Up-front disclaimer: I work for a pharma company.

Even though Canada, etc. will try to break patents (actually easier than reverse-engineering; Drug Master Files, I believe, are held by the FDA and public) the product can still be dodgy. There are some drugs that even though they are considered equivalent, do not act that way in real patients.

p.s. I need to ask someone in Regulatory about the public/private status of DMFs.

In (strictly) my opinion, there is a lot of waste and "drag" in the American health care system. E-records coupled with HIPAA can lead to a whole load of unintended consequences. Here's a real-world example of how this can blow up:

Records in Pharma used to be strictly kept on paper; output from computers would be signed and dated and go into the permanent record. Someone had the bright idea to enable "electronic signatures" and this led to an invention of the devil called "21CFR Part 11". This rule, in existence for about 10 years or so, has probably cost my industry billions of dollars.

Caveat emptor!!