You may have heard from a friend, or read somewhere on the internet, that you can import a personal supply of generic PrEP drugs from the US for a fraction of the cost.
All you have to do is set up a US bank account and post office box, get a prescription for Truvada from a Canadian doctor, order a generic version of the drug from an online pharmacy, drive across the border, pick up a three-month supply and drive back. Instead of paying over $900 a month for Truvada, or going through the bureaucratic nightmare of applying for insurance coverage, the drugs will cost a mere $50 a month.
But is it true Canadians can bring PrEP from the US? It depends whom you talk to.
When Daily Xtra contacted Health Canada, media relations advisor Rebecca Gilman said no, Canadians cannot bring any prescription drugs from the United States outside of special circumstances. She said driving across the border to pick up generic PrEP would be in clear violation of Health Canada regulations.
The confusion hinges on one clause in the agency’s rules. Health Canada policy reads: “So as not to interrupt a course of treatment, Health Canada may use enforcement discretion to permit a Canadians [sic] returning from abroad to bring with them on their person a single course of treatment or a 90-day supply based on the directions for use, whichever is less, of a prescription drug.”
That makes it sound like Canadians can bring back prescription drugs as long as they are undergoing continued treatment by a doctor. Gilman says, however, “So as not to interrupt a course of treatment” only refers to a situation in which a Canadian is prescribed a drug in the US, and has to keep taking it even after returning to Canada.
“A course of treatment is like when you go down to Florida for two weeks and get diagnosed with a blood clot and need blood thinners before you come back to Canada, and you have to take them for two months,” she says. A Canadian doctor prescribing the drug does not count as a course of treatment that would justify buying prescription drugs from the United States.
Gilman’s explanation, however, conflicts with the experiences of actual men who have tried, and succeeded, to openly bring PrEP across the border. One man from Vancouver, who agreed to speak to Daily Xtra anonymously, said he explained everything to border guards and had no problems.
“I declared it,” he says. “I said it wasn’t covered by Canadian Medicare and it was cheaper for me to bring it across the border. The border guard seemed very nice, she even said ‘what’s it for? I kind of know a bit about it.’”
“She asked me how much it was and I told her $190 approximately after shipping and taxes. She asked how much I was bringing in and I told her three months, because legally that’s the max I can do at any time. She said okay and simply waved me through.”
Another man from Vancouver who spoke to Daily Xtra says when he went to pick up his generics he made sure to bring copies of his prescription, invoices, and even copies of the Health Canada regulations. In the end, he says, the border guards were entirely unfazed.
“I went down there for 10 minutes, turned around, and came back,” he tells Daily Xtra. “She asked me how long I’d been gone, and I said I just crossed. She asked me what I was doing in the States and I said I was picking up a prescription. She asked what prescription and why I wasn’t picking it up in Canada. I went through the basics, that because Truvada is off-label in Canada, insurance and support aren’t in place and the price difference was $950.
“She asked me about the medication and what it was for, and I told her that the off-label use was for the prevention of HIV. She asked me why it wasn’t approved, and she was actually really supportive of it. Then she said to make sure for the future that I can only bring back three months at a time. She asked me the value of the prescriptions, and I told her it was about $150 US. And that was it.”
Gilman, at Health Canada, says she thinks the border guards are simply mistaken. “It doesn’t look like this is a thing that is technically allowed,” she says. “I kind of think they are just letting it go, rather than following the law.”
She stresses, however, that the rules at the border are often flexible. “It’s case-by-case. It depends what’s going on, and it’s very subjective,” she says. “It could be discretion.”
To make things more confusing, when Daily Xtra called Health Canada’s British Columbia compliance and enforcement office to ask if it’s legal to bring prescription drugs across the border, an agent said only importing by mail or courier are entirely banned — and that driving across the border was “absolutely at the discretion of the border agent.”
Daily Xtra also contacted the Canadian Border Services Agency and received a similar, but subtly different reply. A media spokesperson wrote that CBSA will generally follow Health Canada’s lead on enforcement issues, but that Health Canada may use discretion to allow Canadians to return with 90 days of drugs.
“This discretion,” she writes, “is generally reserved for, but not limited to, Canadian residents returning to Canada with prescription drugs which were dispensed for a treatment prior to leaving Canada, or drugs obtained through a filled prescription to treat an illness while abroad.”
To summarize, Health Canada told Daily Xtra that bringing generic PrEP to Canada is not legal, but Health Canada’s BC branch says it might be allowed on the discretion of border agents. Border Services, on the other hand, says it may be allowed on the discretion of Health Canada.
Meanwhile, Daily Xtra has found that CBSA agents have allowed Canadians to bring generic PrEP back to Canada as long as they prove they have a prescription.