On the Legitimacy of Cross-Border Pharmacy

Abstract

Cross-border pharmacy sales of prescription drugs to U.S. patients by Canadian Internet pharmacies have generated significant controversy in the U.S. and Canada. Violative of U.S. legislation and Canadian professional codes of conduct, cross-border pharmacy has nonetheless flourished in response to strong demand and incomplete enforcement. Proponents laud the greater affordability of needed drugs provided by cross-border pharmacy; opponents decry the practice as unsafe, economically ill-advised and harmful to Canadian interests in the long term. This article evaluates the safety arguments that have been put forward by the U.S. Food and Drug Administration and others and concludes that they do not justify a prohibition on prescription drug imports from Canada. Similarly. Canadian professional regulatory bodies' objections to the participation of Canadian pharmacists and physicians in cross-border dispensing are a misapplication of conduct rules developed in another context. Objections to cross-border drug sates based on an economic analysis assume normative positions that should be explicitly identified and socially determined. On the other hand, if patient safety, professional responsibility and economic arguments fail to provide adequate support for a policy of prohibition, then self-interest in protecting domestic drug supplies and prices may support, at least from a Canadian perspective, some constraints on cross-border pharmacy.