I am in the Pharmaceutical industry, so understand that I have some biases here. First of all, the current cheap drugs from Canada option will not last much longer, at least in connection with branded, non-generic drugs which are still on patent (which are the ones which are most expensive anyway.) The reason is that the Canadian market is smaller than the market for the New York City metropolitan area, and drug companies are not going to screw up their entire price structure in the US by selling drugs cheap into Canada for resale into the US. They are already tightening up supply to Canada, and new drugs will likely not even get approved in Canada or be for sale in Canada. (Why go to the trouble to gain approval and market the drug there if it's just going to screw up your most lucrative market.) The reason that drugs in the US are more expensive than drugs overseas, is that generally speaking, the price for drugs overseas is negotiated with a regulatory arm of a foreign government. If you want approval to sell your drug in their markets, you have to negotiate a price in advance with their national health care system. Almost always, this price is going to be lower than the free-market price that one can get in the US. Typically, US drug companies have been willing to accept the lower margins outside of the US, because it didn't affect their higher margins in the US. There are some exceptions, however. Most notably, Bristol Myers told the Japanese to stuff it, when the Japanese health ministry low-balled them on the pricing for Bristol's anti-cancer drug, Taxol. The result is that the Japanese didn't have access to Taxol for more than a year, until consumer demand finally forced the Japanese government to offer BMS a more reasonable price. As to whether or not Amercian consumers are getting gouged, I would argue that they both are and are not. In general, high drug prices reflect the huge investments, long lead times, and very high risks associated with drug development. For every blockbuster drug that makes tons of money, there are 20 or 30 that never make it, where literally hundreds of millions of dollars (for each one) in development costs go down the drain. The politicians love to point out that a drug which costs $1 to manufacture is being sold for $20. They don't focus on the fact that manufacturing costs are almost irrelevant in the drug industry, and the the real cost of doing business is in development. They also don't like to focus on the fact that drug costs are a tiny percentage of health care costs in the US. Where Americans are getting screwed is that the American consumer is footing the lion's share of the bill for development, while Europeans and Japanese, and others are getting a ride on the coat-tails of the Americans. This is fundamentally unfair. What needs to happen, is that pharmaceutical companies need to level out their pricing world wide. Charge the Europeans, Canadians, and Japanese more, and the Amereicans less. That would be fair, and I believe it will be the ultimate, long term result. It will be slow in coming however. It will take some pharma company executives with balls and a blockbuster drug to be able to force such a change. As for safety, assuming that the pharmacy is not inept, fraudulant, and that the drug has been handled correctly in shipping, drugs from Canada and Europe should be just as safe as those purchased in the US. The problem isn't in the drugs, but in the distribution chain. If the source is reliable, the drugs should also be reliable. The problem is that you can't necessarily judge the reliability of some internet pharmacies. Do you really want to wonder about whether or not your drugs are really cheap because they are out of date? Just my 3 cents.