- Americans pay a lot for their medicine, and it only seems to be getting worse.

US spending on prescription drugs has increased by 76% in the last 20 years.

Today we pay around twice as much as other wealthy nations on average.

- This can have devastating effects on the individuals who rely on them, with one in three Americans reporting that they skipped prescribed medications because of the cost.

Many others have gone into debt or even suffered bankruptcy over high drug prices.

- But there is another option that Americans are increasingly taking advantage of, buying prescription drugs from other countries.

The practice is not without health and legal risks, but the price differences can be so huge it's understandable that people are willing to take a gamble.

For many it might be the only way to access life-saving medications.

- But before you pop over the Mexican border for some insulin, or log onto a Canadian website for asthma inhalers, you should know how much you can really save, whether the risks are worth the reward, and how we got into this mess in the first place.

- Why are drugs so expensive in the US?

The short answer is that here pharmaceutical companies are allowed to charge whatever they want.

Virtually all other wealthy nations have regulatory bodies that determine how much new drugs can cost, based on how medically effective they are.

If the drug company doesn't like the price cap, the drug won't get approved.

- By contrast, the FDA must approve every drug as long as it's considered safe and effective, and has no say in the price.

Individual insurers and hospitals can negotiate with drug companies, but because the market is so fractured, they don't have much leverage.

The only organization big enough to throw its weight around, Medicare, is legally prohibited from haggling.

They're required by law to cover nearly every drug the FDA approves at whatever price the drug companies ask for, the upshot is that Americans have access to a much wider range of prescriptions but at prices so high they're effectively inaccessible to many.

- It's not surprising that many Americans have decided, "Hey, if my government won't do anything about drug prices, I'll just buy from a country that will," this can mean dropping into a pharmacy while on vacation abroad, or ordering from an international website.

It's surprisingly easy, and there are a lot of savings to be found, especially on name-brand drugs.

So why not go for it?

Well, for one thing, it's illegal.

- US law prohibits the importation of prescription medication from other countries, even those that are FDA-approved and manufactured in America.

But in reality you're very unlikely to get into trouble for it.

The FDA specifically allows agents to overlook infractions, as long as the quantity is obviously for personal use, say, three months worth, and the drug doesn't pose any serious health risks.

- Although the possibility of legal jeopardy might not be much of a deterrent, there are still health and safety risks involved.

- To talk about them, we've invited some real healthcare professionals on the show.

Dr. Alok Patel and Sheena Williams from PBS Vitals.

- It's true, brand-name prescription prices in the US far exceed those of many other countries.

And as we've been hearing from Philip and Julia, in most cases, importing prescription drugs into the US for personal use is prohibited and illegal.

Some might say that's to protect pharma's bottom line but the safety issues are very real.

- Here's an interesting fact, according to the World Health Organization, one in 10 medical products found in low and middle-income countries are either substandard or counterfeit.

In a separate study, scientists found that up to 41% of tested drugs purchased abroad failed quality specification, that says something about the oversight from the US FDA, which is really considered the gold standard around the world.

(upbeat music) (water slurping) - But for some the financial benefits outweigh the risks.

If you're in the market to buy prescription drugs outside the US, here are some helpful tips for you to be able to spot a counterfeit.

Number one, get a prescription from a US physician and make sure you're familiar with the medication's size, shape, color, and taste.

If there are cracks, discoloration, or stickiness, throw those away, as they're probably counterfeit.

Check out these counterfeits, notice how the label and print have different font styles and printing patterns.

Also, in some cases the drugs might be smaller or larger in shape.

Pills should be in their original packaging and not loose or in a plastic bag or envelope, that'd be just weird.

The most common counterfeit prescription drugs include erectile dysfunction drugs such as Viagra, Levitra, and Cialis.

Cholesterol medication like Lipitor, diet pills, antihistamines, antivirals like those used to treat HIV and AIDS, and expensive chemotherapeutic drugs.

- You also want to consider that not all countries are the same when it comes to making your purchase.

Oversight in some places is a lot better than others, your odds are a lot better if your meds are coming from well-regulated countries like Canada, New Zealand, Australia, Turkey, or most of Western Europe.

Another thing to look out for, double-check that the pharmacy you are purchasing your medicine from is licensed in the country of origin.

There are several resources to find safer and affordable medicines abroad.

The Canadian International Pharmacy Association runs a site that can help you find legitimate certified pharmacies.

Another option is pharmacychecker.com.

They compare prices and the legitimacy of prescription drugs, available online and abroad.

Finally, check out the Medicines Quality Database by the US Pharmacopeial Convention.

They've compiled alerts issued for poor-quality medicines found in Africa, Asia, Eastern Europe, Latin America, and the Caribbean.

- One more thing, if you've been prescribed something that is outside your price range, ask your doctor for a generic prescription.

A recent study found that 88% of the most commonly prescribed generic drugs in the United States were almost 68% cheaper than purchasing a generic in Canada, what's up with that?

- If you want more information about medical tourism, come on over to Vitals - Back to you, dynamic duo at Two Cents - Beyond your own personal health, both medical and financial, there's another reason that some discourage the practice of buying cheap drugs abroad, it's bad for the industry.

Pharmaceutical companies claim that they're high prices are reflective of the steep cost of research and development of new drugs.

If everyone paid low prices, they'd have to cut back on developing new drugs for serious ailments like cancer and Alzheimer's.

"I know you want a good bargain but you're not on the side of cancer, are you?"

- Boo!

- This is the same argument they use against any kind of price controls or regulation, that it will stifle the future of pharmaceutical research, beside the fact that they're basically asking Americans to subsidize low prices for the rest of the world, there are some reasons to be dubious about this explanation.

- For one thing, prices have been rising steadily on drugs that haven't changed in decades, and thus require no research and development, that would be like if Apple never updated their iPhone since 2008, but raised the price on it every year, you'd only buy that if your life depended on it.

- Also, despite claims of high costs, recent analysis found that drug companies actually have plenty of financial wiggle room.

They make more than enough money to cover the costs of R&D, and have enough leftover for large profit margins.

Many other companies like auto manufacturers spend more on R&D with smaller profit margins.

- In fact, of the top 10 pharmaceutical companies, nine spend more on marketing than research.

That's right, those incessant ads that tell you to ask your doctor if such and such is right for you, are more responsible for high drug prices than the cost of innovation, which means we could have fewer of those ads and lower drug prices?

Sounds like a win-win to me.

- Growing more frustrated with high prices and more skeptical of the industry's excuses, a majority of Americans now support the legalization of importing drugs from other countries.

In 2021, the Biden administration signed an executive order allowing states to legally purchase inexpensive drugs from Canada, which could be good news for millions of patients burdened by high drug prices.

- And yet there's something strange about the whole situation.

Rather than just regulating the price of drugs here, we're going to let people import America- made drugs from other countries that are willing to regulate prices?

- It does seem ridiculous, especially considering that the vast majority of Americans also support some kind of regulation on drug prices but the pharmaceutical industry still has a lot of sway in Washington, and it's much easier to kill a bill than to pass one.

- Meanwhile, millions of Americans are forced to weigh their health needs against practices that may be medically or legally risky.

It may not be a viable long-term solution, but in the current American healthcare landscape, you can't blame people for doing what they need to survive.