When Michelle Fenner signed up to run this year’s Los Angeles Marathon, it got her thinking: Tijuana, Mexico, is only a 2½-hour drive from L.A. Why not take a trip across the border and buy some insulin for her son?
"It’s so easy to just go across the border," mused Fenner.
This idea had been in the back of Fenner’s mind for a while. Her son was diagnosed with Type 1 diabetes nine years ago, meaning he needs daily injections of insulin to live. The list price of the modern generation of insulin has skyrocketed since his diagnosis. On one trip to the pharmacy last year, Fenner was told that a three-month supply of insulin would cost her $3,700.
That same supply would cost only about $600 in Mexico.
So, when she booked her trip to Los Angeles, Fenner said, "I decided we need to update our passports and go and get more insulin."
Fenner is not the only one thinking like this. The U.S. government estimates that close to 1 million people in California alone cross to Mexico annually for healthcare, including to buy prescription drugs. And between 150,000 and 320,000 Americans list healthcare as a reason for traveling abroad each year. Cost savings is the most commonly cited reason.
‘Right to shop’ legislation
In Utah last year, the Public Employee Health Plan took this idea to a new level with its voluntary Pharmacy Tourism Program. For certain PEHP members who use any of 13 costly prescription medications—including the popular arthritis drug Humira—the insurer will foot the bill to fly the patient and a companion to San Diego, then drive them to a hospital in Tijuana, Mexico, to pick up a 90-day supply of medicine.
"The average cost of an eligible drug in the U.S. is over $4,500 per month and is 40-60% less in Mexico," PEHP clinical services director Travis Tolley said in an announcement of the program in October.
The program was part of a "Right to Shop" bill championed by healthcare economist and Utah state representative Norm Thurston in 2018. Thurston said there is not yet enough data to know how much in savings the program provides; the first patients traveled to Tijuana in December.
But, Thurston said, he expects that in the next six months, savings will likely be "in the ballpark of $1 million."
There are some questions about traveling abroad to buy prescription drugs, however. The first: Is it legal?
According to the Food and Drug Administration, "in most circumstances, it is illegal for individuals to import drugs into the United States for personal use." But the agency’s website does provide guidance about when it could be allowed. And the U.S. Customs and Border Protection’s website has a whole section on traveling with medications in its "Know Before You Go" guide.
While the guidelines may still raise questions, Thurston said, this sort of purchase for personal use is a widely established practice.
"When we talked to people about this, there has never been a single person who has been prosecuted for doing it. And it happens every day at every border crossing all over the country," Thurston said.
"The general understanding is you can bring up to a 90-day supply of a prescription from overseas, even though it’s a technical violation," said Nathan Cortez, a law professor at Southern Methodist University.
"My sense is the FDA does not want to worry about individuals going overseas and bringing back small amounts of prescriptions that last a few months," Cortez said, adding, "That doesn’t mean the FDA couldn’t change its mind at any point and start cracking down."
A second major concern that comes up in any discussion of medical tourism is about the quality of that imported medicine. According to the FDA, the reason it’s mostly illegal to import drugs is because the agency "cannot ensure the safety and effectiveness" of those drugs. In 2017, the World Health Organization estimated that 10% of drugs in developing countries were either substandard or falsified.
To address that problem, the Utah program sends its patients only to a designated, accredited Mexican hospital. Individual patients like Michelle Fenner are left to take their own precautions.
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