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There could be a variety of reasons

When you go through a clinic and a licensed compounding pharmacy, that chain of custody is built in you're not trusting an anonymous website's claim about what they shipped

Documenting exposure and interpreting intake-related elevation A thorough exposure history can resolve many of these cases on its own

In Canada, provincial and federal governments negotiate drug prices with pharmaceutical companies, which often results in lower costs than the US, where market forces play a more significant role