Access to Health Care in the U.S.-Mexico Border Region:
Models, Research, Policy and Action
Crossing the Border for Prescription Drugs
Howard J. Eng, RPh, MS, DrPH
Southwest Border Rural Health Research Center
Mel and Enid Zuckerman Arizona College of Public Health, Rural Health Office
University of Arizona
October 15, 2004
Presentation Overview
• Rising Health Care Costs in the United States
• U.S.-Mexico Border
• Top 10 Prescription Drug Price Comparisons: U.S.,
Canada, and Mexico in 1999
• FDA International Flyer: “Purchasing Medication
Outside the United States”
• U.S. Prescription Drug Availability in Mexico
• FDA Guidance for Coverage of Personal Importation
• Recommendations
• Arizona Accepts Mexican Prescriptions
This boundary fence is seen
from Nogales, Arizona as you
go into Nogales, Sonora.
The U.S.-Mexico Border area is
defined as 100 kilometers (62
miles) north and south of the
Border and close to 2,000 miles
in length.
Photo: Community Access Program of Arizona (CAPAZ)
Nogales, Sonora houses seen
from a hill in Nogales, Arizona.
About 13 million people reside
along the U.S.-Mexico Border
region (6.4 million in Mexico
and 6.6 million in the U.S.).
Considered together, U.S.
border communities are 50%
Hispanic, although in cities
like Nogales, Arizona the
proportion is much greater,
about 93.5% Hispanic.
Photo: Community Access Program of Arizona (CAPAZ)
Vehicles and pedestrians
crossing into Algodones,
Mexico from Andrade,
California during the winter
months.
Estimates on U.S.-Mexico
border crossings range from
300-400 million legal crossings
in each direction per year, or
between 800,000 and 1.1
million legal border crossings
per day.
Photo: Community Access Program of Arizona (CAPAZ)
The Plaza Flamingo sign shows
some of the many health care
services offered in the small
town of Algodones.
According to a 1997 Health
Care Services Report
completed for Arizona’s
Governor Jane Hull, 5% of
border crossings were for the
purchase of medical and dental
services.*
Photo: Community Access Program of Arizona (CAPAZ)
* Health Services: Strategic Economic Development Vision for the Arizona-Sonora Region, October 1997
Price Comparison of Top 10 U.S. Rx Drugs
[USA Today November 10, 1999] (1)
Drug
Condition
U.S.
Canada
Mexico
Prilosec
Heartburn/
Ulcer
$3.31
$1.47
$0.99
Prozac
Depression
$2.27
$1.07
$0.79
Lipitor
High
cholestrol
$2.54
$1.34
$3.60
Prevacid
Ulcer
$3.13
$1.34
$1.18
Epogen
Anemia
$23.40
$21.44
N/A
Price Comparison of Top 10 U.S. Rx Drugs
[USA Today November 10, 1999] (2)
Drug
Condition
U.S.
Canada
Mexico
Zocor
High
cholestrol
$3.16
$1.47
$3.66
Zoloft
Depression
$1.98
$1.07
$1.96
Zyprexa
Mood
Disorder
$5.27
$3.39
N/A
Claritin
Allergies
$1.96
$1.11
$0.92
Paxil
Depression
$2.22
$1.13
$1.83
U.S. residents purchasing
medications in Algodones,
Mexico.
During the winter months
Yuma, Arizona is populated by
“snowbirds” (people who live
in one state, but spend their
winters in a state with a
warmer climate). Many of
Yuma’s snowbirds go to
Algodones, Mexico to purchase
their medications.
Photo: Community Access Program of Arizona (CAPAZ)
FDA Purchasing Medications Outside
the United States Informational Flyer (1)
• Some medications and their ingredients, legal in foreign countries,
may not be approved for use in the United States.
• The product label, including instructions for use and possible side
effects, may be in a language the user does not understand (e.g.,
Mexico - Spanish). Further, labeled directions may not be approved
for use in the United States.
• It can be dangerous to take some medications without medical
supervision (This is the primary reason for placing medications on
prescription drug status in the United States).
• FDA cannot assure that products not approved for sale in the U.S.
conform with the manufacturing and quality assurance procedures
mandated by U.S. laws and regulations.
Source: FDA January 12, 1994 Informational Flyer to State Boards of Pharmacy and State Drug Programs.
FDA Purchasing Medications Outside
the United States Informational Flyer (2)
• Some medications may be counterfeit versions of U.S. approved
products.
• Treatment of an adverse drug reaction can be delayed or hindered
without sufficient product information.
• Possession of certain medications without prescription from a
physician licensed in the United States may be a violation of state
and local laws.
Source: FDA January 12, 1994 Informational Flyer to State Boards of Pharmacy and State Drug Programs.
U.S. Prescription Drug Availability in Mexico
(Diccionario de Especialidades Farmaceuticas 2003)
U.S. Prescription Drug Name
Mexican Prescription Drug Name
Premarin
Premarin
Premarin
Premarin
Premarin
0.3 mg
0.625 mg
0.9 mg
1.25 mg
2.5 mg
(Tablet)
(Tablet)
(Tablet)
(Tablet)
(Tablet)
****** NA *******
Premarin 0.625 mg
****** NA *******
****** NA *******
****** NA *******
Zantac
Zantac
150 mg
300 mg
(Tablet)
(Tablet)
Azantac
Azantac
Lanoxin
Lanoxin
Lanoxin
0.125 mg
0.25mg
0.50 mg
(Tablet)
(Tablet)
(Tablet)
****** NA *******
Lanoxin
0.25 mg
****** NA *******
150 mg
300mg
(Tablet)
(Tablet)
(Tablet)
(Tablet)
FDA Guidance for Coverage of Personal Importation
U.S. Customs and Border Protection: May allow an individual entering
the United States to import a three month supply of an unapproved
drug if all the following conditions are met:

The intended use of the drug is for a serious condition for which effective
treatment may not be available domestically.

The drug will not be distributed commercially by the importer.

The product is not considered to represent an unreasonable risk.

The individual seeking to import the product affirms in writing that the drug
is for his or her own use.


Provides the name and address of the U.S. licensed doctor who is responsible for his or her treatment with
the product or
Provides evidence that the product is for the continuation of a treatment begun in a foreign country.
Source: U.S. Custom and Border Protection http://www.cbp.gov/xp/cgov/travel/alerts/medication_drugs.xml 10-12-04
Recommendations
•
The use of medications purchased in Mexico needs to be monitored
regularly by a medical doctor to assure therapeutic effectiveness.
•
There must be a prescription for each medication purchased in Mexico
in order to avoid any problems with U.S. Customs.
•
Since not all drug strength and dosage forms are available in Mexico
and Mexican pharmacists are not generally trained in therapeutics, the
buyer needs to make sure he or she is purchasing the right drug.
•
The buyer may not purchase more than a 90 day supply. Buying more
than the limit may be considered a violation of the law by the U.S.
Customs inspector.
•
It is important to select the right Mexican pharmacy to assure that the
medications are stored properly and are not counterfeits.
Arizona Accepts Mexican Prescriptions
• Arizona Board of Pharmacy regulation does not prohibit a
pharmacist, or an intern under a pharmacist’s supervision, from
filling a new written prescription order for a drug or device issued by
a medical practitioner licensing board of Canada or the Republic of
Mexico.
– No refills
– Mexican State Department of Health (e.g., Soñora) provides the
approved prescriber names to Arizona State Board of Pharmacy.
• The proprietor, manager, or pharmacist in charge of the pharmacy
shall keep a separate record of prescriptions filled.
• A pharmacist or intern shall not fill a prescription order issued by a
medical practitioner licensed by the appropriate licensing board of
Canada or the Republic of Mexico for a controlled substance.
Source: Arizona Board of Pharmacy Rules and Statutes, Title 32 Professions and Occupations, Chapter 18 Pharmacy,
Article 3 Regulation, 32-1969.
¡Gracias! -- Thank You!
Contact Information
Howard J. Eng, MS, DrPH
Director
Southwest Border Rural Health Research Center
Rural Health Office
Mel and Enid Zuckerman Arizona College of Public Health
2501 E. Elm Street
Tucson, Arizona 85716
[email protected]
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Access to Health Care in the U.S.