Investigation by Minnesota Pharmacy Board Finds Problems With Some Canadian Mail-Order Prescription Services

Two inspectors from the Minnesota Board of Pharmacy have found that although some Canadian mail-order pharmacies meet U.S. standards, others have "lapses in proper controls" that could lead to medication errors, according to an internal state report, the Wall Street Journal reports. Minnesota conducted a week-long inspection of eight Canadian pharmacies to help determine which pharmacies should appear on the state's reimportation Web site (Middleton, Wall Street Journal, 2/12). Minnesota Rx Connect Online, which the state launched last week, lists the prices for 829 brand-name and generic medications and phone, mail and e-mail contact information for the two state-approved Canadian pharmacies -- Total Care Pharmacy of Calgary and Granville Pharmacy of Vancouver. Minnesota residents must fax or mail a prescription for as much as a three-month supply of their medications, medical history forms and order forms from one of the state-approved pharmacies. The pharmacies must have a Canadian-licensed physician review the information submitted by state residents and write new prescriptions before they ship the medications (Kaiser Daily Health Policy Report, 2/11). David Holmstrom, executive director of the state board of pharmacy, said that the two Canadian pharmacies listed on the Web Site "probably are as good or better than Minnesota pharmacies," adding that Total Care "far surpassed the other seven pharmacies" inspected. However, four of the pharmacies inspected "would not currently provide acceptable pharmacy services to Minnesota residents," according to state inspectors Michele Mattila and Stuart Vandenberg. Problems identified included lack of proper supervision of pharmacy technicians; failure to obtain complete medical histories from patients, such as past allergic reactions to medications; failure to use child-resistant safety caps on prescription drug containers; shipment of generic medications not approved for sale in the United States; and shipment of medications sold over-the-counter in Canada but available only by prescription in the United States.

Reaction
Kevin Goodno, commissioner of the state Department of Human Services, said that the problems found in the inspection "reinforced for us how important it was that Minnesota found safe, reputable firms for our citizens." Holmstrom said that the state board of pharmacy may move to license the Canadian pharmacies that appear on the Web site to ensure that inspectors have "complete access for thorough annual inspections," but the move would require a change in Minnesota law, the Minneapolis Star Tribune reports. Goodno said that he will expand the Web site to include information to help consumers select Canadian pharmacies and avoid the problems found in the inspection. Holmstrom also said that the approval of the two Canadian pharmacies on the Web site "is somewhat provisional," adding, "We did not have unannounced visits, and we did not have complete access to all records and personnel" (Wolfe, Minneapolis Star Tribune, 2/12). Tom McGinnis, director of pharmacy affairs for FDA, said that the results of the inspection raise concern "because, like the state's inspectors, the average consumer buying from a Canadian pharmacy can stumble into a wide range of service," according to the Journal. Andy Troszok, vice president of the Canadian International Pharmacy Association, asked FDA to conduct a similar inspection to "verify pharmacies do a good job," the Journal reports (Wall Street Journal, 2/12).