User:Yanni910/Medication tourism

Medication Tourism refers to the phenomenon of people traveling outside of their home countries for cheaper prescription medicines. The term Medication Tourism is still fairly new but with the rising cost of prescription medications, especially in the United States, there is no doubt that this trend is only going to grow in the future. More and more patients have begun to flock to countries such as Canada, India, Egypt or Brazil to pay less for expensive medications that treat health complications such as hepatitis C, diabetes, and asthma. However, medication tourism presents a new set of complications for international patients when it comes to their healthcare. Patients have to worry about things such as travel costs, authenticity of the drug, and how much of the drug they are legally allowed to bring back to their home countries. Similar to medical tourism however, professional agencies and companies are now beginning to emerge with the purpose of helping patients relieve these issues. Also, as international drug costs are cheaper, insurance companies are now giving travel packages to patients in order to give them more incentive to go abroad for treatment. Additionally, when it comes to the legal issues of importing drugs, states such as Florida, Vermont and Colorado have begun to pass laws that make it possible for some patients to purchase drugs online in bulk. In fact, even president Donald J. Trump has said that importing medications from Canada may be the solution to the rising cost of drugs in the United States. With more and more people participating in this new trend, the long term effects this may have on country's economies and the international drug market as a whole must be examined to ensure that future problems do not arise.

Benefits

One of the major benefits of traveling abroad for prescription medications is the cost savings. As drug prices continue to rise in the United States, medication tourism has offered a new route to obtaining life saving drugs at a fraction of the cost. For example, when it comes to the drug sofosbuvir, which treats hepatitis C, the price in the United States for the entire 12 month treatment plan can cost $360,000 where as in countries such as India or Egypt, the price is up to 100 times cheaper . Similarly, when it comes to the price of insulin, a three month supply can cost $3,700 in the United States where in Mexico, the price is 6 times less costing a mere $600 in comparison. Another benefit of medication tourism would be the business that is generated by international patients. Similar to medical tourism, patients traveling from abroad generally spend up to 12 times more than domestic patients. This extra boost in spending can be attributed to hotel stays or housing accommodations, dining and participating in tourism activity which all generate a big boost for the host country's economy. Additionally, as medication tourism becomes more popular, more and more employment opportunities in the drug manufacturing industry will open up for any country wanting to attract the most foreign patients. Like medical tourism, this increase of focus towards the health care industry can lead to facilities and workers that are better able to treat not just international patients, but also meet local population's health needs as well. All of these things help increase the standard of living for people in host countries as they have better access to wealth, medications and healthcare facilities.

Risks

Despite medication tourism's growth in the recent decade, there are still risks involve wether it has to do with the medications themselves, or just from the act of traveling internationally. Specifically when it comes to importing medications, as that is currently illegal to do in the United States, the FDA has strict guidelines to ensure that any drugs or medications being brought back to the United States are less than a 90 day supplies worth. This can make it hard for traveling patients as they are required to make multiple trips throughout the year which can be difficult to do especially when they are sick. While the FDA does this to prevent the illegal usage of some medications, they also want to ensure the safety and authenticity of foreign drugs that are being brought back into the United States. Authenticity of foreign drugs seems to be the main concern when it comes to medication tourism. As regulations and standards of healthcare are different across countries, it is always a risk to seek health treatment abroad which makes it so important for more research to be done on medication tourism. In fact, in 2017, the World Health Organization estimated that up to 10% of drugs in developing countries were falsified or falling below U.S. standards.

Additionally, when traveling to countries that speak different languages, there is always the chance of miscommunication between the healthcare provider and the patient. which is always dangerous especially if the patient has never taken the medication before. While some companies and agencies have proven helpful in helping find patients authentic pharmaceutical retailers and helping resolve the language barrier, there is still some risk involve which can lead to harm being done to the patient.

Another issue pertaining to medication tourism is that some prescription medications are easier to obtain in other countries which can lead to improper use of medications or even death. For example, in 2014, a couple was found dead in their hotel room in India after an apparent prescription medication overdose. However, despite this incident occurring, there are still reports of people flying to countries such as India to stock up on medications that are easier to obtain just to sell them in their home countries. These stories prove that not enough regulations are in place to ensure that incidents like these don't happen in the future.

National Response

While patients from the United States seem to be the most impacted from drug pricing, the government response towards medication tourism is on a general trend to make it easier to bring in bulk amounts of medicine into the United States. The law pertaining to bringing medications across U.S. borders is hardly ever enforced and even President Donald Trump has said that importing medications into the United States might be the solution to overcome the drug pricing problem. Additionally, states such as Florida, Vermont and Colorado have passed laws intending to make it easier for patients or companies to buy bulk size orders of medication online. However, this is not the first time this solution has been tried. In 2003, the Medicare Modernization Act was passed which allowed the Secretary of Health and Human Services to import drugs from Canada only if they did not pose a risk to public health and generated cost-savings for American patients. To this day, the law is yet to be used as no Secretary has been able to meet both of these requirements yet. Additionally, programs and laws similar to the ones established in Florida and Colorado have also been previously implemented only to be terminated due to failure a short four years later. It is clear that the main concern pertaining to drug importations in the United States has to do with authenticity and inability to meet FDA's safety standards.

Some insurance companies and hospitals have begun promoting traveling for medication as the cost of the trip, hotel stays and price of the actual medicine are cheaper than from buying the same medicine in the United States. Some American pharmaceutical companies such as Wagstaff are beginning to establish pharmacy tourism departments to specifically deal with the importation of foreign drugs. Representatives from Wagstaff will make regularly scheduled trips to places such as Egypt and India to refill on prescriptions for a fraction of what they would cost in the United States. Even with just two trips, the company managed to save over $80,000 on purchasing common drugs. Similarly, The Pharmacy Tourism Program, which is part of Utah Public Employees Health Program, are now offering packages for patients to fly to San Francisco and then drive down to Tijuana, Mexico to fill their prescriptions. They claim that this program is specifically for patients with serious chronic conditions such as rheumatoid arthritis or multiple sclerosis. When asked about the authenticity of the drugs from Mexico, they say that the chain of custody, a series of tests that are performed to establish medication standards, meet FDA requirements ensuring that the drug from Mexico is the exact same drug as one from the United States. While this program is currently only offered to about 400 people, there is much potential for other companies to go down this avenue of business.

International Response

Canada

Canada has been one of the leading countries when it comes to medication tourism. Many pharmacies near the border see American patients regularly and are even encouraging them to continue making the trip. While many drugs produced in Canada meet U.S. standards, the FDA still warns people from becoming too comfortable with these foreign medications as companies do not always have the patients interest at heart. For example, it has been previously found that Canadian pharmaceutical companies such as Canada Drugs were importing counterfeit or illegally blanketed drugs into the United States. This is one of the many reasons why regulation on foreign drugs needs to be established in order to ensure that instances like these do not cause harm or even death to a patient.

Mexico

Similar to Canada, Mexico is also one of the dominant countries involved in medication tourisms. As the trend continues to grow, it can be assumed that more programs such as the one part of the Utah Public Employees Health Program will soon start to give incentives for their customers to travel down to Mexico in order to obtain refills on their medications. Additionally, as more people begin to find out about the difference in drug pricing, people will want to take the trip if it means saving hundreds of dollars on medication they need. Again, as previously stated, regulations need to be in place however, to ensure the safety of the patient.

Thailand

Thailand has been a popular player in the medical tourism field so naturally, medication tourism is something that they also strive in. Thailand is known for its ease of access to prescription medications which leads to people taking medicine they should not be taking. However, when it comes to serious illnesses such as Hepatitis C, Thailand can be a viable option for American patients looking for cheaper prescriptions. In fact, there are even credited business who specifically work in resolving any sort of issue that international patients may face such as housing, traveling and even language barriers. For example, Bumrungrad International Hospital, a hospital with a high quality of recognition, has recently launched a program designed to encourage American patients to visit Thailand to refill their prescriptions claiming they can save as much as 80% compared to U.S. costs. Companies such as these compete with Mexican and Canadian pharmacies in order to attract the most foreign patients.

Long Term Solution

Medication tourism might offer a short term solution to the drug pricing issue in the United States, but experts are in agreement that it is no where near a long term solution. Currently, the majority of patients in the United States who travel for their medications go to places in Canada and Mexico. However, these two countries are in no place to take over the drug demand that Americans have while staying consistent with the medication needs of their own citizens. This is one of the reasons Canadians fear that there will be drug shortages in their own country. That is why the drug pricing issue needs to be resolved domestically as it is the only way to ensure that no disadvantages are being done towards patients in all participating countries. However, as representatives of the pharmaceutical companies will continue to state that looking towards outside countries for drug supplies will lead to harm to patients, one that that is clear is that this issue will take months to solve.

Future Research

Because medication tourism is still a fairly new phenomenon, more research is needed to fully examine the effects and causes it has on not just individual countries, but on the entire global drug market. With the potential risks it may have on patient populations, wether coming from traveling while ill or from taking unauthentic drugs, it is very important that this research is begun quickly as to ensure that there are no unforeseen problems or issues that may arise from this practice. However, because each patient's diagnosis is unique, this will be fairly hard to do and research may take longer than usual. That is why patients should still be wary when it comes to medication tourism and perform it at their own risk.