U.S. patients got medicine cheap in Tijuana. Now they struggle with border delays

As coronavirus restrictions make it more difficult to cross the border, some San Diego-area residents say they are struggling to get the medications they normally purchase at a discount in Tijuana.

Chula Vista resident Liz Salcido has diabetes and regularly purchases her insulin in Tijuana. "Even with the insurance, it's twice as much here in Chula Vista as it is in Tijuana," said Salcido, 52.

Before the pandemic, Salcido would regularly cross the border and purchase her insulin at half the price. With a new baby in the house — her granddaughter — she doesn't want to risk exposing her family to the coronavirus. So she's paying the extra money to purchase the medicine at regular cost at a local pharmacy.

"I'm just being extra cautious because I have this baby here. I have a responsibility to her. I can't be getting her sick because I went to Mexico to get my medications," she said.

Though crossing the border to purchase medications is considered essential by Mexican authorities, longer border waits and concerns over exposure have discouraged southbound trips.

Tijuana has a lower infection rate than San Diego County, but health experts and government officials say a severe lack of testing means the community spread in Tijuana may be up to eight times higher than the official numbers reported daily.

Prescription drug costs can be so much cheaper in Mexico that one Utah health insurer saves money by flying customers to Tijuana to collect their medications. The insurance program saves tens of thousands of dollars a year while paying for each person and a guest to fly round-trip to Tijuana, with enough left over to throw in a $500-per-trip bonus.

Tijuana pharmacist Armando Guzman, 49, said approximately 70 percent of his clientele are U.S. citizens who cross the border to purchase prescription medications they can't afford or access in the United States. He said business is nearly non-existent right now during coronavirus restrictions.

"This insulin pen is $400 in the United States. Here it's $150. No prescription needed," said Guzman.

Patients with type 1 diabetes must take insulin every day to survive. The autoimmune disease prevents the pancreas from making insulin needed to regulate blood-sugar levels. Some type 2 diabetes patients still produce the hormone insulin on their own, but need additional blood-sugar regulation and also use synthetic insulin.

According to the American Diabetes Association, the cost of insulin in the United States nearly tripled between 2002 and 2013, and has continued to grow.

In California, the cost is so high that Gov. Gavin Newsom floated the idea in January of the state producing it under its own prescription drug label to lower prices.

Cost isn't the only reason people cross the border for medicine, Guzman says. Another factor is the amount of time people have to take off work in the United States to go appointments to get their medications prescribed by a doctor. Often the appointments are only available during normal working hours and can take several hours.

In Tijuana, everything from high-dose pain relief to anti-depressants to insulin can be bought without a prescription. Many medical clinics throughout the city offer walk-up access to a doctor without an appointment, and some offer services 24-hours a day.

Physician Jesús Abraham Sánchez Frehem, president of the Colegio Médico de Tijuana, a college that trains health care professionals, said quick medical care that circumvents doctors isn't always an advantage for the patient.

"Unfortunately, it's a societal problem we have here in Mexico that people go to pharmacies before doctors," he said.

Salcido agreed that quick access to medical care, not just the cost of her medication, brings her south of the border.

"I've learned that the medical care is just better over there," she said, referring to Tijuana.

One of her children had a high fever, keeping Salcido from being able to go to work.

"I took her to the doctor three times. They just kept saying: 'Give her Tylenol and she'll be better in a couple days.' But she didn't get better," she said.

After the process went on for weeks, Salcido decided to take her daughter to see a doctor in Tijuana.

"We got right into to a doctor without an appointment, and they gave her one shot of antibiotics, and literally she was better within 30 minutes," said Salcido.

This picture of efficient medical care in Tijuana is seemingly at odds with reports that Mexico's public health care system was on the brink of collapsing at the onslaught of the spread of coronavirus. The answer lies in Mexico's two very different health care systems.

The majority of Mexican citizens receive health care through the government — either through the Social Security Institute, if they are employed, or through Insabi, a public health care system aimed at Mexico's poorest citizens. These public health care systems have struggled for decades with under-staffing, lack of resources and equipment and corruption, even more so in recent years.

It's the country's private hospitals, clinics and pharmacies that provide the health care some argue is better than in the United States.. But that system is often not accessible for a majority of Mexican citizens, who can't afford it.

The pharmacy where Guzman works, located about 200 yards from the U.S.-Mexico border on Avenida de la Amistad, caters to U.S. clientele by keeping well stocked with over-the-counter pain medication, asthma medications and anti-depressants.

"They come here because in the United States, the medicine is very expensive," said Israel Sosa, a pharmacist at a Roma pharmacy, a popular chain in Tijuana.

Sosa said his business had dropped off significantly since border restrictions went into effect on March 20.

"I would say it's down by about 80 to 90 percent," he said. Even as U.S. restrictions have eased, "the Americans have not yet returned," he added.

San Ysidro resident Ernesto Márquez, 47, normally takes medication for his bipolar disorder, high-blood pressure and attention deficit disorder. He hasn't been able to get most of his medicine since the county's stay-at-home recommendations went into place.

His blood-pressure medicine, which he needs to prevent complications if he were infected by the coronavirus, costs more than three times more on the U.S. side of the border than in Tijuana.

"The difference in price is absurd," he said.

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