On the Legitimacy of Cross-Border Pharmacy

Abstract

Cross-border 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. drug legislation and of 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 drugs for U.S. customers; opponents decry the practice as unsafe for U.S. patients, economically ill-advised, and ultimately contrary to Canadian interests. This article evaluates the safety arguments put forward by the U.S. Food and Drug Administration and others and concludes that these concerns, though valid, do not justify the current U.S. prohibition on prescription drug imports from Canada. Similarly, professional regulatory bodies' objections to the participation of Canadian doctors and pharmacists in cross-border pharmacy are misplaced. More compelling are the economic arguments against cross-border pharmacy, though even here opponents assume normative positions that should be explicitly defined and socially determined. Finally, however, the article acknowledges that Canada may be compelled by real-world circumstances to curtail cross-border pharmacy in order to safeguard domestic drug supplies.