Eliquis costs over $600/month in the US. I pay about $20/month for the generic Apixaban, which HAS been approved for use in the US since 2019, however Bristol-Myers has managed to block its availability until at least 2028.

My generic is manufactured by Taro Pharmaceuticals, an Israeli company that has been in existence since 1950. In 2024 Taro merged with Sun Pharmaceuticals, which is the fourth largest generic pharmaceutical company in the world, established in 1983. You need a valid prescription from your US doctor to purchase.

My doctor - cardiologist/electrophysiologist - was skeptical, ie, worried that it might not be legit, so he ordered a blood test. My serum level of Apixaban is exactly in the middle of where it's supposed to be.

I also have numerous friends (in addition to my parents, years ago) who have had great results and have saved a lot of money importing expensive drugs from Canadian pharmacies.

I'm sure there are fly-by-night outfits out there -- you have to do your due diligence - but apparently the FDA, lobbied by Big Pharma, releases these scare stories all the time. Big Pharma has even managed to coerce credit card companies NOT to allow purchases from Canadian pharmacies. Easy enough ... I just set up a second bank account with just enough money to cover my drug costs, and the pharmacy takes payment automatically.

Edited to add: One thing to look for, re: medications ordered from Canada, is certification by the Canadian International Pharmacy Association.

I have epilepsy and I do not trust generics to have the same active ingredient as the brand name. I have been getting my epilepsy drug from an online Canadian pharmacy for over 10 years now. My pills come in the manufacturer's box. I have never had an issue.

I would be more worried about generic manufacturers in general than online pharmacies. The FDA has little to no oversight of overseas generic drug manufacturers.

NOTE: I had always assumed generics were the same, or close enough, to brand name and I never thought twice about taking a generic. Then I started noticing certain generics didn't seem to work the same and I would have side effects I'd never had with brand name. That's when I started digging. I ran across the book "Bottle of Lies" by investigative reporter Katherine Eban. A whistleblower approached her about alarming quality control issues and falsifying records at Ranbaxy, one of the largest generic drug manufacturers in India (at the time).

It should be a national security issue to increase drug manufacturing in the US, IMO. 90% of generics are now manufactured overseas. Quality issues are so alarming that the DOD recently partnered with a private lab, Valisure, to test all generics for the military.

A recent horror story:
https://www.propublica.org/article/glenmark-pharmaceuticals-recalls-fda-oversight

I was fairly confident that this particular generic (Apixaban) would be ok, but I'm still glad that my doc ordered a blood test for confirmation. I've had no side effects, and there has been no change that I'm aware of since I switched from the overpriced brand name drug. It's packaged in the official Sun Pharma Canada bottle.

I think I mentioned that my Canadian pharmacy is certified by the Canadian International Pharmacy Association (CIPA), as well as a similar agency in British Columbia. That, and the excellent interactions I've had with the pharmacy, were very encouraging. My sister is a Canadian citizen, and she was actually on the same generic for a while when she was being treated for a possible DVT. She also had no issues.

I'm going to check out Bottle Of Lies ... thanks for that.

Definitely recommend the book, Bottle of Lies.

I'm sure you're fine with the generic Apixaban since your blood test confirmed it (great that your doctor ordered it). Sounds like you found a generic that works, which is good, and as long as you are able to stick with the same manufacturer you should be fine. My problem is I never found a good generic that I was confident was close enough to not cause me any issues.

Yes, my Canadian Pharmacy is CIPA-certified as well. The difference in cost: US would be almost $1000 for 30 days of brand name, Canada Pharmacy is ~$150 for 90 days worth of brand-name. I mean, it's ridiculous what we pay for pharmaceuticals in US compared to other countries.

of generics forever and that book scared me even more.

Here is an interesting slide deck from a presentation done by Army Colonel Victor Suarez along with Valisure's CEO David Licht on the deeply concerning issues with the quality of generic drugs (76% of recalls are due to quality concerns). The concern is so great that the DOD has partnered with Valisure to do a pilot study of the efficacy, safety, and quality of generic drugs.

They are advocating to change from a model of the "cheapest" manufacturer getting rewarded with purchases to the highest quality manufacturer getting the bid. The way to do this is to have each batch of generic drugs independently tested. Those generic manufacturers that score the highest on quality get the bids. Kaiser already partners with an independent lab to test all generics that their hospitals use.

https://cdn.prod.website-files.com/6215052733f8bb8fea016220/64d11616fb4da9d2ffd7b88a_AHRMM23_Quadruple%20Threat_FINAL.pdf

Yes, Sun Pharma is based in India, but they keep buying out other manufacturers worldwide. In my case, they bought out Taro Pharma, originally an Israeli company, which manufactures generic Apixaban, the active ingredient in Eliquis. My container is labeled 'Taro-Apixaban', manufactured at Sun Pharma Canada, in Brampton, ON. My pharmacy tells me it's a product of Canada, and the shipping route is direct from Canada to the USA, no overseas shipping involved.

Sun Pharma owns a staggering number of drug manufacturing companies worldwide, including facilities in the USA. They have a licensing agreement with Merck, etc, etc. It seems almost impossible to keep track of the drug industry.

Sun and its subsidiaries have received warnings from the FDA at various times, but that could be good in that the regulatory process is working as expected. It seems all of the complaints were resolved. It's on Forbes lists of 'World's Best Regarded Companies' and 'World's Best Employers', and it's won a number of international awards.

there. That freaked me out because your doctor will dump you if you catch an infection from ordering something "illegally".
Fortunately, I finally figured out how to put on false eyelashes.

That is a difference of $50,000 per year. A DOCTOR prescribed it, INSURANCE (United, OF COURSE) won’t cover it, so then what??

But our own government gives us a runaround of scare stories, AND I know that there is SOME danger, perhaps.

The runaround is the FDA and Big Pharma create website (safe.pharmacy) supposedly so you can “check the safety” of online pharmacies. If you type in the website of an online Canadian pharmacy you’ll see a scary warning about it not being recommended. You have to look hard on that website to find out the reality: NO online Canadian pharmacies are in their website — and why is that?

Q: Why is a pharmacy not included in the list of Accredited Healthcare Merchants?
A: Only pharmacies that have achieved NABP’s Healthcare Merchant Accreditation are included on the list.
Q: I am located in the United States. Are there any Canadian pharmacies I should purchase from?
A: Currently, no Canadian pharmacy is licensed in the US. For that reason, no Canadian pharmacy that offers shipping to the US is NABP-accredited.
To protect patients from harm, each US state requires that resident and non-resident pharmacies obtain pharmacy licenses. Without a valid license, it is difficult (if not impossible) for state regulators to directly inspect or investigate claims of patient harm; this is especially true when the activity is coming from outside the regulator’s jurisdiction.

... you don't see Canadians falling over dead by the hundreds, poisoned by ineffective or adulterated medications. I think Canada actually has more stringent regulations than the FDA, not to mention that they work in partnership and cooperate with the FDA.

My sister is actually a Canadian citizen ... started teaching French up there right after college and married a Canadian. She and her family love the health care system (they have never seen a medical bill and I had to explain what a copay is), and they have complete trust in the medications they get from Canadian pharmacies.

My experience with my Canadian pharmacy has been totally professional. They are very thorough ... my first prescription was seized at the border by the US feds (fairly rare), and they sent a replacement prescription by express mail at no charge. They also helped all their customers get through the recent Canadian mail strike with a minimum of disruption.

BTW, the reason my prescription was seized; although the label contained the Rx number and the prescribing physician's name, as well as the Lot number and other information about medication, the container did not contain the exact words "Rx only". Anyhow, no problems since then, and my doc's lab test was spot on. The FDA was required to send me a letter of notification letting me know why it was seized, as well as a statement that I was absolutely not charged with a crime.

This has been such a source of stress, and aggravation.

the others were selling without a license or a script. given most of them are in foreign countries i dont think they care about a license from the US.
maybe if big pharma wasnt cheating americans....

we need a universal healthcare system in the US so that people aren't forced to buy meds from outside the country.