The high cost of many prescription medicines is a real problem to many people who need to buy them regularly, especially if they don't have insurance coverage. One solution that is often mentioned is buying the medicines in another country where prices are lower. Busloads of senior citizens cross into Canada to stock up, and people in Southern California find that by taking a day trip to Mexico they can buy many prescription medicines over the counter for much less than the pharmacist at home will charge. In the past few years, the Internet has given stay-at-homes the opportunity to have medicines shipped from foreign pharmacies right to their door.

Should you buy your seizure medicines from Canada, Mexico, or some other country? Is it legal? Will you really save? And most important, is it safe?

Is it legal?

The U.S. Food and Drug Administration (FDA), which regulates the production and sale of prescription medicines in this country, says that it is illegal to sell products that are:

• not formulated exactly the same as the FDA-approved product




• not produced according to U.S. quality standards




• not labeled according to U.S. requirements




• not stored or distributed under U.S. quality conditions.

Following this rule, online or mail-order sales from pharmacies in other countries are illegal. This doesn't mean that you will go to jail if you place an order, but you may find that it's becoming harder to find reputable sources to buy from. Pressure from the drug companies and from governments in the U.S. who are losing tax revenue has resulted in crackdowns on some pharmacies in Canada and elsewhere.

What if you travel to another country? When you return, the U.S. customs agent will ask you to declare any medications you have bought. If you have no more than about 3 months' supply of medicine for personal use, you probably will be allowed to keep it, but the law permits the agent to refuse to allow you to bring in prescription medicines from another country, even a foreign version of an FDA-approved product.

Will I really save?



If you visit a few of the websites offering prescription medications from other countries, you will see some low prices for seizure medicines. Other prices are no lower than you'll find at home. You also will probably find that your choice of medicines is limited. Not everything that your doctor prescribes may be available.

When comparing foreign prices to the prices at your neighborhood drugstore or at an

American online pharmacy, you also need to consider other factors that can increase the cost and difficulty of buying overseas:


• Shipping costs are often $10 or $15 per order.




• You'll have to mail or fax your prescription if you are buying from Canada.




• Some sites charge an enrollment fee before they will put your order through.




• If you get the wrong medication, returns are likely to be difficult.




• You may not receive your medication for weeks after you place your order and it's often difficult to find out exactly when it will arrive.

• Is it safe?
  
  

  Seizure control is often a delicate balancing act&#151too little medication leads to seizures, but too much may produce side effects that also disrupt your life. When you and your doctor have found the right dosage, you want to be sure that you can continue to follow it when you get your prescription filled at a new pharmacy. What if that pharmacy is in another country?

  The medicines you buy from a foreign source probably will not be harmful in themselves. (Canada, for instance, certainly has high standards to protect its own citizens.) It is possible, though, that you could get medicines that are not what you expected. They could be counterfeit, or there could be a mistake that goes unnoticed because the name and appearance of the product is different.

  Even more likely is that it will be difficult to obtain medicines of consistent strength and quality. As already mentioned, the FDA has strict rules about how prescription medicines are produced, stored, and labeled. A product from another country, although similar to the American product, may be just different enough to upset your seizure-control balance, and each new batch may be a little different from the batch before. It may come from a different manufacturer or it may have been damaged through improper storage or shipping. And don't look for advice from the label of your Mexican medicine&#151it's in Spanish!

  So what to do?
  
  

  Some people with epilepsy do save money by buying their medications from Canada, Mexico, or other countries, but it's risky. Before you send your prescription overseas, explore the opportunities for savings at home.

  If you have a limited income, you may qualify for one of the programs that drug companies and government agencies sponsor to provide medicines at low cost. The websites www.rxassist.org and www.rxhope.com will help you find out which programs may apply to you. The Medicare website (www.medicare.gov) has information on programs available for elderly or disabled people who qualify for Medicare.

  You also may save by comparing prices at various local drugstores. Some (often pharmacies in big discount stores) will be cheaper than others. Another possibility is ordering your seizure medicines from an online or mail-order company in the United States. These companies will quote a price for your prescription. When you compare prices, be sure to include the cost of shipping and any other fees. Medications that need refrigeration are likely to require high-cost overnight shipping, if they are available at all.

  Share your experiences
  

  Have you bought seizure medicines from another country? What was the result? Were you satisfied? Would you do it again? Have you found some other safe way to reduce the high cost of medication?