Lowering Prescription Drug Prices by Shopping Globally
Data Shows Prescription Drug Prices in the U.S. Continue to Increase While Those at International Mail Order Pharmacies Become Even More Affordable
Despite fear tactics wielded by pharmaceutical companies and their PR teams, our prescription drug marketplace is global in practice, and experts contend explicitly expanding that global access through safety assurances could lower drug prices here in the United States. The situation in the United States is quite dire: PharmacyChecker data shows that out-of-pocket prescription drug prices have increased at U.S. retail pharmacies since 2019 but have in fact decreased substantially at international mail-order pharmacies.
In September 2023, the Health Management, Policy and Innovation journal accepted the paper “Arbitrage Deterrence: A Theory of International Drug Pricing” by Stephen Salant, professor of economics at the University of Michigan, which concludes that safety warnings surrounding personal and commercial importation of foreign prescription drugs keep drug prices high in the United States. Salant says that the millions of dollars drug manufacturers spend on “safety” warnings to consumers are unwarranted considering the peer-reviewed safety of imported prescription drugs. Now, just a small fraction of Americans, both concerned about quality and price, search online to compare prescription drug pricing across pharmacies located in other high-income nations. Salant believes more patients could stand to take advantage of our international prescription drug marketplace, citing a National Bureau of Economic Research (NBER) study that established “drugs purchased from foreign pharmacies certified safe by PharmacyChecker.com are just as safe as drugs purchased from domestic, brick-and-mortar pharmacies.” Knowing that 80% of the active ingredients in the American generic drug supply are manufactured in foreign factories anyway – most of which are located in India and China – a consumer may decide to expand their search to drugs sold in pharmacies located in India, Turkey, Mauritius – so long as those pharmacies are accredited for safety by a reputable credentialing authority.
Salant isn’t the only one with his eye on a more global marketplace as a means to lower costs. Authors of “Why Drug Pricing Reform Is Complicated: A Primer and Policy Guide to Pharmaceutical Prices in the USA” published by The Aspen Economic Strategy Group, Amanda Starc, Ph.D., Associate Professor of Strategy at the Kellogg School of Management and a Faculty Research Fellow at the NBER, and Craig Garthwaite, Professor of Strategy and the Director of the Program on Healthcare at Kellogg, believe that “a broader system of importation [of generics] across developed countries with similar safety and regulatory systems” could decrease prescription drug costs. Starc and Garthwaite suggest that “a wise policy [...] would be to increase the size of the drug market overall by allowing more imported drugs and spending more on regulatory agencies like the FDA to ensure drug quality."
In August 2022, Caroline E. Malone, Judicial Law Clerk, submitted a dissertation at Vanderbilt University entitled “Reducing the Price of Prescription Drugs: Gag Clause Prohibitions, Government Patent Use, and Shopping Abroad,” in which she, too, recognizes both the globality of the marketplace and PharmacyChecker itself as a key resource to “help consumers find verified international pharmacies online”:
In lieu of government action, individuals can use existing online resources such as PharmacyChecker to identify reliable online foreign pharmacies. However, government action has the distinct advantage of making the process of importing prescription drugs for personal use de jure legal rather than de facto legal."
This suggestion is in line with PharmacyChecker’s October 2023 report, “Medicare Should Set Sights On Canada In Drug Price Negotiations”, concerning what patients can do in the meantime to save on their prescription drug bill while they wait for Medicare-negotiated pricing to be implemented in 2026.
Malone’s paper includes research by PharmacyChecker.com conducted in 2019:
Research from PharmacyChecker, an online company that helps Americans find low-cost prescription drugs from licensed pharmacies in Canada and other countries, found that consumers could save between 75 percent and 90 percent on ten of the most commonly prescribed, brand-name medications without a generic alternative (Figure 2)."
Years later, in 2023, we found glaringly worse price discrepancies (see charts below). Patients in the United States can save an average of 74.25% by ordering their medication from an accredited online pharmacy that dispenses medication from a pharmacy in Canada. They save an average of 93.25% by expanding their search to accredited mail-order pharmacies located in other countries. PharmacyChecker compared the prices of those same ten drugs we looked at in 2019, finding that U.S. coupon prices have increased by an average of 6.55%; and Canadian online pharmacy prices have increased by 10.92%. Conversely, international online pharmacy prices have decreased by 26.14%. International online pharmacy prices are derived from websites that work with not only dispensing pharmacies located in Canada, but in Australia, India, Mauritius, New Zealand, Turkey, the UK, and the United States. All websites and dispensing pharmacies are verified and monitored through the PharmacyChecker International Pharmacy Verification Program.
Comparing Out-of-Pocket Drug Prices Between U.S. Retail Pharmacies, Canadian Online Pharmacies, and International Online Pharmacies |
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| Brand Name | Strength | Qty | US Coupon Price | Canadian Online Pharmacy Price | International Online Pharmacy Price | Canadian Savings | International Savings |
| Xarelto | 20mg | 1 pill | $17.43 | $3.72 | $0.88 | 78.66% | 94.95% |
| Januvia | 50mg | 1 pill | $17.59 | $4.35 | $0.55 | 75.27% | 96.87% |
| Eliquis | 5mg | 1 pill | $9.01 | $2.21 | $0.56 | 75.47% | 93.78% |
| Spiriva | 18mcg | 1 pill | $16.46 | $2.77 | $0.73 | 83.17% | 95.57% |
| Bystolic | 5mg | 1 pill | $5.64 | $2.11 | $0.67 | 62.59% | 88.12% |
| Vesicare | 5mg | 1 pill | $12.40 | $2.39 | $0.69 | 80.73% | 94.44% |
| Janumet | 50/1000mg | 1 pill | $8.79 | $2.23 | $0.31 | 74.63% | 96.47% |
| Symbicort* | 160/4.5mcg | 1 inhaler | $260.25 | $123.08 | $33.25 | 52.71% | 87.22% |
| Invokana | 300mg | 1 pill | $19.23 | $3.96 | $2.43 | 79.41% | 87.36% |
| Tradjenta | 5mg | 1 pill | $16.88 | $3.40 | $0.71 | 79.86% | 95.79% |
| Average Savings | 74.25% | 93.06% | |||||
PharmacyChecker Research, October 2023
Pricing per pill/unit as published on PharmacyChecker.com. Canadian and other international pricing includes shipping to U.S. from PharmacyChecker-accredited online pharmacies.
*International Online Pharmacy Price (with shipping) of Symbicort reflects the price of one Vannair Aerosol 200/6 mcg inhaler, sold in New Zealand. Symbicort is also marketed internationally under the name Vannair Aerosol. Patients should consult their clinician to see if a change of prescription would benefit them considering the potential savings.
U.S. Retail Pharmacy Coupon Price Changes 2019 - 2023 |
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| Brand Name | 2019 US Price | 2023 US Price | Percentage Change |
| Xarelto | $15.51 | $17.43 | 12.38% |
| Januvia | $15.62 | $17.59 | 12.61% |
| Eliquis | $7.69 | $9.01 | 17.17% |
| Spiriva | $14.88 | $16.46 | 10.62% |
| Bystolic | $5.00 | $5.64 | 12.80% |
| Vesicare | $13.36 | $12.40 | -7.19% |
| Janumet | $7.81 | $8.79 | 12.55% |
| Symbicort* | $369.60 | $260.25 | -29.59% |
| Invokana | $17.11 | $19.23 | 12.39% |
| Tradjenta | $15.11 | $16.88 | 11.71% |
| Average: | 6.55% | ||
PharmacyChecker Research, October 2023
Pricing per pill/unit as published on PharmacyChecker.com. Canadian and other international pricing includes shipping to U.S. from PharmacyChecker-accredited online pharmacies.
*International Online Pharmacy Price (with shipping) of Symbicort reflects the price of one Vannair Aerosol 200/6 mcg inhaler, sold in New Zealand. Symbicort is also marketed internationally under the name Vannair Aerosol. Patients should consult their clinician to see if a change of prescription would benefit them considering the potential savings.
Canadian Online Pharmacy Price Increases 2019 - 2023 |
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| Brand Name | 2019 Price | 2023 Price | Percentage Change |
| Xarelto | $3.33 | $3.72 | 11.71% |
| Januvia | $3.79 | $4.35 | 14.78% |
| Eliquis | $2.19 | $2.21 | 0.91% |
| Spiriva | $2.66 | $2.77 | 4.14% |
| Bystolic | $1.70 | $2.11 | 24.12% |
| Vesicare | $2.09 | $2.39 | 14.35% |
| Janumet | $2.13 | $2.23 | 4.69% |
| Symbicort* | $105.73 | $123.08 | 16.41% |
| Invokana | $3.48 | $3.96 | 13.79% |
| Tradjenta | $3.26 | $3.40 | 4.29% |
| Average: | 10.92% | ||
PharmacyChecker Research, October 2023
Pricing per pill/unit as published on PharmacyChecker.com. Canadian and other international pricing includes shipping to U.S. from PharmacyChecker-accredited online pharmacies.
*International Online Pharmacy Price (with shipping) of Symbicort reflects the price of one Vannair Aerosol 200/6 mcg inhaler, sold in New Zealand. Symbicort is also marketed internationally under the name Vannair Aerosol. Patients should consult their clinician to see if a change of prescription would benefit them considering the potential savings.
International Online Pharmacy Price Changes 2019 - 2023 |
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| Brand Name | 2019 International Price | 2023 International Price | Percentage Change |
| Xarelto | $1.68 | $0.88 | -47.62% |
| Januvia | $0.83 | $0.55 | -33.73% |
| Eliquis | $1.05 | $0.56 | -46.67% |
| Spiriva | $0.82 | $0.73 | -10.98% |
| Bystolic | $0.49 | $0.67 | 36.73% |
| Vesicare | $1.14 | $0.69 | -39.47% |
| Janumet | $0.72 | $0.31 | -56.94% |
| Symbicort* | $35.00 | $33.25 | -5.00% |
| Invokana | $2.56 | $2.43 | -5.08% |
| Tradjenta | $1.50 | $0.71 | -52.67% |
| Average: | -26.14% | ||
PharmacyChecker Research, October 2023
Pricing per pill/unit as published on PharmacyChecker.com. Canadian and other international pricing includes shipping to U.S. from PharmacyChecker-accredited online pharmacies.
*International Online Pharmacy Price (with shipping) of Symbicort reflects the price of one Vannair Aerosol 200/6 mcg inhaler, sold in New Zealand. Symbicort is also marketed internationally under the name Vannair Aerosol. Patients should consult their clinician to see if a change of prescription would benefit them considering the potential savings.
