Storm swirls over drug imports

While dermatologists, for the most part, "go through the standard purchasing procedures and go directly to the manufacturer," says Seth Matarasso, M.D., clinical professor of dermatology at the University of California, San Francisco, School of Medicine, with patients, it's another story.

For those inclined to seek savings internationally, sources abound, many just a mouse click away. Additionally, patients are visiting Mexican and Canadian pharmacies by the busload. Most often, they seek fillers and Botox.

"And for all intents and purposes," Dr. Matarasso says, "you're getting the same exact product. But it's cheaper abroad. And it's not that difficult to obtain. If you're in Southern California, you can drive to Mexico and buy these products right over the counter."

A lure? Granted, low prices can be deceiving.

"Sometimes Web sites use those drugs as inducements to try to get prescriptions," says Marc J. Scheineson of Washington, D.C., a partner in the legal firm Alston & Bird, LLP, who heads the group's food and drug practice.

In Mexico, drug companies benefit from lower costs of doing business, in part because that country's regulatory system lacks the rigor and associated expense of the U.S. Food and Drug Administration's approval process.

Conversely, Canada's public health system ensures that if a drug is sold for substantially less in another country, its vendor must match that price. In contrast, Medicaid's rebate system is limited, while its best-price policy says only that if one is selling into the Medicaid system, one must offer a 15 percent discount or, if one makes a lower price available elsewhere, offer it to Medicaid.

These pressures notwithstanding, the trend his firm has seen is not that doctors are using imports to save money. Rather, they're procuring hot drugs not yet approved in the United States. Examples include Q-Med's Perlane and Restylane Finelines, plus various forms of botulinum toxin such as Dysport (Ipsen Ltd./Inamed).

Treatment abroad At the same time, patients are traveling abroad for filler treatments, sometimes with poor results.

"I have had people who come to me after they've had any number of substances injected for lip augmentation or facial enhancement," says Tina S. Alster, M.D., director of the Washington Institute of Dermatologic Laser Surgery and clinical professor of dermatology at Georgetown University Medical Center. "Many of these were acquired in salons or skincare treatment centers which are not overseen by a licensed physician. I've had at least six such cases (in 2004) coming from various places - Mexico, Brazil, the U.K. and elsewhere in Europe."

These patients' complaints include swollen lips, recurrent granulomas and stubborn infections.