Maine allows importation of mail order prescription drugs

BMJ 2013; 347 doi: (Published 11 October 2013) Cite this as: BMJ 2013;347:f6159
  1. Michael McCarthy
  1. 1Seattle

Residents of Maine can now order drugs from foreign pharmacies under a new state law that is the first of its kind in the United States.

The law, which went into effect on Wednesday 9 October, allows state residents to obtain prescriptions by mail order from pharmacies in Canada, the United Kingdom, New Zealand, and Australia.

Americans typically pay some of the highest prices in the world for prescription drugs, and for years many people have taken to ordering drugs by mail from countries where prices are lower, especially Canada.

Although the practice violates federal law, federal authorities have rarely gone after consumers who purchased drugs from abroad.

Over the years several municipalities and companies in Maine have contracted with a Canadian company, CanaRx, to supply their employees with brand name prescription drugs. The company supplies the drugs at prices that are considerably lower than those in the US and requires no co-payment, further reducing the cost to consumers.

It is estimated that the program for employees of the city of Portland, for example, had saved the city more than $3m (£1.9m; €2.2m) over eight years.

However, last year the Maine Merchants Association, which represents pharmacies in the state, protested after it was learnt that CanaRx was entering into an agreement to provide prescription drugs to state employees. The association argued that it was inherently unfair to allow a company that was not licensed in the state to compete against Maine based companies that must follow all the state’s rules and regulations.

The state attorney general agreed and ruled that the state’s Board of Pharmacy lacked the statutory authority to license mail order pharmacies located outside the US and therefore that CanaRx was operating in violation of Maine law.

But the state legislature responded by passing legislation in June that allowed licensed pharmacies in Canada, the UK, Australia, and New Zealand to export prescription drugs to Maine residents, specifically exempting those pharmacies from the state’s licensure requirements.

Last month state industry groups, including the Maine Pharmacy Association and the Maine Society of Health-System Pharmacists, were joined by the Pharmaceutical Research and Manufacturers of America in a suit filed in the US District Court for the District of Maine calling for an injunction to halt the law’s implementation.

In their complaint the plaintiffs called the law an “attempt to circumvent federal law” governing prescription drugs that put “Maine residents at risk of serious harm” from substandard, out of date, and counterfeit drugs imported from abroad.

In its motion to dismiss the complaint, the state has countered that the new law did not “affirmatively” authorize Maine residents to buy drugs from pharmacies from other countries.

Instead, it said, the legislation was “a classic example of a State acting to limit the extent of its traditional police powers—deciding not to assert its regulatory authority over certain conduct.”

Under the US Constitution Maine had no obligation to enact state laws “to further federal policies” or statutes, the state argued. There was no constitutional provision that “requires Maine as a state to regulate in an area it chooses not to regulate,” it said.


Cite this as: BMJ 2013;347:f6159

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