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It may be cheaper to buy prescriptions overseas, be vigil

Earlier this year my wife was diagnosed with asthma and COPD, neither severe. Her physician prescribed Breo Ellipta to ameliorate her symptoms. We have a bronze plan purchased though the New York State healthcare insurance exchange — the other plans were just too expensive — and it has a $4,000 annual deductible for each of us. Her first 30-day supply of this drug cost $365 out-of-pocket and shouldering another $3,365 would be a significant burden. So I decided to look for other options.

One option would have been to use a prescription discount card. GoodRx offered the best discount — about $100 — but our insurance company would not permit the cost to go toward her deductible. So while it appeared that she would save money using a drug discount card, taken together it would really be the drug manufacturer, the pharmacy benefit manager (PBM), the pharmacy and the healthcare insurance company who would benefit, all to her detriment.

Incidentally, the three top PBMs handled about 76 percent of all prescription drug claims in 2019 (see https://www.beckershospitalreview.com/pharmacy/top-pbms-by-market-share.html) and this is a clear case of an oligopolistic market which could potentially violate the Sherman and Clayton Act antitrust laws. The Federal Trade Commission should re-visit this situation but I’m not optimistic that it will.

Our second option was to purchase the drug from a foreign pharmacy. Two Canadian pharmacies offered the drug, manufactured by GSK, for about $180, still relatively expensive but more affordable than what she paid. I looked further afield and found a pharmacy in Israel that offered a similar product called Relvar, manufactured by GSK in the UK, that cost about $110 delivered. Although Relvar is 10 pecent weaker than the American version she and her doctor agreed that it was an acceptable alternative and going forward she has used Relvar with good results. As a repeat customer she is now charged $100 — $111 when corrected for the lower strength — for a one-month supply freight included.

Not all drugs purchased offshore are cheaper than drugs purchased in the USA so care should be taken when purchasing drugs outside of the USA.

CHARLES F. HEIMERDINGER

Edinburg

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