What are the real differences between a Canadian pharmacy and a pharmacy in the United States? There are many, as you could easily guess. What is the current situation and what are the options for the US customers regarding saving money on pharmaceutical shopping to the north of the border? Let’s see in detail.
US pharmacy vs. Canadian pharmacy: what’s different in 2018?
In Canada, drugs and a whole list of food supplements are regulated by the pharmaceutical monopoly and cannot be sold outside this circuit. This gives the system some security in the distribution. And even if it is true, this monopoly is a little questioned at the moment, the differences are and will remain huge between Canadian pharmacies and pharmacies in the US
In the United States, pharmacies are often affiliated with chains: Walgreens, CVS or Rite Aids. There are still some independent but they are very rare. And in these chains when you come back, you’ll find candies, Christmas decorations first if you’re in December, Halloween if you’re in October, American flags if you’re in June.
You also find, a large radius of cards at the bottom of the store, you also find sodas, milk, crisps and peanuts – not really enough to heal you… Finally, you will be hated by the cosmetics department, with all brands of nail polish: creams, brushes, diapers (and it is only lately that CVS has banned from its pharmacies cigarette packs).
In general, at the bottom you will find the pharmacy. The place where you can fill a prescription. and before that, you will also fall (finally) on the rows of drugs, supplements, vitamins and medical equipment. Medications are usually sorted by symptoms. In addition, all supermarkets have their own medicine department.
At these pharmacies, you will not find a pharmacist to help you choose. You can possibly ask at the pharmacy counter if there is one. But, the person too much pressed by the prescriptions that it must make, will have the trouble to grant you time, and especially, it will not engage on a firm advice. question of responsibility.
The problem is, a drug is not a product like the others: it is used to treat, but misused, it can be dangerous. In the United States, many drugs are over-the-counter while they are under prescription in Canada.
The first visit to a US based doctor will be a little longer than the following and you will be asked to fill in several pages of information. The consultations take place in two stages as follows: At first, a nurse comes to take the pulse, the tension, and the temperature, then weigh and measure. A first summary interrogation (cause (s) of consultation, symtoms), without giving any notice is carried out.
During a second visit, the doctor comes, consults the data and after asking some questions, proceeds to the physical examination. After having made a diagnosis, or not, he can then make a prescription. He asks for the name of the pharmacy where you want to get his prescription: the prescription is sent directly to the pharmacy and you leave without a prescription. He or she may also prescribe additional examinations, an X-ray test, a blood test, or prescribe sessions of physical therapist. Sometimes these exams can be done in the same premises or in the hospital. Similarly, he may decide to send you to see a specialist. Nurse sometimes comes back to administer the vaccines if necessary.
The network of pharmacies is very developed in the United States. Most supermarkets (Safeway, Target, Hyvee, Walmart) have integrated pharmacy shelves. A drug dispensing counter is often located at the back of the store (indicated by a Pharmacy sign next to the name of the sign). There are also big chains that look like supermarkets and where you can find almost everything (there is a little more choice of medicine but not much more). The main chains are: CVS, Rite Aids, Walgreens etc. Alternative and organic (organic) supermarkets, like Whole foods, Sprout, have a wide range of herbal products, homeopathy, probiotics etc .
Besides these pharmacies, there are small independent pharmacies, a little like in Canada: they are present sometimes in large cities, but sometimes also in small villages. They are quite rare. There are also very few pharmacies, so-called integrative pharmacies. The most known chain is: Pharmaca (present in the western states). Pharmaca also has an interesting website and sells by mail.
There are two kinds of drugs: prescribed medications will be removed in a counter usually present at the bottom of the store. They are prepared and issued after receipt of the prescription electronically. Only the bare necessities are delivered, reconditioned with the exact amount of prescribed drugs.
In the chains’ shelves, there are many self-service drugs. Under apparent affluence, the choice of drugs is relatively low. The rays seem full, but they are often the same drugs in different forms and dosages (marketing does not escape the drug market!)
The main therapeutic classes present on sale are:
- painkillers / antipyretics: paracetamol (under the name of acetaminophen), aspirin and ibuprofen.
- against constipation,
- against diarrhea,
- against the cold (cold blow): the spray, the tablets ..
- anti-allergic creams, tablets,
- bandages and disinfectants, creams,
- eye drops,
- medicines against vaginal cystitis and mycosis,
- a children’s department with painkillers, antipyretics …
- vitamins, some plants.
- sometimes, a little homeopathy.
In homeopathy, a wide range of Boiron specialties is present, as well as granule tubes. There are other brands like Hyland’s or Similisan. These brands are found everywhere but especially at Whole Food and Pharmaca.
As much as the prices of the drugs in free access are reasonable, as the prices of the drugs under prescription are exorbitant (example: $160 for a cream which costs in the €7 in Canada). But the price that remains to be paid depends heavily on the insurance coverage. On the shelves and at the counter, pharmacists are not really there to give advice.
As an expatriate, you are sometimes subject to an expatriate-specific health insurance scheme (CFE): in this case, you escape the US health insurance system. But this is not the majority of expatriates in the US. Despite the reform of health insurance, known as Obamacare, social protection has not really evolved for those already affiliated with private health insurance.
To understand his health insurance, there are several terms to understand:
the deductible: this is the amount from which we start to be refunded: example: you have a deductible of $3,000, you will start to be reimbursed by the insurance when you have spent $2,999. The deductible generally covers a one-year period. The deductible is not present in all the insurances.
The co-pay: in other insurances, the co-pay is the part which remains with the load of the insured. Example: instead of paying, consultation: we only pay $20 co-pay and the rest is sent to the insurance that will pay directly to the doctor.
HMO: it is registered or not on your insurance card: it means: Health Maintenance Organization. If you are in this case, it is imperative to choose a primary doctor (family doctor): it is he who will centralize and organize all your medical procedures.
PPO: term also included on your card: Preferred Provider Organization. You can choose a family doctor, you can change and you can go to a specialist on your own. The system is more flexible. There are several types of insurance: Besides the medical insurance, there are also insurance for dental expenses and ophthalmic insurance. Dental insurances often cover preventive acts relatively well. In addition to insurance, there are so many repayment conditions. The doctor never knows on what basis, it will be refunded: it is not uncommon to see a subsequent bill of expense finally borne.
Bref, this insurance system is a real headache, a system unfair and terribly destabilizing for us French, accustomed to our rigorous system of Social Security Finally, it is important to know two things: insurance stops when you leave your company. Everything is negotiable: example if you do not yet have insurance, hospitals offer discounts. Ssimilarly, you can put pharmacies on the price of prescription drugs if your insurance does not cover them entirely.
In Quebec, pharmacists have gone from ‘drug distributors’ to ‘patient care provider’. Care centered on it has taken precedence over the traditional practice of pharmacy (as seen in the US). For example, the pharmacist is entitled to the management of certain chronic diseases, notably through the issuance of pharmaceutical opinions.
When a hypertensive patient does not reach his blood pressure targets, the pharmacist can give an opinion and offer the doctor a dose adjustment. Or, in case of a side effect of a drug, the pharmacist must make a recommendation to the patient, intervene with the prescriber and follow up with the patient.
Other examples can be cited as the administration of drugs to demonstrate (inhalers, insulin SC injections for example), writing prescription for minor ailments already diagnosed (allergic rhinitis, herpes labialis), extend a prescription or modify it (form or dose of medication), prescribe laboratory tests.
A valued service offer
This expanded offer of services is popular with the public who cannot imagine returning to the old model. In addition, these received care carry an additional cost which is however quite accepted by the general public. However, this transition has not been uniform in Canada since Quebec has only recently authorized these new practices while the other provinces were already applying them. This transition is also highly appreciated by pharmacists who find their new missions very stimulating.
A larger product offering
In addition to the transformation of the profession itself, pharmacy as a business is also very different. It’s a business, much more diversified and developed than in France. It consists of two distinct parts, physically separated by a plexiglass wall. On one side, the commercial part: there is a little bit of everything (drinks, cakes, photo labs, post office, etc). On the other, the pharmacy as such with the drugs. A pharmacist can own both parts of the premises, or just the pharmacy section. This opening of the profession is considered ‘very stimulating’ by a large number of Canadian pharmacists, who no longer consider selling only boxes.
Canadian pharmacies and the rules of importing drugs in the US
The list of the most reputable Canadian pharmacies for 2017 looks like this:
- DRUGStore Pharmacy
- Jean Coutu
- Catz group of companies
- London Drugs
- Proxim (merger of Essaim and Santé Services)
- Value Drug Mart
Those are verified and certified Canadian pharmacies it is perfectly safe to shop at. However, there are several points to be observed for the US citizens wanting to save their money on mail-ordered drugs from Canada.
While it is officially frowned upon to import drugs in the US from abroad, including from Canadian pharmacies, the unofficial non-enforcement policies of the country make it possible for the citizens to import drugs for personal use, provided those are purchased in good faith and for established diagnosis.
Buying drugs online in Canada: safe scenarios
For a variety of reasons, some people choose to buy drugs online in Canada. We wish to inform you of the risks related to this practice, through various scenarios frequently encountered.
- Scenario 1: My doctor is already prescribing this medicine.
- Scenario 2: The website I am consulting is certified.
- Scenario 3: One of my relatives / friends got a product on this website.
- Scenario 4: I am convinced that I know what I am suffering from.
- Scenario 1: My doctor is already prescribing this medicine.
If your doctor prescribes a medication for a specific period of time, say three months, it’s because he or she wants to follow up after that time. Continuing to take a medication on your own, without first obtaining the advice of your doctor, could be hazardous to your health.
In Canada, the production of drugs in industry is supervised by Health Canada, which ensures the quality of the product purchased in pharmacies. By buying drugs online, you have no guarantee of compliance with this legal framework. Even worse, it could be a counterfeit drug, allegedly produced by people with no expertise in the field.
As you do not know where the medicine comes from, no one can guarantee its quality, or its actual content of active ingredients. The products you receive may be contaminated with other products, or may not contain the desired active ingredient, at the required dosage.
In addition, many medications require follow-up by a pharmacist. As you do not go to the pharmacy to renew your medicine, the pharmacist is not able to ensure that this therapy is always suitable for you (side effects, interactions with food or other drugs, etc.).
Reminder of the risks related to the purchase of medicines online:
- Provenance unknown
- No control over the quality and quantity of active ingredients
- Danger of contamination
- No medical and pharmaceutical follow-up
Scenario 2: The website I am consulting is certified.
Some websites claim to have a certificate of authorization from certain regulatory bodies, such as Ordre des pharmaciens du Québec (see website). Please note that the College of Pharmacists never issues such certificates. Other sites display the Canadian flag, while they are not located in Canada; it’s just a ploy to reassure you. Remember that it is very easy to display logos without legal permission to use them. You should therefore be very vigilant.
Scenario 3: One of my relatives / friends got a product on this website.
First, it is virtually impossible to determine the quality of the product received by this person. Physically, two tablets can be identical without containing the same ingredients. Sometimes, the harmful effects of certain drugs are felt only after several months or years of use; therefore, short-term effectiveness cannot be relied upon based on a single individual.
Secondly, we should take into account that health problems are changing and that treatments can change. This is the reason why a prescription has a limited duration. Certain health parameters must be known by a pharmacist or a doctor, especially those related to side effects. With online purchase, this tracking is non-existent.
Scenario 4: I am convinced that I know what I am suffering from.
Some people are convinced that they suffer from a particular health problem without having obtained the advice of a doctor beforehand; sometimes they simply feel uncomfortable talking to their doctor about a health problem. Know that your doctor is not there to judge you. He is the only one able to evaluate your condition in order to prescribe an effective product. Without his wise opinion, you risk ineffective treatment, or worse, delaying the discovery of a serious illness.
In addition, if you already use other drugs, there may be a negative interaction with the product purchased online. For example, it can be dangerous to take medication for erectile dysfunction if you have heart problems. Your doctor and pharmacist are the professionals best placed to help you. Tell them about your situation, they will be your best advisors!
The website of affiliated pharmacies for different channels and banners should not be confused with those selling drugs. On the sites of pharmacies affiliated to Quebec pharmacy chains and banners, it is possible to renew prescriptions already active, which is quite acceptable. To obtain other answers or to make a complaint against a website purchase online, contact Health Canada or visit their website.
Canadian Pharmacies online and telemedicine consulting websites
The technological solutions offered by digital healthcare attract patients, but at the same time still frighten them. Also – or perhaps above all – when it comes to serious respiratory diseases, where the mechanical fan is indispensable. Such are the results of a survey conducted by the European Lung Foundation, the body created by the European Respiratory Society (ERS) in 2000, to bring together professionals, patients and the public to improve respiratory health. Almost half of the respondents are in favor of a remote control, by their own carer, of the device used to monitor the state of health of patients who follow a home therapy, but another 30% of the sample remains in doubt and more than 20% oppose it for the most different reasons. Yet these are highly disabling pathologies, whose welfare, psychological, physical and even economic weight falls on all the family members who in the vast majority can only rely on themselves. So the possibility of support, albeit at a distance, should be welcome.
Just reflect on the latest data: in the U.S: only 2% of citizens have already used the telemedicine services, only 30% have heard of it (37% among the chronic) and only 21% know what it is. In telemedicine, as for other eHealth applications, there is no single recipe for everyone, but we must focus on customizing the answers.
What emerges from the analysis of the literature is still contradictory. One cannot think of an indiscriminate use of these systems. Thus, the type of patient who can get the most benefits from telemedicine is the one who lives in disadvantaged areas (the periphery of a metropolis may also be), chronic and with more pathologies, socially isolated and with little or no family support. In short, a great ‘consumer of health resources’ as the technicians define it. Some pathologies respond better than others to the use of telemonitoring: disabling neuromuscular ones, such as amyotrophic lateral sclerosis, or sleep respiratory disorders.
In this context, telemonitoring can offer a great support from the diagnostic and prescriptive point of view – adds the pulmonologist – as well as in terms of control of adherence to therapy. Remote monitoring can also be helpful in education campaigns to promote lifestyles change, in patients who suffer from sleep disorders, who are obese and / or hypertensive. On the contrary, the results on pathologies such as chronic obstructive pulmonary disease and the consequent chronic respiratory insufficiency seem to be more contradictory.
Also in the field of digital health, an interesting initiative should be pointed out: the virtual reality brought home by oncology patients to improve their quality of life and reduce the negative impact of socio-sensorial isolation. It is the goal of The Look of Life, a virtual reality project conceived by non-profit association for specialist and free home care for cancer patients. The experiences proposed, some customized according to the wishes of patients, have the potential to give a relaxing moment, awaken the attention and the pleasure of discovery through emotions such as the wonder, the joy and the amazement that often the disease risks to move away from daily life of the patient and his family members. There will also be created a portal The Look Of Life, also open to those suffering from non-oncological diseases but equally disabling.
Another such example is a service offered for patients suffering from ED (erectile dysfunction), a problem that most men consider too embarrassing to even approach it at specified centers during a personal consultation. Others find it hard to make time for a real-life investigation, while the third type of patients resorting to telemedicine services in case of ED have an established diagnosis and seek to have their routine questions answered – like the mundane questions that do not require physical presence in the doctor’s office. Websites as GetRoman.com distribute such services alongside with selling ED drugs like Viagra, Levitra and Cialis to patients approved for such therapy remotely.
Compared to this new type of services, Canadian Pharmacies still have a long way to go. Could be that a Canadian pharmacy of the nearest future will become a hybrid between an online drugstore and a telemedicine portal – certain e-pharmacies of Canada have already started moving in this direction, offering free medical consultations to overseas and remotely located customers. All things considered, if you manage to find an online pharmacy in Canada whose pricing policy is typical for this country and whose list of services includes telemedicine assistance, such a winning combination will work even better for customer’s health and budget.