Abstract
OBJECTIVE: Few data are available about how personal prescription drug importation behavior has changed over time in tandem with increases in the U.S. prices of many medications, or how importation has varied over time as a function of access to licensed prescribers. The study objective was to examine trends in personal drug importation by U.S. adults over time and assess these trends stratified by access to a provider. METHODS: This cross-sectional study used data from the 2011-2018 National Health Interview Survey on adults aged 18 years or older. Using procedures that accounted for the complex survey design, linear trends in the prevalence of importation were assessed using linear regression models fit with ordinary least squares. Prevalence ratios with 95% CIs comparing other survey years with 2015 were estimated using log-binomial regression models. RESULTS: Between 2011 and 2015, the percentage of U.S. adults importing medications from foreign countries decreased from 1.91% to 1.28%, an average decrease of 0.19% per year (95% CI 0.14-0.24, P < 0.001). However, in 2016, the percentage of adults importing medications increased to 1.49%. The percentage remained stable in 2017 at 1.50% and then increased slightly to 1.57% in 2018. Compared with 2015, the prevalence ratio for importation was 1.50 (95% CI 1.31-1.73, P < 0.001) in 2011, 1.17 (95% CI 0.96-1.42, P = 0.12) in 2016, and 1.23 (95% CI 1.01-1.50, P = 0.05) in 2018. Individuals who had difficulty finding a licensed prescriber were consistently more likely to import medications than those who had no difficulty across all years, with no marked difference in trend by prescriber access. CONCLUSION: The importation of medication and its relationship to provider access should continue to merit the attention of legislators, clinicians, and researchers.