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Big numbers, but big problems. For starters, the CMAJ Canada-foreign gap looks extremely high compared with other studies. The Patent Medicines Prices Review Board reported last year that the difference in generic prices between Canadian and foreign markets was more like 19 per cent in 2014, and heading lower as generic prices continue to fall.

Any international price comparisons are bound to take us deep into a pharmaceutical jungle where thousands of drugs are sold by hundreds of companies to billions of people and institutions around the world. Take New Zealand, which the CMAJ study finds has drug prices that are 84 per cent below Canada’s prices. New Zealand is a unitary state with one level of government, a tiny population of 4.5 million, and no local pharmaceutical industry. All drugs are imported.

We’ve got monopolies on liquor, electricity, transit… now they want to add medicine

The CMAJ study compared prices of 51 drugs on New Zealand’s official drug formulary. Prices look very low in New Zealand, although no details were provided as to why or how the price gap could be so huge. Could it be that the international drug companies use New Zealand as a fringe market where products are dumped?

The study also did not mention New Zealand’s persistent problems with shortages of prescription drugs in a system that uses tenders to grant drug makers supply monopolies.

The claim that Sweden’s drug costs were 60-per-cent lower was based on a comparison of 28 drugs, although in 12 of the comparisons Swedish prices were higher or about identical. The CMAJ study, in other words, extrapolated billions in savings on the basis of lower prices on 16 drugs on Sweden’s universal list imposed on a country whose health care system is notorious for some of the world’s longest health care waiting lists and unavailable doctors.