Pharmacy, The Internet, And Expatriates

Risk & Insurance, Sept 16, 2001 by John Otrompke

Michael Weiland, director of International Services and Medical Affairs for GlobalCare, agrees. "This is a tremendous problem for expatriates," he says. "A lot of them will have somebody courier the drug in. If somebody brings in 300 pills, and the customs official sees the bottles without the person's name on it, they may seize the pills as illegal."

Cigna's Jenny Hollis says that frequent solutions to the problem of finding pharmaceuticals in unwelcoming nations include finding a local doctor to recommend a suitable substitute for the medication, or finding a nearby international source. "We can get our clients set up with a doctor in Thailand, for example," she says. "IF it's illegal to bring the drug into Burma, they'd have to take that risk themselves." Hollis says that parents of children with attention deficit disorder (ADD) may suffer especially in this area; many Southeast Asian nations still ban Ritalin as a controlled substance.

Because the international pharmaceuticals trade is a game played by different rules in different countries, the potential for Internet activity varies considerably according to local factors. Even in the United States, a relatively heavily regulated market, so-called "rogue" operators have found a tremendous niche for lifestyle drugs, including Viagra, Propecia, and other medications, sending them into the country from Thailand, New Zealand, and all over the world. The activity demonstrated that international pharmaceuticals, fueled by Internet marketing, may be beyond the power of any country to fully regulate. Last summer, Congress held lengthy hearings considering the passage of federal legislation against "rogues," and the FDA recently has been threatening to seize all overseas pharmaceuticals shipments at the border.

And legal exceptions abound as well. In the United States, for example, an organ transplant pharmacy named Chronimed in Minnetonka, Minn., is able to send medications overseas to some countries, with a prescription written by a U.S. doctor, if the medication is not a refrigerated item.

The possibilities in less-regulated nations are even grander. "Almost all countries in Europe have equal access to medications," says GlobalCare's Weiland. "If you can buy it in England, you can also get it in Poland, under a different name."

Where things get interesting, says Weiland, is in less-developed nations. Weiland sometimes gets calls from clients seeking medications in Africa. "For example, a drug may not be available in Nairobi or Kenya," he says. "I would call the United Kingdom to see whether the drug could be shipped from there. Or if an expatriate were in the Ivory Coast, I would look in France. Because of the past colonial relationship between the two countries, there's often a 'most favored nation' status."

In some countries, the potential for Internet distribution of pharmaceuticals is wide open. "In Mexico, Hong Kong, and Thailand, you can just walk into a drug store and order prescription drugs over the counter," Weiland says. In many nations, there is no law requiring a face-to-face consultation with a physician--a standard of care that is often used against "rogues" here in the U.S. In other words, the chief barrier against a thriving Internet pharmacy trade in some countries may not be rules against remote prescribing, but tariffs and taxes imposed on trade.