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If medication prices in the US are higher than in other countries, why not import from there?

This is a natural extension of this question.

Basically

  1. Drug prices in US are high
  2. A Free market could fix it. Countries beyond the US governments' reach can simply produce cheaper drugs
  3. Pharmacies lobby against it. Under the pretext that drugs must pass health approval/FDA whatever, people cannot import the drug.

However, something is missing.

With Silk Road, people can import heroin almost with impunity.

If people can import heroin, cocaine, ganja, even though it's illegal, how much more can people safely import insulin for example?

Say I have a diabetes. Say I import insulin or Viagra from India for personal use. Will I go to jail?

Is punishment heavy on that?

Does the US have laws jailing people for importing medically necessary drugs for personal uses? I mean normal drugs, like insulin. Not narc like XTC.

Even if the drugs are patented, do people go jail for importing small amounts of generic drugs, say insulin, for personal uses?

If not. Then why not just import it? Even if it's illegal, why not just import it?

The US government cannot enforce laws against insulin import easily.

Note: The way Silk Road works is that selling in Silk Road is very dangerous for the seller. One fingerprint, he's done. However, buying is relatively safe.

For legal drugs, like insulin, I do not think the seller needs to fear getting caught. I don't think an insulin pharmacy should fear getting raided. They're selling insulin, not narcotics.

If importing insulin for personal uses can lead to jail time, that would be an answer. (However, that would be very bizarre. What? People sent to jail for importing something totally save? Insulin, unlike ganja, doesn't have that bullshit story that it's not safe. Everyone knows insulin is safe.)

Note: A good answer would be things like, they will go to jail if they import Viagra from another country. That would explain why they don't. (As far as I know that's not the case.) Another good answer would be, people don't know it. In fact, I want to know if it's even illegal in the first place to import many drugs for personal uses.

This is a sumary of the question after some comments and answers told me that there is no penalty at all for buyers for personal uses.

There is a solution for high drug price in US. Just smuggle

The penalty is nonexistant for personal uses. You're only in trouble if you're selling it. But the sellers are outside US and outside US jurisdiction.

Why the market doesn't take care of this is beyond me? Why Americans still complain about high drug prices?

So why not? Why don't I see online pharmacies where people just buy cheaper stuff online? The pharmacy can smuggle the drugs in US. I am not talking about narc here. Normal drugs.

closed as off-topic by Drunk Cynic, JJJ, Machavity, SJuan76, Joe Jul 10 at 14:01

This question appears to be off-topic. The users who voted to close gave this specific reason:

  • "The primary purpose of this question appears to be to promote or discredit a specific political cause, group or politician. It does not appear to be a good-faith effort to learn more about governments, policies and political processes as defined in the help center." – SJuan76, Joe
If this question can be reworded to fit the rules in the help center, please edit the question.

  • You might very well die from an insuline OD (or from most other regulated drugs, actually). That is why you need a doctor to prescribe them to you and to specify the dosage. – SJuan76 Jul 7 at 11:52
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    Insulin is deadly. Diabetics must carefully measure the dosage or they go into hypo. This kills people. You don't mess about with insulin. – James K Jul 7 at 12:14
  • Insulin is just a sample. Also that's not the problem. The problem is importing the drugs. How to administer that is a different issue – user4951 Jul 7 at 13:51
  • They're trying, but aren't very successful at it. There are some arrests, though. – Bobson Jul 7 at 14:00
  • @SJuan76, Presumably, (because they're not dead), the diabetics victimized by price-gouging have already been prescribed insulin locally, so they know just what they need, and how much. A diabetic might more reasonably worry that smuggled insulin could be adulterated or mislabeled. – agc Jul 7 at 14:07
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Well, it would be smuggling. Trade in unlicensed medical products will be prosecuted.

  • In most countries, there are strict licensing requirements for medical products. In the US, the Food and Drug Administration does this.
  • Importing medical products from abroad requires paperwork, even if the drugs are properly licensed where they came from.
  • There may be exceptions when a traveler brings (prescription or prescription-free) drugs for personal use, but that doesn't cover online trade.

I recall news reports that some US residents would travel to Canada and buy drugs like insulin, but the journalist said this was legally a gray area.

  • They can buy stuff from posts. Forget insulin. Viagra, for example. My friends have been selling those cheap. Real ones. – user4951 Jul 7 at 12:51
  • @user4951, so they'd be breaking laws, right? What do you feel about that? – o.m. Jul 7 at 12:56
  • Do they go to jail for it? Do people go to jail for importing viagra from other countries? If not, so what? – user4951 Jul 7 at 13:50
  • I think laws not enforced with huge penalty will be like anti cohabitation laws. What do you feel about that? I feel that it's my right, and I am gonna do it anyway. – user4951 Jul 7 at 13:53
  • Importing drugs for personal use is not "a gray area". If they are for your own use in reasonable quantities, it is allowed. If they are for selling, it is not. Importing them for selling while claiming that they are for personal use might be difficult to prove, but it is just an illegal activity that might be difficult to prove. – SJuan76 Jul 7 at 15:37
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Why not smuggle indeed?.

The price-gouging and market fixing that presently exists, but in decades past would have been illegal in the US, is causing patients to die:

The price is so high that people are doing desperate things to get by, like using expired insulin, relying on crowdfunding to pay their bills, or taking less insulin than they need in an effort to ration their supplies. Rationing is extremely dangerous and can lead to a deadly condition known as diabetic ketoacidosis. Three people died in 2017 while rationing their insulin. Three more died in 2018.
--- High insulin costs are killing Americans (The Right Care Alliance)

And in 2019: Another Person Has Died After Rationing Insulin.

So the rationale would be to protect patients from something that clearly should be a crime, (arguably murderous price-gouging), its victims might be morally justified in committing a crime doing something that should certainly not be illegal, (staying alive by obtaining an inexpensive dose).

As for feasibility, apparently Americans have been smuggling prescription drugs for years. Here's a picture from 2003 of Nogales, Mexico pharmacies with signage aimed at the American tourist market:

Storefront picture of neighboring Mexican pharmacies, each with huge signs in English


OTOH, there's always the doubt that the conspicuous misery and harm done by a bad law itself is a form of political capital that if properly wielded is the best tool to repeal or reform the bad law. Citizens evading that misery and harm inadvertently reduce the force of that political capital, thus unwittingly prolonging the bad law's tenure.

  • This could use more detail as to tourists going to Canada for smuggling, smuggling via web sites, and the degree of punishments doled out relative to market size. – agc Jul 8 at 0:59
  • Why don't those shops sell online? Don't even need tourists anymore. They can sell online and send. Yes, custom may capture it. But given the low penalty for getting caught it's worth the risk. – user4951 Jul 8 at 8:22
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For the same reason that any other property, whose production involves intellectual property licensing, cannot be imported without a license granted by the intellectual property holders.

The main cost of drugs is in development and securing FDA approval through clinical trials. The approval process alone can cost on the order of hundreds of millions of dollars and it is usually done by having a separate corporate entity go through the effort sponsored by various pharmaceutical companies who "invest" in that entity. This "investment" plus the cost of buying the company after the approval is attained is where the hundreds of millions of dollars are spent.

This is not unique to drugs. It is also not legal to import movies which are sold oversees if they are not licensed to be sold in the US. The same is true of music (although very little music is sold on physical media nowadays). And, to some extent, it is true of books (although not as much because, other than textbooks, books are pretty much priced pretty similarly).

Some comments have suggested that the question is also concerned with the cost of drugs whose cost is not at all dependent on intellectual property licensing costs (off-patent drugs). There are already pharmacies (such as Costco) whose business models are based on selling commoditized drugs at steep discounts. They do import some of their products from abroad. So, in effect, this suggestion is already implemented in the market place.

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    No, the purported high costs of modern clinical trials aren't relevant to the problem of price gouging for insulin medication, which has been around since the 1920s. Insulin's development costs are long since recouped, and most forms of it are off-Patent so that there is (for those forms of it) no property holder. – agc Jul 7 at 23:47
  • @agc insulin, the compound, has been around. But new delivery mechanisms (for example, under-the-skin continuous release) are developed. I was specifically referring to medication which has intellectual property component to them. And you are countering that there are medications which don't have intellectual property components to them (which are completely off patent). That's clearly not what I was talking about. – grovkin Jul 8 at 4:13
  • From that reasoning, it would stand to reason that importing "old fashioned" insulin would be legal and free as it does not contain any of that brand new intelectual property... – SJuan76 Jul 8 at 10:21
  • @SJuan76, I think I would agree with that. At least, I don't see any reason why importing on a commercial scale would be illegal. As far as individuals importing it, if it requires a prescription, the filling of the prescription may require a licensed pharmacist as an intermediary. – grovkin Jul 8 at 13:05
  • @grovkin, It was clear enough that you weren't talking about insulin in general, but the problem with this answer is that the OP was. Your answer utterly neglects to address how and why the US medical/industrial complex has in the last 20 years corralled diabetics into its lucrative patent medicine market, whilst deliberately eliminating access to more affordable insulin alternatives. – agc Jul 8 at 14:42
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  1. Importing drugs for personal use is legal. It's not even smuggling. It's legal import. I am not talking about narc. I am talking about legal normal drugs like viagra or insulin.

  2. Purchase of the drug for the purpose of selling is illegal under the pretext of customer safety I bet.

So why don't americans just access tons of pharmacy online where people can buy cheaper drugs from oversea?

I have an educated guess.

The customer is not the one buying the drugs. The insurance, or HMO, or government, buy the drugs. Some drugs are prescription only and you probably can't ask doctors for generic equivalent.

I also suspected that Doctors can get his licensed revoked if he prescribe cheaper generic drugs. I wonder if anyone can confirm. Say a drug cost $200. Can a doctor recommend or prescribe cheaper drugs that cost $10 from an online pharma?

Also if you're insured you have no profit incentive to buy drugs from Mexico. If you're an insurance, you also can't buy drugs from Mexico because that's illegal.

If I were pharma lobbyist, I would lobby government to ensure that as much as possible, all people are "insured" through various government program or have mandatory insurance.

Then pharma companies can jack up prices without having to worry with competition from outside of US jurisdiction.

So, a small number of people that can't afford cheap international drug price is then used as justification to jack up prices for everyone.

That's what I think is happening.

Note: From comments, importing drugs from oversea may be illegal but minimally enforced. In general I have not heard anyone going to jail because they import stuffs for personal uses.

In general, you risk having 5% of your packaging seized. If you can show you have prescription, you probably can still get it.

Here is some info from Wikipedia.

It is illegal to purchase controlled substances from an overseas pharmacy. A person purchasing a controlled substance from such a pharmacy may be violating several federal laws that carry stiff penalties.

Any package containing prescription drugs may be seized by US Customs and Border Protection. The package may be held and eventually returned to the sender if the addressee does not respond and provide proof that they are allowed to receive these drugs (e.g., a valid prescription).[30] In practice, the number of packages containing prescription drugs sent to United States on a daily basis far exceeds CBP's capabilities to inspect them.[31] In the past, packages often passed through customs even if they were not sent from Canada or otherwise didn't meet the requirements of section 844 of 21 USC. Until recently, about 5 percent of prescription drug packages sent from Canada were being seized.[32]

DEA and FDA[33] generally do not target consumers unless drugs are imported in large quantities (suggesting intent to distribute) or represent a perceived danger to public health (opiates, amphetamines).

Rarely, drug importation laws are enforced on the local level. For example, in June 2005 in Baton Rouge, Louisiana, a number of customers of online pharmacies were arrested by local law enforcement officers and charged with possession of a controlled substance without prescription.[34]

The act of importation of the controlled substance from overseas violates 21 USC, Section 952 (up to 5 years in prison and $250,000 fine for importation of non-narcotic Schedule III, IV, or V drugs; possibly more for narcotics and Schedule I and II drugs). The act of simple possession of a controlled substance without a valid prescription violates 21 USC, Section 844 (up to 1 year in prison and $1,000 fine). FDA does not recognize online prescriptions; for a prescription to be valid there must be a face-to-face relationship between the patient and the health-care professional prescribing the drug. What exactly constitutes a "face-to-face" relationship is considered by many online pharmacies to be a subjective definition that would allow them to operate as an adjunct to the patient's own physician if the patient submits medical records documenting a condition for which the requested medication is deemed appropriate for treatment. Sections 956 and 1301 provide exemptions for travelers who bring small quantities of controlled substances in or out of the country in person, but not by mail.

Importation of an unapproved prescription drug (not necessarily a controlled substance) violates 21 USC, Section 301(aa), even for personal use.[33] The Food, Drug, and Cosmetic Act does allow for the importation of drug products for unapproved new drugs for which there is no approved American version. However, this allowance does not allow for the importation of foreign-made versions of U.S. approved drugs.

The law further specifies that enforcement should be focused on cases in which the importation by an individual poses a threat to public health, and discretion should be exercised to permit individuals to make such importations in circumstances in which the prescription drug or device imported does not appear to present an unreasonable risk to the individual.[35]

It is also illegal to import non-approved drugs (21 USC sections 331(d) and 355(a)); however, FDA policies suggest that, under certain circumstances, patients may be allowed to keep these drugs.[36]

Individual U.S. states may implement their own laws regulating importation, possession, and trafficking in prescription drugs and/or controlled substances.[citation needed]

For several years, the states of Nevada,[37] Minnesota, Illinois and Wisconsin have run official state programs to help their residents order lower-cost drugs from abroad to save money.

  • If this is wrong, let me know why. – user4951 Jul 8 at 10:21
  • Well the first bit about what's legal is incorrect. WP's Online Pharmacy discusses the US's sometimes ambivalently minimal enforcement. – agc Jul 9 at 3:50
  • Legal or come with minimal enforcement. That's effectively legal. – user4951 Jul 9 at 9:14

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