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With the borders of Canada and Mexico closed, Americans are trapped in their own healthcare system

2020-08-31T14:07:15.099Z


Mexico and Canada have closed thousands of miles of border for all but essential travel, complicating vacation, work and study plans. For Americans with ...


Implications of the closure of the US-Canada border (March 2020) 2:37

(CNN) - "Do you want to hear a joke about insulin?" Says the dark joke about drug prices in the United States. You have to go to Canada to get it.

But that's not even an option anymore.

Travel restrictions caused by the pandemic have made Americans the prisoners of their own country. Even within North America, Mexico and Canada have closed thousands of miles of border for all but essential travel, complicating vacation, work and study plans. For cash-strapped Americans, it has also cut off access to medicines and health care services that they cannot pay for at home, at a time when money is more limited than ever.

Stephanie Boland's 9-year-old son was diagnosed with diabetes in December. The trip to Canada to get their insulin prescription filled took them a half day by car from where they live in Brainerd, Minnesota, but it was worth it: the purchase was a simple, non-prescription affair. A package of injections, which would last for several months, costs less than $ 100, he says, compared to a list price of $ 530 at home.

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When their son's illness began to rewrite the routines of daily life, the Bolands planned to cross back to Canada to resupply. Then came the pandemic.

Boland, a masseur, was forced to stop working. Her husband, a freelance financial adviser, also had his income affected by pandemic-related turmoil in the markets. Then her source of affordable insulin disappeared behind a border that had never been closed before in the history of US-Canadian relations.

"We were going to make a trip north, one more trip in March, but they closed the border," he said.

Buy insulin abroad

Only 1.5% of American adults who take prescription drugs buy their drugs abroad, according to a June analysis by researchers at the University of Florida at Gainesville, based on a 2015-2017 National Health Interview Survey.

But still there are an estimated 2.3 million people.

Many drugs and medical services are cheaper in neighboring Canada and Mexico, thanks to price controls and the power of the US dollar. The difference is so great that the US insurer PEHP, which covers Utah state employees, offers partially paid trips to Vancouver and Tijuana "to help you save money on your medical formulas." In popular Mexican resort cities like Cabo San Lucas on the west coast or Tulum on the east coast, pharmacies, doctors and dentists targeting the American clientele are found on the main street, with their prices on brilliant display. And the difference between those prices and the costs of the same drugs in American pharmacies can mean life or death.

No drug is a better known example of that calculation than insulin, a vital hormone in the body's metabolism. Seven million American diabetics do not produce it naturally, or not enough, and need to inject it throughout the day. Without it, dangerous levels of glucose build up in the blood, damaging organs and causing a painful stupor. In the worst case, a lack of insulin can cause death in three days.

Donald Trump confirms the closure of the border with Canada 1:44

Americans have come to Canada in search of insulin since scientists learned how to make it in laboratories at the University of Toronto in 1921. One of the first patients to try it was an American: Elizabeth Hughes, the teenage daughter of the then secretary of State Charles, Charles Evans Hughes.

"I am so happy and euphoric," she wrote in a letter to her mother from Canada, describing her first self-injection and the "huge" meal she enjoyed afterward. Before crossing the border, the 15-year-old had managed her condition by starving, the only trick available to diabetics to prolong life before insulin. Hughes was 1.52 meters tall and weighed only 20 kilograms.

One hundred years later, and after a national examination of conscience about the dizzying cost of insulin, some Americans are still starving. Daniel Carlisle, a type 1 diabetic in Texas, has sometimes tried not to eat for days in an attempt to ration insulin. When he was 18 years old and short of cash, he even considered robbing a pharmacy, he says.

"I always do the math on how many days' supply of insulin I have in the refrigerator," says the 60-year-old Texan.

This is how I know my life expectancy at that time. My life expectancy is measured by exactly how many days of insulin I have on hand, plus three days.

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New Progreso, Mexico

For the past three years, buying insulin in Mexico has provided Carlisle with security.

His travels began with a chipped tooth in 2017. "I went to a dentist near where I live and he said he could repair it for $ 10,000," says Carlisle, who has no insurance. “So I said, 'Look, I can't afford to send my kids to Harvard. Surely I can't send yours. '

He tried to ignore his toothache, but at the urging of his family, he eventually drove a few hundred miles south from his home in Houston to the busy Mexican city of Nuevo Progreso.

“As soon as you cross the bridges, the street vendors say 'Do you need a dentist? Do you need a pharmacy? It's just constant, ”he said. The tooth was fixed first: a root canal, a bridge and a crown together would end up costing just $ 750. "The offices are not marble palaces, but they are clean," he says.

Then he went into a pharmacy to ask the price of a bottle of Humalog insulin, one of the two types he takes. The answer: $ 70. He checked the expiration date on the box and then offered $ 20.

"You have to negotiate!" He says. " I'm just telling them I'll die without him and then they'll lose a customer. They don't make a fuss.

A bottle of the same insulin in the US has a list price of US $ 274.70.

Since then, that's the only place he's bought insulin, Carlisle says, and he's never had a problem with its quality. But with the borders closed, he doesn't expect to return anytime soon.

A vehicle heads toward Mexico near the San Ysidro port of entry in San Diego, California, U.S., on Tuesday, Aug.25, 2020.

A vast gray area

Staff at several pharmacies in border cities in both Canada and Mexico tell CNN they have seen significant drops in foot traffic since their countries' borders with the United States were closed. Although some US criminals have been accused of crossing into Mexico to run non-essential errands, border crossings in general have collapsed.

A young man who worked at a pharmacy near Tijuana told CNN that business had dropped about 40% since the border was closed. He asked to remain anonymous because he was not authorized to speak about the business.

Technically, bringing prescription drugs into the United States is illegal. But the US Food and Drug Administration (FDA) has created a gray area for small quantities: importation "might" be allowed, according to the agency's website, if the drug is not exceeds three month supply.

Staff at Mark's Marine Pharmacy in Vancouver, Canada, less than an hour's drive from the U.S. border, typically fill hundreds of orders for U.S. customers, every day, says general manager Jordan Rosenblatt, and you rarely have trouble shipping. With borders closed, online ordering has exploded, he adds.

Reviews over the years on its Facebook page compare the prices of all kinds of prescription drugs to those in the United States, with reviews from as far away as New Jersey and Texas. “They sell and ship my asthma inhalers to me at a price that is not predatory, unlike here in the United States. I am the happiest girl today! Thank you! ”Says a comment.

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How did Canada flatten the contagion curve? 3:42

But ordering online isn't for everyone - there's always the risk that the drug will be confiscated or that temperature-sensitive drugs, such as insulin, will go bad waiting at customs or in US Postal Service delays. .

And while frustrations over border closures stand out, foreign healthcare systems are a poor alternative no matter how they are accessed.

"For any individual in the short term, going to Canada is a decent solution, but it is not a systemic solution," says Dr. Vikas Saini, a Harvard-trained cardiologist and president of the Lown Institute, a group of non-health care experts. partisan.

US President Donald Trump has called for larger-scale imports from Canada to be allowed, among a series of recent proposals to cut prices for certain US drugs. But that is unlikely to make a dent in the US market, says Saini: “Canada is a country of about 30 million people. It doesn't have enough drugs to fill all those prescriptions for the US, a nation 10 times the size.

Some Canadian healthcare industry groups and patients agree. Since 2019, they have warned that Trump's import plan could lead to drug shortages for Canadians, a fear that was likely exacerbated after witnessing a global shortage of vital medical equipment in the early months of the covid-19 pandemic.

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A crumbling economy

As the pandemic progresses, the options are diminishing for Americans who cannot afford to get sick in America, especially after the crumbling economy wiped out nearly 13 million jobs and swept away health insurance options.

Even at Canadian prices, some find it difficult to pay for their medical formulas. “Recently, we learned about all the financial problems of the laid off people,” says Rosenblatt, Vancouver pharmacy manager. "We have American clients who have been working with us for years and under these circumstances we sent them what they needed and said, 'Pay us when you can.'

To make insulin more accessible, some states in the United States have pushed for price caps on copayments. The three companies that control the US insulin market offer discount plans, including new programs to which Americans financially affected by the pandemic can apply for temporary access to cheaper or free insulin. And Walmart offers cheap over-the-counter insulin (although this is an older formula that can make blood sugar control more complicated than the newer prescription versions).

Yet many are still struggling - and not just the nearly 28 million Americans who are uninsured, a figure estimated by the Kaiser Family Foundation - even Americans with health insurance, who benefit from negotiated prices that are lower than list prices sometimes cannot afford all the costs of living with diabetes.

In Dayton, Ohio, Mindi Patterson's family obtained health insurance through her job as a Costco employee. But even then, keeping up with the cost of insulin for both your teens and your husband is still like walking a tightrope. "We had to dig through the trash for (discarded) reservoirs from insulin pumps, when we didn't have money to buy the next supplies," he says.

“Right now I have an insulin refill (from my son) waiting, but I still don't have the funds to withdraw it. So they keep it for me until payday, ”he said.

Sabrina Renaud, a 22-year-old dietary assistant in South Carolina, works full-time at a hospital that offers health insurance to employees, but earns about $ 1,300 a month after taxes and says she just can't pay. the deductible for premiums and copayments of the business plan and you still need to pay the rent. "So I thought, I'm going to have to get through this without health insurance," he says.

Renaud has not seen a doctor to renew his insulin prescription in over a year. Instead, every two months, he sends a message to a woman, whom he has never met in real life, with a list of what she needs. Until now, the life-saving supplies you need keep showing up in the mail.

The woman, who asked to remain anonymous because redistribution of prescription drugs is illegal, told CNN that she has sent insulin to hundreds of people over the years, an effort she describes as a "necessary evil." People in the US and abroad send her replacement vials and injectable pens, and she says she sends them free to any American who requests them.

"I personally do this, my God, an average of four times a week," he says.

"I could tweet right now about someone who needs Humalog (a brand of insulin), and I'll probably get 100 responses from across the country saying 'I have extra,'" he says. "People are willing to pay $ 50 overnight to someone who is in a really bad situation."

She has even received large donations of insulin from Canada.

An increasingly busy 'black market'

More than a dozen diabetic Americans interviewed for this article said they had participated in an informal insulin exchange powered by social media, widely known as the "black market." The organizers are nodes on the web, using their prominence on platforms like Twitter to connect people who have insulin with those who do not.

"The FDA does not recommend sharing or reselling diabetic supplies, including insulin, due to concerns about the safety and efficacy of such resold or shared products," an agency spokesperson told CNN. But advocates for the network say they can't stop, pointing to several deaths of diabetic Americans who rationed their insulin.

"They have left us no choice," says emerging Minnesota politician Quinn Nystrom, whose campaign for Congress emphasizes affordable health care. Nystrom, who is a type 1 diabetic, helps distribute donations of insulin and, before the pandemic, organized "caravans" to Canada to buy insulin.

Am I willing to break the law to keep American citizens alive? Yes, ”she says.

Demand for insulin on the black market has skyrocketed since the pandemic began, said another organizer in Colorado, who asked to remain anonymous because of the illegality of the work. In the last week of July alone, it facilitated insulin donations worth an estimated $ 24,000.

"Before all this COVID-19 crisis, let's say just six or eight months ago, I could hear about someone needing insulin maybe once a month," he says. "That has progressed fast until now, when people are losing their jobs - in the last seven days, I have heard from 15 different people who have almost run out of insulin and have no way to pay for their next purchase."

Daniel Carlisle, the Houstonian, has at times donated some of his own supplies to other diabetics in Houston and Dallas. "If someone died because they lacked insulin and I said I would not share it with you, well, I have a real moral problem with that," he says. If he lived in Houston and needed some insulin, I'd drive and give him a dose.

But it has cash flow limits, he adds. And if you can't get a resupply soon in Nuevo Progreso, Mexico, you'll have to ask for help on the same black market that you once contributed to.

Right now I'm looking forward to February. If I can't get to Mexico by then, and I have the money to make the trip, I'll have problems, "he says.

- Natalie Gallón of CNN in Mexico City contributed to this report.

Border closure COVID-19 Diabetesinsulin

Source: cnnespanol

All news articles on 2020-08-31

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