A Doctor's Trip: Rosarito's Mexican Pharmaceuticals

Photo:  Mexico/San Diego Border

I just had the opportunity to visit the beautiful city of Rosarito, Mexico a couple of weeks ago, 20 scenic miles south of the U.S. border from San Diego. Over one million visitors come to Rosarito each year, mostly for its beautiful beaches, delicious food, and rich culture. It is one of the most popular “Spring Break” destinations for Southern Californians. It is also the location of one of Fox’s studios, and where the famous movie “Titanic” was filmed off the coast (in the photo above, to the far right).

It is also the location of the legendary Rosarito Beach Hotel, one of Baja’s most famous landmarks. Prior guests include Gregory Peck, Spencer Tracy, Anthony Quinn, Rita Hayworth, and Marilyn Monroe. There is a sign above the foyer entrance that reads “Through this door pass the most beautiful women in the world.” Breakfasts here are a must, and I highly recommend the “Chilaquiles De La Casa” – yum!

Somewhere during my rich Mexican adventure, I met a super neat lady by the name of Raquel, who makes exquisite authentic Mexican hand-painted pillows. She showcases her pillows at a gallery called “Polo’s Gallery” in Rosarito, and her work has been illustrated in local Rosarito magazines. This American entrepreneur also has a pretty neat website at: http://raquelferrerart.com/ . I could not help but bring back a couple of these unforgettable yet affordable souvenirs:

While in Rosarito, I decided to mix a little business with pleasure. Many of my uninsured patients tell me that they go to Mexico to purchase their medications. And many walk into my clinic with medicine containers from Mexico, and I find myself searching the internet to find its equivalent in the Unites States. So, since I was in Mexico myself, I decided to take the opportunity to visit a couple of local pharmacies to see what the hype is all about, and seek answers as to why my patients without insurance who report having trouble affording their medication decide to head to Mexico to purchase their medications. Here is what I found out:

MEDICATION NAME	NUMBER TABLETS	PRICE IN MEXICO (in U.S. Dollars)	PRICE IN UNITED STATES (in U.S. Dollars)
sildenafil (Viagra) 100mg	1 tab, 4 tabs	13.18, 52.75	16.79 per tab
“Maxifort” 50mcg (generic for Viagra in Mexico)	10 tabs, 1 tab, 4 tabs	50.92, 9.73, 27.18	None Available
tadalafil (Cialis) 20mg	1 tab, 4 tabs, 8 tabs	14.00, 53.68, 98.69	17.19
vardenafil (Levitra)	10mg: 1 tab, 4 tabs 20mg:  1 tab, 4 tabs	10.87, 46.44 11.73, 45.79	15.49
tretinoin (Retina-A) Cream	0.05% 40g tube 0.1% 40g tube	16.08 23.84	0.05% 45g tube: 162.17 0.1% 45 g tube: 188.18
“Tocoderm” 0.05% (generic for Retin-A in Mexico)	30g tube	5.91	None Available
“Nograine” 50mg (generic for Imitrex in Mexico)	8 tabs	31.18	Imitrex Brand, 9 tabs:  253.34
finasteride (Propecia) 1mg	28 tabs	63.92	57.55
finasteride (Proscar) 5mg	30 tabs	86.96	106.88
“Filuxa” 5mg (generic for Proscar in Mexico)	30 tabs	50.04	None Available
glargine insulin (Lantus)	100 Units/ml (10ml)	49.04	111.88
fluticasone/salmeterol inhaler (Advair Diskus) 50/500mcg	One Inhaler	48.80	274.97
fluticasone inhaler 250mcg	One Inhaler	24.18	224.97
nicotine patch 21mcg	7 patches	16.59	39.43
nicotine gum 2mg	30 pieces of gum	10.30	14.80

Note: 1 Mexican Peso = 8 U.S. Cents (as of today)

Of note, all controlled substances require a prescription from a federally registered Mexican physician, and those from a U.S. physician are considered illegal. Sentence for possession of an illegally controlled substance runs anywhere from 10 months to 15 years in a Mexican prison. However, a prescription is not required for non-controlled substances.

I realize that the lure of Mexico for many of my patients is for the lower cost of these medications. However, most medications in Mexico are obtained without a prescription. That worries me. Some patients taking these medications go unregulated, without the proper follow-up by a physician. That means that my patients may self-treat their diabetes and hypertension. That is a pretty scary thought. Also, it’s important to remember that the drug formulations in Mexico go essentially unregulated. There have been cases in which the medications sold in Mexican pharmacies have been substandard, and possibly even counterfeit -- studies report one in five medications being as such. That means that the drugs my patients are purchasing there may be completely ineffective. That is too great of a risk to take, in my opinion.

Thankfully, most of the medications I prescribe in the U.S. are on the Wal-Mart and Target “$4 prescription list.” I am still surprised to find that many patients and even physicians still do not know about these lists, which contain medications that are often even cheaper than the equivalents found in Mexico. They are often even cheaper than patient co-pays under many insurance plans. It’s truly unbelievable how extensive this list is; check out the one from Wal-Mart, for instance, at http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf . Like oral terbinafine (Lamisil), which is considered a cosmetic treatment of toenail fungus and is not covered by many insurance plans, is only $4 a month. So is carvedilol (Coreg), used in those with heart failure.

To be honest, I find myself prescribing from these lists about 90% of the time. It’s that extra 10% that I struggle with; for instance, steroid inhalers for asthmatics, triptans for migraine headaches, and erectile dysfunction treatment (although most patients don’t seem to mind paying $10 a pill for Viagra for some reason) do not have generics available in the United States currently. However, some of these pharmaceutical companies that produce these drugs offer “patient assistance programs” that provides the medications for free, if the patient meets income requirements. It’s a little extra work for the physician who needs to complete a form that the pharmaceutical companies send them, and they’ll need to make a phone call every so often to refill the medications for the patients. But if the patient really needs it, it may be an available option to them. The patient can find the application forms for these programs on the individual pharmaceutical company websites.

In general, if my patients’ medications are not FDA approved, I personally do not recommend it as a physician and would rather that my patients obtain the medications from the United States. How do you feel, as a patient or as a prescribing physician?