Many widely used generic versions of meds that you and I and everyone else get at mainstream pharmacies come from similar places. India, in particular, has a large generic med-producing industry that provides products to First World countries. For US-bound products, there is some degree of FDA oversight and quality control monitoring, I think.

I don't know what standards are like in Canada. I wouldn't assume anything.

Is it possible for the doctor to write a script for the generic? I am aware that some doctor's prefer brand name over generic. Having had experience with generic vs brand name with a UTI I am aware that the fillers can vary and affect the of absorption.

I know of two people that got their medications from Canada and were very satisfied and saved lots of money going that way.

Please remember these are not actually licensed pharmacies in Canada - Canadian pharmacists cannot fill prescriptions written from outside of Canada.

If you look carefully, you will see that they use a local licensed pharmacy in different countries, and I suspect that all the various website middlemen use the same pharmacies in various countries (some only in Canada, some multiple countries). The prescriptions you submit are essentially rewritten or co-signed by a locally-licensed doctor so they can be legally filled (in Canada, at least, probably in other countries as well).

Maifleur -- There is no generic for Rexalti.

sal 60 -- Do you know the name of the Canadian companies your friends used? I guess I should term these companies 'distributors', not 'pharmacies', although they use 'pharmacy' in their names.

Toronto -- I guessed they would have to have some Canadian-licensed person write or co-sign our MD's prescription, but I don't see a problem with that. From what you and Elmer say, I may be overly concerned about receiving this med from India or elsewhere, and that what we get here may also have originated there.

While doing further research, DH's doctor has prescribed the split-able tablet and his Plan D will charge him $355 for 30 tablets, resulting in 60 doses at about $5 per dose. The Canadian pharmacy quoted half that cost per dose online, for a 90 day supply.

Thank you all for your replies.

"I guessed they would have to have some Canadian-licensed person write or co-sign our MD's prescription, but I don't see a problem with that."

Good - as long as you're going in with open eyes.

Well that is certainly an improvement. What a mess navigating medical issues.

I have used pharmstore.com for the past year and have been very satisfied. My SO's doctor faxed the prescription to them. Our medication is packaged in a box with graphics (similar to other prescription medication one usually receives) and within the box is a labelled and sealed bottle. Both the box and bottle have info identifying pharmacy name & address, batch #, mfg date and exp. date. Ours is manufactured in India but ships from Mauritius. Securely glued to the top of the inside bottle is the extensive drug data sheet.

Allow for shipping time. Covid, the holidays, and shipping constraints made the time from order to arrival of meds in the mailbox about 30 days. More recently, it's dropped to 12 days but with the holidays approaching, I still plan for 30.

You can pay by credit card (fee added), check that you mail to them, or give them info to take payment from your checking account. Initially I mailed a check but found that added 14 days to the time, plus I had to get a special stamp at the post office, IOW. Did that twice then capitulated and gave them the bank info; have had absolutely no problems with that.

They have the drug you named available.

June

I just check junerose's link. I take an RX that's $42/30 pills with my insurance, and $165/30 when I'm in my 'donut-hole' coverage. I see that I can get 84 pills for $99.99, which is cheaper than my Part D insurance at best. I'm following up on this.

PS, interesting to see that the generic product is more expensive.

The drug I have to take is priced at $14,000.00 for one month. Of course I don’t pay that amount, my insurance covers the cost after I meet the deductible. This is the drug (at a lower mg dosage then I need) priced at June’s link.

"India, in particular, has a large generic med-producing industry that provides products to First World countries. For US-bound products, there is some degree of FDA oversight and quality control monitoring, I think."

There have been a number of huge recalls on drugs manufactured in India because of quality control issues (contaminated drugs). Diovan is one of my high blood pressure medications. I had taken the generic for many years, but then there were massive recalls on the generics. Thankfully, the manufacturer that made the ones I took, in the strength I take, wasn't recalled, but I figured it was just a matter of time, so I switched to the name brand.

"Is it possible for the doctor to write a script for the generic? I am aware that some doctor's prefer brand name over generic. Having had experience with generic vs brand name with a UTI I am aware that the fillers can vary and affect the of absorption."

Sometimes doctors will write the generic name and you as the patient have to tell the pharmacy if you want the name brand. Other times, the doctor writes the name brand on the prescription, but a generic can be dispensed unless the doctor checks the little box that says something like, "dispense only as written." A generic drug only has to contain the same active ingredients as the name brand, and has to be dispensed the same way as the name brand, e.g., pill, liquid, injectable. Other than the active ingredients, everything else in the generic can be wildly different. Around 4 or 5 years ago, when the recalls for Diovan were major news, there was a discussion here at the KT about the recalls and the generics. I put together this "chart" showing the difference between the brand name Diovan, manufactured by Novartis, and two generics. I sorted the ingredients alphabetically, to make it easier to see the differences. Here it is again. Click on it to enlarge. I've also posted several times about authorized generics. They are manufactured by the pharmaceutical company that makes the name brand, but they're sold as generics by subsidiaries of the manufacturing company. Not all drugs have an authorized generic.

Just me but I stopped being worried about drug recalls because they are manufactured overseas when I found out just how many drug recalls of made in the US that never hit the news. This area used to have probably ten research facilities both human and animal and more places that manufacture or pack medicines. I am more concerned what extreme heat does to various medicines it can apparently do more than just change the effectiveness.

"There have been a number of huge recalls on drugs manufactured in India because of quality control issues (contaminated drugs)."

This comment is misleading and tells only a portion of the drug recall story. There's an FDA site that lists drug recalls. On the list at any given time are products of plenty of US and other First World based Big Pharma and Biotech companies.

* * *

Congressional testimony of Dr. Janet Woodcock, Director of the Center for Drug Evaluation and Research (CDER) at the Food and Drug Administration:

drug manufacturing has gradually moved out of the United States. This is particularly true for manufacturers of active pharmaceutical ingredients (APIs), the actual drugs that are then formulated into tablets, capsules, injections, etc. As of August 2019, only 28 percent of the manufacturing facilities making APIs to supply the U.S. market were in our country. By contrast, the remaining 72 percent of the API manufacturers supplying the U.S. market were overseas, and 13 percent are in China.

(Click to enlarge image.)

I can't help with chisue's question, but I discovered that I can buy the meds that I take for less than half the price that I'm currently paying with insurance by buying them through a major online retailer's pharmacy!

Patients report finding good Rx prices @

(1) https://costplusdrugs.com

Only generic drugs now, planning to expand.

(2) https://www.amazon.com/pharmacy

(3) Costco - don't have to be member to use pharmacy.

DH's doctor has agreed to fax his prescription to a Canadian provider. Now we have to wait to see if his continuing dose will be 1MG or 2MG. Juneroses and the site itself say to allow lead time of one month, so he'll have to keep paying our local pharmacy $11 per daily dose (with Part D applied) until a shipment arrives from wherever in the world pharmstore.com sources this med. We'd pay $22/day here if we couldn't split a larger dose pill. Full retail is $50/day, but next to nothing if the patient isn't on Medicare and is thereby eligible for Otsuka's Rexulti discount card.

I think we'll order a 60 day supply of 2MG tabs. We'll be able to test how well they split and will have enough supply to allow time for a future order to arrive. The cost would be $5 per day. If their pills can be split, and we can order a 90-day supply the cost would go to about $2.60 per day.

I'm wondering if 'can not be split' only means there is no indentation on a pill to indicate it can be split -- and not that the tablet truly cannot be very closely divided with a pill splitter. Until nine months ago DH took Abilify (aripiprizole), a med similar to Rexalti (brexpiprazole). The cost was the same for any size dose of this, so we got 5MG and I split it into four pieces -- MD said that was close enough to DH's 1MG dose.

Thank you all for your helpful comments. Thank you, Juneroses, for providing a trusted Canadian supplier!

Chisue, I also wondered if the "can not be split" was because of no indentation. The link below shows that none of the various Rexulti mg tabs has one (you'll have to scroll down the page). I think your test plan is a good one. - June

https://www.webmd.com/drugs/2/drug-169294/rexulti-oral/details

Chisue: You probably received your Pharmstore order by now. Was it satisfactory and are you able to split the pills as you hoped? I have since ordered an expensive eye drop Rx from them. That med was also shipped from Mauritius; transit time was 17 days. - June

juneroses -- I should have posted earlier to thank you and tell you that the Rexulti arrived six days after being shipped. It evidently comes straight from Winnipeg. The tablets split just as well as the ones from our local pharmacy. I'm very grateful to have had your recommendation. The company employees have been efficient and pleasant to deal with.

I hope you have escaped damage from Ian. IDK where everyone from the Midwest will go for the winter this year, with Napes and Sanibel is such a sorry state. I've always thought it so clique-y that Easterners choose the East coast, while Midwesterners choose the Gulf side. It will all come back...eventually. Vacationers' plans a big nothing compared to the tragedy for property owners, although the loss of trade will contribute to the financial burden for some.

I'm going to start a thread about pill splitters. Ours is ancient. Still works, but no blade lasts forever.

Not about splitting pills, but we both got our expensive Rx's from Pharmstore. Took 2 weeks for Jim's and 3 weeks for mine, but they came from different countries. I'll save $12 a month on mine pre-donut hole, which started in August, and $125 a month after that. Taking this RX off my prescriptions will keep me totally out of the gap next year. Jim's RX is only about $10 less monthly, but the med isn't even on the company's formulary for next year, so who knows how much it will cost on insurance. Without insurance it is about $100 a month.

We're happy with the service and prices. Just need to remember to order refills a number of weeks ahead next time.

I've heard that there is a lovely pharmacy in Dawson City :-p

Without wishing to comment on the many broken aspects of healthcare in the US, drug prices and insurance costs and coverage certainly being high on the list, I have to wonder about some of these decisions to save money by taking a risk by buying medications of uncertain and unregulated provenance to save money.

Are your personal finances such that buying these drugs in the US would cause you significant financial hardships? Most people prefer paying less to paying more for the same thing, that's understandable, but when there's no assurance that what you're getting is indeed the same thing, I it doesn't seem wise. Except for those in circumstances where the only two alternatives are to buy them from potentially sketchy sources or go without. Simply wanting to save money when the efficacy of a needed medical treatment is at stake seems imprudent.

Elmer, the medications are shipped straight from the same factories that supply US pharmacies.

There's an FDA surveillance program that provides monitoring and inspection of pharmaceuticals sold by US pharmacies. Is there a way to be certain that a third world manufacturer that experiences some lot problems (which happens regularly) isn't going to simply reroute their troubled finished products away from the avenues subject to FDA regulation?

My question remains, is the risk and uncertainty of possibly getting medications that do not meet US standards worth the cost savings, when local procurement is affordable though more expensive? It wouldn't be for me.

Elmer -- I'm looking at the box of Rexulti we received from PharmStore. It arrived within a week of our ordering, mailed from a pharmacy in Winnipeg. I'm sure the box, bottle and even the pills themselves *could* be fake, but the box states the manufacturer (Otsuka) in Tokyo and the importer (Otsuka) in Quebec. I will ask our local pharmacy if I can see a container for their supply of Rexulti.

I also think that DH would quickly notice any difference in the effectiveness of the pills.

chisue, any comment about the mention above about the drug shipped directly from Mauritius?