It’s no secret that countless numbers of people routinely travel to Mexico for cheaper medications and health services. It is especially true in El Paso, where thousands cross the international bridge into Juárez on a daily basis.

Tom Fullerton, a longtime professor of economics and finance at UTEP, has studied this phenomenon known as medical tourism for more than a decade, analyzing price data from both countries.

His studies, part of the University of Texas at El Paso Border Region Modeling Project, have consistently shown that a vast majority of the most popular brand name prescription medications are more affordable in brick-and-mortar pharmacies in Mexico than in the United States.

But can the same be said about online pharmacy prices?

His research says yes — about 40% cheaper. His most recent study further indicates that online pharmacy prices in Mexico adjust quickly as U.S. prices change but still remain more affordable. On average, for every $1 change in U.S. prices, there’s a 46-cent change in Mexican prices, the study shows.

“Medical tourism is alive and well and it’s going to continue to expand and be relevant in the overall economy of the border region,” Fullerton said. “That’s true for brick-and-mortar businesses as it is online.”

Online medical tourism — also known as pharmaceutical e-commerce or virtual medical tourism — has been on the upswing for several years. But experts say e-pharmacies experienced significant growth alongside other online retailers during and since the pandemic.

Rules & regulations

Customers can order medications from Mexico and have them shipped to them in the U.S. if they’re for personal use and don’t exceed 90-day supplies, according to the U.S. Food and Drug Administration.

Although it doesn’t have regulatory powers over prescription medications outside the U.S., the FDA warns buyers that medicines approved outside of the country may have different ingredients that could have harmful interactions or unexpected side effects.

“Additionally, many unsafe pharmacies use fake ‘storefronts’ to make consumers think the medicine comes from countries with equivalent safety standards,” the FDA states on its website.

One Mexican pharmaceutical site, medsmex.com.mx, which was included in Fullerton’s study, indicates that all its products are FDA approved. The site also states there’s no prescription needed to purchase any medicines in its pharmacy and that users agree they’re buying for their personal use.

Officials with the company couldn’t be reached for comment.

“We are simply a resource to be used to acquire medicine at discount prices,” the site states after its disclaimers that it doesn’t have a pharmacist on site, offer medical advice or advise on product dosage or uses.

Shipping fees from medmex.com.mx are listed at about $25 and packages are sent via registered mail within seven to 10 days, the site states.

There are three main reasons why medicines are cheaper in Mexico than the U.S., said David G. Vequist IV, founder and director of the Center for Medical Tourism Research, part of the Liza and Jack Lewis III Institute of the Americas at the University of Incarnate Word in San Antonio.

First, the higher U.S. costs allow pharmaceutical companies to invest in the development of new medicines and to sell the products to developing countries at more affordable costs.

Second, many medications developed across the globe and approved by the U.S. Federal Drug Administration are manufactured in countries like Mexico, which means that the U.S. absorbs the supply-chain costs to get them into U.S. pharmacies.

Thirdly, Vequist said, medicines manufactured in other countries don’t have the same liability concerns as the United States does. In other words, it’s less likely a consumer would sue a Mexican pharmaceutical manufacturer than a U.S. company, which adds those potential liability costs to its prices.

“The pricing dynamics are complicated and fascinating, and I think a lot of consumers don’t realize why,” Vequist said, adding that health care is becoming more global with the use of technology.

Decade of studies

Fullerton’s initial medical pricing study in 2010 looked at 44 brand name medications sold at walk-in pharmacies at Walgreens in El Paso and three Juárez stores: SMart, Farmacias Benavidez and a MediMex catalog.

Fullerton and his colleague Osvaldo Miranda in the “Are Brand Name Medicine Prices Really Lower in Ciudad Juárez?” study quantified what many already knew anecdotally: Customers can find substantial savings for many brand name prescription medicines when bought in Juárez.

For example, at that time, a customer could save more than $1,615 a year if they bought Nexium for acid reflux or ulcers at SMart or Benavides in Juárez compared to an El Paso Walgreens. The savings for Prozac for depression were nearly $1,000 a year, $434 for Crestor for cholesterol and $275 for Zyrtec for allergies.

The study also notes savings in doctor’s visits, as many customers who cross into Juárez for medications also get a consultation in Mexico with either a doctor or a pharmacist without having to have insurance.

“Even with insurance, for many people copayments are high and the cost of medicine in the U.S. is high,” Fullerton said. “So you end up not only with people from the region going to Juárez, but you get people from as far as Canada and a lot of snowbirds from Florida and other regions across the U.S. crossing into Mexico for their medications.”

Those savings ring true with Olaya, an El Paso resident who frequents the Farmalivio pharmacy in Juárez about twice a month.

“It’s cheaper here and aside from that, I don’t need a prescription or to spend on doctors,” Olaya said in Spanish during a recent trip to the pharmacy, adding that she preferred not to give her full name. “Over there, a doctor’s visit costs $300. Here it’s less than $10. That’s a big difference.”

Olaya called the quality of the Mexican medications “excellent,” saying that in just one dose she feels better and her health improves.

“In comparison, in El Paso, the treatment is for seven days and you only kind of feel better. But in reality it doesn’t even cure you and you have to go back for another 15-day treatment,” she said.

Luis Enrique Jimenez Armendariz, a pharmacist at Farmacia Similares on Juárez Avenue, said many of his clients from the United States complain about medical services and costs.

“Aside from being economical here, they also come here for the service,” he said. “We have very good doctors; they’re all licensed.”

Jimenez said he sees customers from across the U.S., as well as from Canada, who typically buy medication for high blood pressure and a few who purchase antibiotics or vitamins.

Farmacias Similares have their own laboratories, he said, which makes them more affordable.

Transitioning to e-pharmacies 

A year after Fullerton’s initial study came out, the drug cartel violence in Juárez became exponentially prevalent and dangerous. Medical tourism — as international tourism in general — practically came to a halt. Pharmaceutical prices in Mexico that used to be much closer to prices in the U.S. dropped in 2011, Fullerton said.

“We found that people migrated online in response to the violence along the border,” Fullerton said.

That led to the 2014 study.

Fullerton and his colleagues — Francisco J. Pallares and Adam G. Walke — published “Are Online Pharmacy Prices Really Lower in Mexico?”

The study looked at sample data for the top 50 selling brand-name prescription medications sold over the internet in the U.S. and in Mexico. The medications included everything from A to Z — Abilify to Zyprexa. Generic medications were not included in the study, and shipping fees and taxes were also excluded.

That study showed that all but 10 of the 50 medications were cheaper in Mexico, and that U.S. consumers could save more than $1,000 annually by buying prescription medicines online from Mexican pharmacies.

For example, a month’s supply of Gleeve, which is used to treat certain types of cancer such as leukemia, cost nearly $2,260 online in the U.S. — and $675 a month from an online provider in Mexico. That was a savings of nearly $1,600 a month.

Buying more standard medications such as Protonix for heartburn or Spiriva for asthma online from Mexico was $186 and $155 cheaper per month than online in the U.S., respectively, the 2014 study shows.

Among those medications with lower U.S. prices were Lantus, the insulin for diabetes. That medication was about $116 cheaper per month from U.S. online suppliers than from Mexican online pharmacies. That could be because of the higher rates of diabetes in Mexico, raising demand and prices, Fullerton said.

Other medications cheaper in the U.S. included Lyrica for epilepsy and fibromyalgia, Lipitor for cholesterol and coronary artery disease, Diovan for hypertension and Cialis for erectile dysfunction.

Cross-border correlation

Last month, Fullerton and his colleague (and son), Steven Fullerton, released an update to the study, “Aggregate Online Brand Name Pharmacy Price Dynamics for the United States and Mexico.”

That looked specifically at how prices evolved over the years and whether online prices for medicines from both countries correlated over time.

“Over the course of the 15-year sample period, internet medicine prices in Mexico are, on average, 40% below the online prices charged in the United States,” the report states.

For example, purchasing a month’s supply of Flomax to treat an enlarged prostate online from a Mexican pharmacy costs about $146 compared to $585 online in the U.S. — a nearly $440 savings. That assumes the patient takes one pill daily.

Assuming a patient takes one pill daily, a month’s supply of Lipitor for cholesterol and coronary artery issues is about $215 cheaper when bought online from a Mexican provider; while a month’s worth of chewable Singulair for asthma is about $288 less.

As in the original online medication study, the prices don’t include shipping fees or taxes.

Unlike other price adjustments in Mexican merchandise when U.S. prices rise — which is typically 30 to 60 days, prior Border Region Modeling Project research has shown — online medicine prices move in a near contemporaneous manner, Fullerton said.

The price fluctuation doesn’t typically work the other way around, which implies that those medicine prices in Mexico respond to the changes in the higher income market, Fullerton said.

Fullerton said that aside from giving consumers information to make buying choices, the studies also provide decision makers at various levels scientifically researched data for policy making.

“Once you understand what’s going on in the markets you can craft policies based on real data,” he said.

Fullerton said his interest in medical tourism was inspired by a toothache: As a UTEP student many years ago, he needed a wisdom tooth pulled. He didn’t have dental insurance.

“My boss at the time said his wife goes to a dentist on Lopez Mateos (Avenue) in Juárez and that I should go,” he recalled. “That was my first experience with cross-border medical tourism.”

Corrie Boudreaux contributed to this report.