Mexican Pharmacy Invites USA Shoppers For Safe Discount Drugs
The constantly increasing cost on pharmaceuticals in the United States of America prompts customers to seek their medications in the neighboring countries or look for the solution through online pharmacies. While the widespread practice of obtaining medications north of the border, that is from Canadian retailers has been quite a topic of public debates while state legislators were pushing legalization and trying to enforce strict regulations, the Pharmaceutical Market Access and Drug Safety Act (2007) made such over-the-border purchases legal only in the number of approved Canadian pharmacies. The FDA made sure the medications were up to their high standards of safety and efficacy. Similarly, the US southern border makes a convenient connection with pharmacies situated in Mexico immediately across the border. American citizens frequently turn to Mexican pharmacies to obtain their medications. However, unlike with the northern border, the legislation enforcement agencies have not yet put significant effort to take the situation with obtaining medication from Mexico, either legally or illegally, under their control. One of the reasons for that is that the health officials are not sure if the strict regulations on the medications traffic would improve health situation of the US border residents.
Compliance of medications sold in Mexico pharmacies with the United States standards
Several researches had come to conclusion that obtaining medications from Mexican pharmacies might be not safe and may ensue undesired consequences for the consumers due the evident lack of quality monitoring programs currently existing in Mexico.
The examples of such unreliable cases include:
- In 2014, the FDA found out that certain Mexican pharmacies across and near the border had been selling simvastatin and carisoprolol, both containing significantly lower quantities of their respective active ingredients than there were declared in the specifications of the respective medication.
- In 2015, the FDA examined Evista, Lipitor, and Viagra and came to similar conclusions: these medications were containing lower amounts of the respective active ingredient.
However, these cases are rather exceptions. The majority of medications that have come under the observation of the FDA and other controlling health institutions, have been found in compliance with the standards of the United States Pharmacopeia.
Socio-Demographics of the US-Mexico border
There are twenty-four counties in the United States bordering Mexico. The total population is comprised of 6.8 million people. Around the third of this population are individuals younger than 18 years of age. Hispanics comprise more than fifty percent of the border population. The poverty rate at the bordering counties is higher than the mean rate across the United States, while the rate of uninsured individuals is higher than the mean one across the United States. The population is mostly of lower formal education. There is a significant shortage of qualified health professionals across all fields of medicine at the bordering area.
In this review we consider the population of the cities of El Paso (Texas, US) and Ciudad Juarez, Mexico. These two cities are the largest at the bordering area and also are handy in reviewing the overall tendencies as they are historically closely related and intertwined, while there are many families who have their members in both cities. In reality these two cities comprise one unified metropolitan, with more than two million inhabitants with close proximity to goods and services offered in both cities, yet separated by the international border with all its strict regulations.
The rate of American citizens with lower income who use Mexican pharmacies is much higher than the similar rate of the citizens with higher income. The studies have shown that of 100 low income migrant families in El Paso County, 40 percent who had been sick during the one year prior to the research used self medication, while around 10 percent opted for Mexican pharmacies. A full 85 percent had obtained medications directly from Mexico.
The popularity of Mexican health care services
Across the border, in the Mexican city of Ciudad Juarez, pharmacy businesses are sprawling quickly. These pharmacies are mostly chain ones, while local, usually family owned businesses with only one outlet, are serving mostly the local citizens. They are referred to as traditional pharmacies and are showing the signs of decline in revenues in recent years. The traditional pharmacies’ prices are higher across the offered assortment than those of chain pharmacies. Because of the inability to compete with large chain pharmacies, the traditional ones are slowly running out of business and losing their customers to the competitors. They also go for expanding their assortment to include other goods except medications.
Several studies conducted in recent years across the bordering counties in the United States have shown that there is a significant amount of American citizens who opts for receiving health care services with Mexican providers. Some of the studies revealed that up to one third of the population went for health care service at least once during the calendar year. The number of border citizens that obtain medications from Mexican pharmacies, while preferring these to their home analogs is reaching around half of the population.
Purchasing medications in Mexico is much more convenient for an American citizen for a number of reasons. the chief one is that the prescription for the majority of the medications is not required in Mexico. The notable exception where the prescription is enforced by regulations include: controlled substances such as analgesic opioids, benzodiazepines, codeine, and various barbiturate and antibiotics. Antibiotics used to be prescription-free as late as in 2010, but were put under the scrutiny of the state health commissions since then and now sold only with prescription.
The peculiarities of the pharmaceutical business in Mexico
The larger, chain pharmacies in Mexico usually occupy a unit inside an all-purpose mega-mall. These huge malls are usually set in the vicinity of the US-Mexico bridges, which makes a convenient shopping for those that travel across the border with a vehicle.
The Mexican regulations do not specify who can be a particular owner of a pharmacy. It is clear, however, that physicians are not allowed to offer their services inside these pharmacies. Because of that, pharmacies usually have a mutual agreement with medical professionals from the medical centers that are situated in close proximity to them. Some medical centers are even situated right next to the pharmacy, sharing the same unit with them, but featuring a separate entrance, in order to comply with the regulations. A consumer may get a basic medical advice related to his issue promptly and for a low price.
As was previously mentioned, according to local health regulations, pharmacies in Mexico require a prescription only in the case of controlled substances and antibiotics. All possible other prescriptions that are usually required, count for as long as a consumer has them. That is to say, they never expire.
This is a unique situation, where a consumer might not be under any medical observation and would still be able to obtain a medication with a help of the prescription he might have had for twenty years.
Most prescription medications in Mexico feature a sheet with only limited information. This is due to the regulation issued by the health authorities that was aiming to prevent consumers from self-medicating practice. In turn, the consumers are forced to follow recommendations they receive from the sales employees inside pharmacies or otherwise have to look for the information available on the prescription.
The situation with the sales employees in Mexico is such that they have virtually zero responsibility for what they are recommending. Mexican education and health authorities do not impose any educational prerequisites on such sales employees, except for the completed secondary education.
Moreover, sales employees do not have a traditional for American stores manager/ supervisor, nor can they ask an advice from a licensed chemist or pharmacobiologist, since the latter are required to be present in a pharmacy only for a few hours per week to control mentioned above prescription-mandatory substances. Pharmacobiologists are there to have a position in the chemical industry or in the medical laboratories. There are virtually no trained hospital or even community pharmacobiologists who would focus on the local, community tasks.
The online Mexican pharmacies are hard to track down. The Internet is the common marketplace for all sorts of generics (analogs of the branded medications, featuring the same active component.) The online pharmaceutical market in Mexico is not yet well-developed and is mostly popular with the customers in need of medications for erectile dysfunction (Viagra, Levitra, Cialis, etc.), weight loss, haircare, and others. Because of significantly lower prices offered at such online pharmacies, the consumers are turning to these more and more. However, most Americans travelling to Mexico for medications still prefer behind-the-counter pharmacies, mostly because of the low trustworthiness of the overall online Mexican marker and of fear of the potential fraudulent activities connected to the personal data the customers share with online sellers.
Characteristics of clients and pharmacies
Our research has shown, that among overall customers shopping in Ciudad Suarez, 25 percent were Mexicans legally employed in the United States, and they were assisting US residents in obtaining the medications for them. On the other hand, around 10 percent were American residents who have a job in Mexico and who were buying medications for Mexican citizens.
As far prescription medications go, around 40 percent of participants in the survey said they were buying medications with a prescription attached, while almost 90 percent of respondents had prescriptions obtained through Mexican medical specialists, of which 70 percent included prescriptions presented by American residents.
There is a not an uncommon practice of selling prescriptions to consumers who needs these in order to obtain prescription-mandatory medications at Mexican pharmacies. There are even advertisements published within the pharmacies facilities claiming they have a medical specialist who can write a prescription for a small fee at around USD 2. The package includes the observation of a patient and a subsequently issued prescription.
The research shows that the reasons the residents of the United States opt for purchasing medications through Mexican pharmacies include:
- Low cost (around 80 percent),
- Expected quality (around 38 percent),
- Prescription not required (around 39 percent).
The specifics of the medications most wanted in the border cities pharmacies
Let’s look into the specifics of the medications obtained either with or without prescription by residents of either Mexico or the US, both online and behind the counter deals included.
The study has shown, that out of 200 specific products that were sold without a prescription, 120 required an actual prescription. For example, nobody of consumers who purchased analgesic opioids or oral contraceptives had a prescription. The high percentage of antibiotics, blood pressure regulation medications, thyroid medications, erectile dysfunction treatments and corticosteroids were also sold without prescription present, the latter is a strict requirement under the FDA guidelines.
- Nobody among American residents who bought thyroid medications or testosterone medications used a prescription;
- 10% blood pressure regulation medications were purchased with prescription,
- 20% corticosteroids medications were purchased with prescription,
- 25% antibiotics medications were purchased with prescription,
- 50% antiepileptics/antidepressants/ansiolytics medications were purchased with prescription.
30 percent of the medications purchased were for American residents. And out of those, 70 percent were self-prescribed while only 10 percent were recommended by a medical specialist. The lack of the prescription is the indication that the patient was not under any medical observation as of the time of the purchase. Of the remaining 20 percent, 10 percent were advised by a pharmacy sales person and 10 percent were recommended by the traditional healers.
On the other hand, the citizens of Mexico opted for self-prescribed medications in 45 percent of the cases where the prescription were required. Mexicans also followed an advice from a medical specialist in 25 percent of the cases and followed a recommendation of the pharmacy sales person in 20 percent of cases; all of these are higher figures than those pertained to American buyers.
Among the most popular medications recommended by the sales persons in Mexican pharmacies were antibiotics and analgesic opiates, both groups require a prescription.
Characteristics of pharmacy sales specialists
The study has shown that pharmacy sales specialists were young, had low levels of education in health, and the majority at around 90 percent learned their trade from their colleagues who in their turn had not have a formal training. On the other hand, traditional Mexican pharmacies mentioned earlier feature trained pharmacists who are capable of giving a qualified medical advice. They are present at these pharmacies most of the time.
Pharmaceutical companies in Mexico are naturally promoting medications they are selling, and the total income of sales assistants in pharmacies is dependent on the amount of the medications they sell.
The survey has shown also that at only one third of the cases when a consumer would inquire about a particular product a sales assistant at a pharmacy would inquire deeper into the nature of the health issue the consumer is experiencing.
On the other hand, at around quarter of the cases, when a customer would present a prescription, the sales assistant would offer an alternative which would bring more profit and consequently an income to the sales assistant. Curiously, around 80 percent of such offers are accepted by the consumer in need.
Only around 5 percent of the consumers were sent to a physician by the sales assistant in a pharmacy to obtain further recommendations, while most attempted to sell any medication at hand they found to be related to the case presented.
Of the total of the medications sold, 15 percent were accompanied by verbal information on the product. The sales assistants gave very little information about side-events or possible harmful interactions with other medications.
Risks and benefits of Mexican online pharmacies
- The border studies have shown that use of Mexican pharmacies across the border with the United States would definitely entails the set of risks and might result in complications with a user’s health.
- The consumers might simply waste their money on the medications they would not need at all. For example, a consumer might purchase the medications to battle the fatigue or for weight management, while not taking care of the underlying condition, of which the fatigue or weight loss were only symptoms.
- Patients might also obtain medications that could potentially result in hindering the recovery. For example, cough medications might be counteractive with productive cough.
- Consumers might obtain medications that could be detrimental to the health. For example, thyroid regulators and various fixed-dosage medications.
- The attractiveness of a medical consultant present at the walk-in pharmacy and who is able to prescribe the medication on the spot for a small fee.
- The uninsured American citizens, as well as those who are falling their co-payment plans.
- The Government of Mexico has issued the legislation which enforces a prescription for any antibiotics purchases. The sales of the latter have decreased as a result, which in its turn have caused massive opening of the professional consultation businesses situated next door to the pharmacies. There was a little effort to encourage the appropriate use of antibiotics.
- The medication industry is biased in any country, and, when it is out of the strict control by the governmental agencies, such as FDA in the United States, can influence the pharmacies with lucrative incentives to promote one medication over another: the practice widespread in Mexico, especially when a customer is asking for an advice from the sales consultant who belongs to the pharmacy.
- While there is not a significant difference in price between popular medications in Mexico and in the popular stores in the United States (such as Walmart), online Mexican pharmacies may offer lucrative, cheaper solutions, with the delivery included inside the Mexico, which makes these offers extremely attractive for American residents.
Our Suggestions and Recommendations
- It is highly recommended to eliminate conflicts of interest that result in financial incentives offered to pharmacy sales persons and medical specialists working closely with pharmacy stores. These conflicts currently lead physicians to over-prescribe medications that don’t need to be prescribed, while, on the other hand, the sales persons are incensed to sell these medications more and more, regardless if a consumer needs them.
- Increase the amount of information easily accessible and written in a simple language to orient a consumer in the effects, side-effects, and precautions of the medications, especially those that require prescription.
- Make pharmacy-oriented college degrees mandatory for sales assistants at regular stores and implement the system of promoting the benefits of education in the pharmaceutical field across the border provinces in Mexico.
- The United States border government and its departments responsible for health may consider working closely together with Mexican health authorities in the research and implementation of joint health programs to promote the proper use of pharmaceuticals.
- The border authorities may start to denounce practices that put the health of pharmacy customers at risk and that result in the decline of health of customers.
Este diplomado tiene como objetivo identificar nuevas formas de ejercicio del poder donde se contemple la interlocución y corresponsabilidad entre el gobierno y los actores sociales para diseñar, implementar, monitorear, y evaluar las políticas de atención a los mexicanos en el extranjero y a los migrantes en nuestro país, a fin de potenciar su eficiencia.