Should doctors help patients buy drugs overseas?

As the cost of medication rises, do doctors have a responsibility to help people safely source cheaper options?

A Macquarie University medical ethics researcher is calling for doctors to make their patients aware of cheaper online options for buying medicines to combat a growing affordability crisis.

Many medications in Australia are subsidized under the Pharmaceutical Benefits Scheme, but out-of‑pocket costs can still be as high as $30 per prescription. For high-cost treatments that are not subsidized, the price can run to tens of thousands of dollars per dose.

In his new paper in the Journal of Medical Ethics, Dr. Narcyz Ghinea says people in lower socioeconomic groups are particularly affected by the cost of medication, and the problem is made worse if they have multiple conditions.

"There's an increasing realization that cost is a barrier for many people, and one that doctors should be considering and making people aware of when they prescribe a medication," he says.

"A 2017 Productivity Commission report found 8% of Australians were either not filling their prescriptions at all or were skipping doses due to the cost, and in the Aboriginal community, this rose to 36%.

"Any increases in co-payments can have a significant impact, too. When the co-payment for a cholesterol-lowering medication rose by 21%, 16% of people either stopped taking it or reduced their dose."

Australia is not the only country to be affected by medication affordability. It is a global problem, especially in countries with fewer safety nets.

In the U.S., it has been estimated that up to 15% of people with diabetes, cardiovascular disease and high blood pressure are risking their health by not taking some or all of their prescribed medication due to the cost.

Buying online is legal, but risky

Under Australian law, most medicines can be imported from overseas for private use via the Personal Importation Scheme.

But with the online medicine industry worth an estimated US$138 billion a year, there are big incentives for unscrupulous operators willing to take advantage of people looking for cheaper medicines.

In a 2021 Interpol crackdown on illegal vendors, 113,000 websites selling unauthorized medicines were removed or had their URLs blocked in the U.K.

It is estimated that a quarter of drugs in circulation in middle-and-lower-income countries, where medicines tend to be cheaper, had quality issues.

The biggest problem is that the drugs either don't contain any of the active ingredient or at least not enough of it to be effective.

"Several years ago, fake versions of cancer drugs were found to be in circulation in the U.S. and Europe," Ghinea says.

"It is very difficult for anyone to know which products are safe to buy online, and we need to seriously consider what role doctors have to help patients access drugs they need but cannot afford.

"Yes, there are systemic issues that need to be addressed, and I agree that it is expecting a lot of a workforce that is already under pressure.

"But when the system is failing people, it can be argued that doctors do have an extra duty towards patients to help them overcome those failures, and one way they can do that is by helping them access cheaper medications from abroad.

"Nobody in health has the patient's primary interest at heart in the same way as their own doctor does."

Safety in numbers

The legal ramifications associated with doctors helping patients to source medication from overseas has yet to be tested, but Ghinea suggests it would be similar to that associated with the Special Access Scheme, which, in certain circumstances, allows doctors to prescribe medicines and devices that are not included on the Australian Register of Therapeutic Goods.

"A good rule of thumb is for doctors to check with their medical indemnity insurance provider to see what they will cover," he says.

Some doctors are already helping their patients source cheaper medicines from overseas, either on an individual basis or through online buyers' clubs. As in the movie, The Dallas Buyers' Club, people are banding together to import cheaper versions of the treatments for chronic conditions such as hepatitis C and cystic fibrosis from trusted sources.

Ghinea also recommends that doctors should work together to share information, in the way the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine has in the past.

"As medication costs rise, personal importation will boom, and if it isn't done safely, then more people will be at risk from sub-standard products," Ghinea says.

"If a patient needs a medicine to save their life, and the government and health system has failed to provide them with affordable access, then don't doctors at least have some responsibility to make them aware of other ways to access affordable treatments that could help them?

"Of course, there are risks that need to be considered. But patients missing out on treatment they need because of cost is also risky."