Canadian drug shortages

NICK EICHER, HOST: Next up on The World and Everything in It: drug shortages in Canada.

President Trump announced plans last month to allow  health care providers in the United States to import cheaper prescription drugs from Canada. There’s just one problem: Canada doesn’t have enough medicine to share with American patients. In fact, our northern neighbors often don’t have enough medication to fill their own prescriptions.

MARY REICHARD, HOST: WORLD intern Hannah Harris recently wrote about this for WORLD Magazine and joins us now to talk about it.

Good morning, Hannah!

HANNAH HARRIS, INTERN: Good morning, Mary!

REICHARD: Proponents of single-payer healthcare in the United States often point to Canada as an example of a successful system. But your story reveals some significant challenges patients there face. Tell us what you learned.

HARRIS: Canada has a longstanding problem with prescription drug shortages. One pharmacist I spoke to said it’s not uncommon for patients to get only part of the drug supply they request. For example, a patient who has a prescription for a 90-day supply of blood pressure medication may only get 10 days worth. Sometimes drugstores just run out of drugs altogether and patients have to go home without getting any medicine at all. And the problem has only gotten worse in recent years.

REICHARD: You gave an example involving EpiPens. Those are the automatic injectors that deliver epinephrine to people having severe allergic reactions. Tell us about EpiPens in Canada.

HARRIS: Right. Pfizer was the only company authorized to provide EpiPens in Canada. So when supplies ran low last year, Canadians had to keep their expired EpiPens and just hope they would work if they needed them. Now the country is facing another EpiPen shortage. So the Canadian health minister signed an emergency order allowing a U.S. company to sell its auto-injector north of the border. But it wasn’t a simple process. The new injectors didn’t have instructions in French, so pharmacists in Quebec had to translate. They came in packs of two, which meant pharmacists had to repackage them into single doses. And they didn’t work like Pfizer’s model, so pharmacists had to spend extra time explaining that to patients. All-in-all it was a mess.

REICHARD: Why do these shortages keep happening, not just with EpiPens but all medication?

HARRIS: Well, like most problems, it’s complex. And analysts like to blame different parts of the supply chain. Problems with manufacturing and shipping. Disruptions in international supply. Discontinued generics in favor of newer, brand-name drugs with greater profits. Lack of suppliers. And of course, government price caps imposed by Canada’s nationalized healthcare system.

REICHARD: Ahhh! But that’s what makes the Canadian market so attractive to Americans! But it sounds like Canada can’t support an influx of new customers.

HARRIS: No, it can’t. And Canadians are really worried about what might happen if this import plan becomes reality. The U.S. market is 10-times the size of Canada’s. According to one study done in 2018, just one-fifth of U.S. prescriptions would deplete Canada’s drug supply in six months.

REICHARD: But I also understand some analysts think exporting drugs isn’t even possible under the agreements Canada has with manufacturers.

HARRIS: That’s right. Pharmaceutical companies sell most of their drugs through wholesalers and distributors. But those arrangements require the drugs to be sold only to Canadian customers. Pharmacies that try to sell to Americans could see their drug supplies completely cut off. That happened in the early 2000s when online and mail-order pharmacies became popular with U.S. buyers. GlaxoSmithKlein and Pfizer both threatened to cut them off and began limiting supplies to just what they needed for local, Canadian customers.

REICHARD: Sounds like there are a few details to be ironed out then.

HARRIS: Hannah Harris is an intern for WORLD Magazine and a graduate of the World Journalism Institute. Thanks for joining us today!

HARRIS: You’re welcome.

(Jerry Holt/Minneapolis Star Tribune via ZUMA Wire/Alamy) Quinn Nystrom traveled from Minnesota to purchase insulin at Shoppers Drug Mart pharmacy in Fort Frances, Ontario. 

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