Purchase of medications abroad by nativity and race/ethnicity

From the Ko Group, Division of Public Health Sciences

The price of prescription medications in the US has affected how Americans purchase much needed medications. Over recent decades, the price of prescription medications has increased, and continues to increase faster than inflation.  In 1960, spending on prescription medications was $90 per capita. In 2017, the reported spending on prescription medications was $1025 per capita. About 80% of Kaiser Family Foundation Health Tracking Poll respondents expressed interest in importing medications from Canada as an additional purchase option.  Millions of Americans have purchased medications outside of the US due to the high cost and constant increases in domestic pricing. Other factors associated with buying medications outside of the US include: the need for antibiotics or analgesics, lack of health insurance, low cost, easy accessibility, non-essential prescriptions, and physician recommendation.  Mexico and Canada are two of the main exporters of medications to the US. 

Earlier studies determined the prevalence of prescription medications purchased outside of the US, the type of medications purchased, and the reasons for the purchase. The current study by Dr. Linda Ko’s group in Public Health Sciences Division is novel in its approach; the study’s population represents the demographic population of the US. With multiple demographic groups, this study has the ability to identify common and unique factors associated with the purchase of medications by nativity (foreign born vs US born) as well as race/ethnicity. Dr. Sou Hyun Jang, the article’s first author, adds to the rationale behind the study: “The number of Americans who buy medications from another country - mostly Mexico or Canada- is increasing every year, but this behavior is illegal. However, the nativity of those more likely to engage in this behavior and what are the associated factors with this behavior is less studied. Thus, our study timely contributes to the literature on health behavior.”

In order to determine the use of prescription drugs as a proxy of healthcare utilization, Dr. Linda Ko’s group employed the Anderson healthcare utilization model.  This model recommends three components to healthcare: predisposing (which includes demographic differences), enabling (factors that empower a person to research the healthcare system through income or insurance), and needs factors (includes health status that promotes healthcare). The Anderson health care utilization model was applied to the study aims to compare factors associated with the purchase by nativity and race/ethnicity.  The results were published in the Journal of Immigrant and Minority Health

Graphical Representation of The proportion of buying prescription medications from another country by nativity and race/ethnicity
The proportion of buying prescription medications from another country by nativity and race/ethnicity Image from Dr. Sou Hyun Jang

The figure above compares the proportion of prescription medication purchases abroad by nativity and race/ethnicity.  About 15% of survey respondents reported purchasing of prescription medications abroad within the last 12 months as a means to save money. Foreign born individuals were more likely to buy prescription medications abroad than those who were U.S. born. Regardless of nativity, Hispanics had the highest rate of purchasing prescription medications abroad (4.26%), followed by Asian (2.08%), white (1.17%), and black (0.43%). Foreign born Hispanics were more likely to purchase medications abroad than native born Hispanics.  Using logistic regression, the Ko group reported that foreign born respondents had 2.79 greater odds of buying medications abroad than their US-born counterpart. Interestingly, the Ko group also found that recent immigrants who have lived in the U.S. for less than 10 years are more likely to buy medications abroad than immigrants who have lived in the U.S. 10 years or longer. 

Dr. Jang elaborated on the study’s findings, “Despite the previous studies suggesting that financial burden or medication costs are one of the most important reasons to buy medications abroad, our study found that poverty and income level were not associated with this behavior across all groups, except for US-born Hispanics. This finding suggests that factors other than financial reasons are likely to be associated with this behavior. Future studies can examine the non-financial factors associated with buying medications abroad.”

Purchasing medications outside of the US is illegal and the FDA is concerned about the quality of imported medications.  Many Americans may not be aware the dangers of buying unregulated medications from abroad.  According to Dr. Jang, “Researchers can work on how to effectively and widely disseminate this health information in the future.”

This work was supported by the National Institutes of Health (NIH)/ National Cancer Institute (NCI) [5T32 CA092408-18].

Fred Hutch/UW Cancer Consortium members Linda Ko and Hendrika Meischke.

Jang SH, Ko LK, Meischke H. Factors Associated with Buying Medications Abroad by Nativity and Race/Ethnicity in the US. Journal of Immigrant and Minority Health. 2020 Jan 20:1-9.