Well, for one ... it's illegal to import drugs that aren't FDA approved. You can import a few months personal supply of a prescribed drug that is FDA-approved but doesn't just mean that the active-ingredient is FDA-approved. It has to be the same exact product, manufactured in the same FDA-approved facility with the same packaging/labeling/etc to be considered "FDA-approved". The most expensive FDA-approved drugs are sold at US prices globally, so there's no geographic arbitration. Then other non-FDA approved brands are sold at lower prices - importing these is a smuggling offense, though enforcement was pretty low (but now with CBP's upcoming budget increases, who knows if this will continue to be practical or ultra-risky).
More practically - HMG is a very difficult drug to assay for purity. It's too complex to interpret with qNMR, HPLC testing is also very hard to interpret. The testing that exists evidently either has a very high margin of error or involves lots of rats and dissections.
Even testing for hCG, while it can be done reliably with HPLC, results between different labs are not comparable because the primary assay is also to test bioactivity on rodents, so they're not normalized to the same standard.
The lack of any independent testing for HMG means that some of the more accessible international manufacturers don't actually test their own product. Combined with its high price, that all makes it a very common target for counterfeit.
Yes, the American pharmaceutical system absolutely has quality-control issues. 80% of our generic pharmaceuticals come from overseas production. The pentagon wanted to independently test the drugs it was purchasing for the VA, so it worked with a company named Valisure who determined that about 10% of the drugs had issues with contamination or a lack of the active ingredient[0]. The FDA responded by shutting down Valisure's third-party testing.
But even with the problems we have here in the USA, HMG is the one drug I would particularly not trust from gray-market supply chains. It's conjecture, but I wouldn't be surprised if the doctor said that because other patients had tried it and had poor results.
Not only the drug has to be approved but the production process and laboratory.
There is a lot of bureaucracy and audits. It is but as if a European laboratory is allowed to sell a generic drug without at huge costs for certifications ( and viceversa)
I am not saying that buying your medicines to questionable online web is a good idea. Just that other countries have their own controls depending on their policies
Yes. There are a lot of good non-FDA drugs that have been available for online purchase by US citizens. It's illegal to get them shipped to you, but enforcement has historically been nearly non-existent and given that 75 million Americans are under-insured ... it probably has been the rational option for many. India, China, and Turkey are perfectly capable of making high quality pharmaceuticals when the business owner actually cares about quality.
Also, compounding pharmacies in the USA sometimes get their raw active ingredients from even the shadiest suppliers in China and India. It's not always perfectly legal, things aren't always QA/QC'd at any point in the process the way they should be, but it happens. So again, "buying American" isn't exactly a golden ticket.
European HMG from reputable pharmacies is probably great quality - but it's still rather expensive compared to Chinese HMG and there's really no way to trust anyone selling it online, you'd basically have to fly to Europe yourself. And taking it back on the airplane would still be illegal, and you'd be rather more likely to be caught by customs than a mailed package.
I'd assume it was their telling them specifically not to get it from a foreign country that was the odd part, as opposed to simply prescribing it from a US pharmacy since ofc that is what a US doctor will do. Maybe enough patients tried this, to save costs, that it resulted in some kind of issue for the doctor and that is why they brought it up.
You need to understand that the system is deliberately so opaque that doctors don't even know what your costs would be. Sure there's a sticker price, but for most medications that's so high as to be absurd. From there, it's entirely dependent on your insurance, coinsurance, pharma benefits, etc, etc.
They try, but they're not in a position to do anything about it.
> They try, but they're not in a position to do anything about it.
Well, somebody's got to be, and the doctors seem like the ones with the most leverage to get those people to do something about it, right? Customer/patient pressure obviously isn't working.
> the system is deliberately so opaque that doctors don't even know what your costs would be.
You're telling me professionals who make $300k after 20 years of education have 0 clue about what their patients might pay, or have never had patients who expressed concern over costs? Or don't have friends or relatives who expressed dissatisfaction with a high-deductible plan? Or aren't complicit in getting kickbacks for prescribing opioids?
We gotta stop absolving people of accountability. And that includes EVERYONE in the chain who benefits. Yes, this includes doctors.
Btw, I have had doctors who do try, and many more now will accept reasonable cash prices for their services. That should be encouraged and commended.
Indeed. At the end of the day, the entity underwriting the insurance plan decides the price. This is often the individual's employer. Your doctor does not know what your HR team decided to ask for when designing their health plan.
Why do they care? Referral bonus?
Did you report them?