Among the recent laws changed at the federal level in Mexico, few have direct consequences over American visitors, but one in particular has impacted medical tourism to Tijuana, that have many cross-border travelers surprised that they can no longer buy some medication that was once readily available.

    Until now, consumers in Mexico had no restriction in order to buy antibiotics at a local pharmacy but the law has changed and it now requires a medical prescription to buy this kind of medication.

    Self-medication is fairly common in Mexico and the measure seeks to curve the irresponsible use of antibiotics, and halt the rapidly growing number of microorganisms that have antibiotic-resistant strains.

    The law took effect August 25th but pharmacies had a 2 month grace period in order to complete staff training. After October 4th Drug Safety Administration agents are closely monitoring pharmacies for full compliance.

    The law took effect almost simultaneously to the anti-money laundering law, one that prohibits the use of US currency in the payment of public services and utilities and changes the conditions for stores and store owners to accept payment in US currency or hold a bank account.

    This created confusion for many border residents; many cross-border visitors thought they no longer could buy any type of medication in Mexico and that their US currency would not be accepted at all.

    The confusion led to a 50% drop in medication sales all across the more than 2 thousand pharmacies around Tijuana, according to Tijuana Chamber of Commerce vice-president, Julián Palombo Saucedo.

    Many business associations decided to create an information campaign with billbords at the border and by posting “We accept your dollars” signs on their store fronts.

    The Drug Safety Administration has published a list of medications that are sold either over the counter or need a prescription (http://www.cofepris.gob.mx/).

    The head of Drug Safety, Ricardo Zamarrón has made it clear US nationals are free to buy medication in Mexico, but need to have the proper prescription given by a doctor with a license in Mexico.

    Prescriptions should be clearly made out to the patient and include the doctor’s license number and office phone. The prescriptions will be asked for by the pharmacy technician and are kept as proof after the sale is done.

    Therefore, US customers should ask their Mexican doctors to give them two copies of the prescription; one kept by the Mexican pharmacy and another to show CBP officers at the border if needed upon their return to the US.

    Dr. Jesús Cornejo Rincón is a pediatrician and current president of the Tijuana Medical Association. He recommends US patients visit the Association website for a list of certified doctors (http://www.cometi.org/) and to make sure to ask the doctor for two copies of the prescription.

    “By doing that you can lower the risk of encountering unethical doctors, because we are in charge of making sure doctors listed with us adhere to the highest ethical standards” Cornejo said.

    “Visitors also have to remind the doctor to give them two copies of the prescription, so they don’t have any trouble at the border when going back, because the pharmacy is going to keep a copy of the prescription as proof of sale in case of an audit” he added.

Legal loopholes

    Pharmacies in Mexico have been quick to respond to this potential revenue loss and have resorted to a practice that is not yet illegal but has been questioned and labeled as an unethical use of medical services by the medical community in Tijuana.

    Under current law, a doctor or pharmacy technician cannot give out a prescription over the pharmacy counter —because it is a business not a medical office—. But the law has been bypassed by medical offices owned and operated by pharmacies and opened right next door.

    There, pharmacy employed doctors offer an inexpensive and sometimes free consultation.

    Pharmacy chains have adopted this strategy, first developed by the discount pharmacy chain “Similiares”, where almost every single location has a doctor’s office next to it.

    In many cases, “Similares” have been fined after authorities have found alleged doctors are just pharmacy technicians illegally signing prescriptions.

    But such cases have not stopped “La más barata”, “Farmacias Nacional” and “Farmacias Soriana” from following their lead and create their own doctor offices.

    Pharmacy representatives have long argued they are not breaking the law, but rather giving access to medical attention to working families with a tight budget that otherwise might have to wait for weeks in order to get a doctor’s appointment at a public hospital.

   Even Zamarrón, agrees pharmacies are not breaking the law, as long as the patient is not required to buy the medication at the pharmacy next door.

   But for Dr. Cornejo this is done at a clear risk to patients, because the doctors hired by the pharmacy have a clear conflict of interest.

   “Those doctors are clearly pharmacy employees, young, recent graduates affected by the high unemployment rate, who are basically paid for their signature in order to give the public what they want but not necessarily what they need” Cornejo explained.

   Cornejo said he is not the only one who is worried about this growing practice that could easily cancel all the expected benefits of the new drug regulation. The Medical Association is already working at the state and national levels, pressuring the federal government into passing tighter legislation that would end the pharmacy-doctor duo.

   “What I would recommend for US patients is for them to go to a trusted, recommended doctor: patient-doctor relationship is very important in healthcare and it should not be interrupted by pharmacies, owners have other interests besides the patient’s health” said Cornejo.