpact, a health-and-economic-insights group in The Netherlands. Dr. Carrera, who wasn't involved in the study, has researched the financial burden that cancer patients face.

Purchasing prescriptions abroad could be a "maladaptive coping strategy," she said, where cancer patients and survivors feel they need to buy medications elsewhere due to high costs. This could negatively affect the safety and efficacy of ongoing treatment, as well as the doctor-patient relationship, she added. Instead, federal policies should address the financial, health insurance and access issues so cancer patients can buy the prescriptions they need - and where they want to buy them.

"That cancer survivors purchase their medicines abroad highlights the financial and access-to-care issues that persist in the U.S.," she told Reuters Health by email. "It may even worsen where actions are not taken to mitigate the financial toxicity of treatment."

SOURCE: https://bit.ly/3qdwdEs American Journal of Preventive Medicine, online December 24, 2020.