For onecustomer, a three-month supply of insulin would cost $3,700 in theU.S. That same supply would cost only about $600 in Mexico. (Photo:Shutterstock)

When Michelle Fenner signed up to run this year's Los AngelesMarathon, it got her thinking: Tijuana, Mexico, is only a 2½-hourdrive from L.A. Why not take a trip across the border and buy someinsulin for her son?

“It's so easy to just go across the border,” mused Fenner.

This idea had been in the back of Fenner's mind for a while. Herson was diagnosed with Type 1 diabetes nine years ago, meaning heneeds daily injections of insulin to live. The list price of themodern generation of insulin has skyrocketed since his diagnosis. Onone trip to the pharmacy last year, Fenner was told that athree-month supply of insulin would cost her $3,700.

That same supply would cost only about $600 in Mexico.

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So, when she booked her trip to Los Angeles, Fenner said, “Idecided we need to update our passports and go and get moreinsulin.”

Fenner is notthe only one thinking like this. The U.S.government estimates thatclose to 1 million people in California alone cross to Mexicoannually for health care, including to buy prescription drugs. Andbetween 150,000 and 320,000 Americans list health care as a reasonfor traveling abroad each year. Cost savings is the most commonlycited reason.

'Right to shop' legislation

In Utah last year, the Public Employee Health Plan took thisidea to a new level with its voluntary Pharmacy TourismProgram. For certain PEHP members who use anyof 13 costly prescription medications — including thepopular arthritis drug Humira — the insurer will foot the bill tofly the patient and a companion to San Diego, then drive them to ahospital in Tijuana, Mexico, to pick up a 90-day supply ofmedicine.

“The average cost of an eligible drug in the US is over $4,500per month and is 40-60% less in Mexico,” PEHP clinical servicesdirector Travis Tolley said in an announcement of the program inOctober.

The program was part of a “Right toShop” bill championed by health care economist andUtah state representative Norm Thurston in 2018. Thurston saidthere is not yet enough data to know how much in savings theprogram provides; the first patients traveled to Tijuana inDecember.

But, Thurston said, he expects that in the next six months,savings will likely be “in the ballpark of $1 million.”

There are some questions about traveling abroad to buyprescription drugs, however. The first: Is it legal?

According to the Food and Drug Administration, “in mostcircumstances, it is illegal for individuals to import drugs intothe United States for personal use.” But the agency's websitedoes provideguidance about when it could be allowed. And the U.S.Customs and Border Protection's website has a wholesection on traveling with medications in its “KnowBefore You Go” guide.

While the guidelines may still raise questions, Thurston said,this sort of purchase for personal use is a widelyestablished practice.

“When we talked to people about this, there has never been asingle person who has been prosecuted for doing it. And it happensevery day at every border crossing all over the country,” Thurstonsaid.

“The general understanding is you can bring up to a 90-daysupply of a prescription from overseas, even though it's atechnical violation,” said NathanCortez, a law professor at Southern Methodist University.

“My sense is the FDA does not want to worry about individualsgoing overseas and bringing back small amounts of prescriptionsthat last a few months,” Cortez said, adding, “That doesn't meanthe FDA couldn't change its mind at any point and start crackingdown.”

A second major concern that comes up in any discussion ofmedical tourism is about the quality of that imported medicine.According to the FDA, the reason it's mostly illegal to importdrugs is because the agency “cannot ensure the safety andeffectiveness” of those drugs. In 2017, the World HealthOrganization estimated that10 percent of drugs in developing countries were either substandardor falsified.

To address that problem, the Utah program sends its patientsonly to a designated, accredited Mexican hospital. Individualpatients like Michelle Fenner are left to take their ownprecautions.

“You get a little nervous. You want to make sure that you have areputable pharmacy,” Fenner said. To get pharmacy recommendations,she has been consulting with friends and acquaintances who havepurchased insulin in Mexico. She's calling those pharmacies now tomake sure they have the type of insulin she wants to buy. When theMarch 24 marathon gets closer, she's planning to call ahead withher order.

Fenner, who splits her time between Dallas and Arvada, Colo.,said the amount she's expecting to save on insulin could warrantmultiple trips to Mexico every year.

Global savings

Fenner is just one of the growing number of activists online whoare discussing the great lengths they go to — sometimes literally —to afford insulin. Lija Greenseid is another. Her daughter has Type1 diabetes.

Almost one year to the day after her daughter's diagnosis,Greenseid and her family were visiting Quebec City, Canada, in July2014. Her daughter's blood sugar started spiking and Greenseidfeared her insulin might have gone bad, so she went to a pharmacy.With no prescription and fearing that her daughter's life was onthe line, Greenseid was prepared to pay a fortune.

Instead the box of insulin pens that normally costs $700 in theU.S. was only around $65 or so.

“At that point I started tearing up. I could not believe howinexpensive it was and how easy it was,” Greenseid said.

“I said to [the pharmacist], 'Do you have any idea what it'slike to get insulin in the United States? It's just so much moreexpensive.' And he turned to me and said, 'Why would we want tomake it difficult? You need insulin to live.'”

The more Greenseid traveled with her family, the more theyrealized how inexpensive insulin was everywhere except in theUnited States. In Nuremberg, Germany, she could get that $700 boxof insulin pens for $73. The same box was $57 in Tel Aviv, Israel,$51 in Greece, $61 in Rome and $40 in Taiwan.

“We get so accustomed in the United States to thinking thathealth care has to be difficult and so expensive that people don'teven consider the fact that it could be so much easier and lessexpensive in other places,” Greenseid said. “In fact, that is thecase in most countries.”

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with KaiserPermanente. This story is part of a partnershipthat includes SideEffects Public Media, NPR and Kaiser HealthNews.

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