Pharmacydude; Your cousin needs to get a new doctor who will prescribe V off label. That kills two birds, one she will be prescribed the better drug, (highest quality) and two it might just educate the doctor who won't prescribe.
I have a PA here and she was educated properly by her colleague (MD) who attended one of the Cardiovascular conferences Amarin presented at years ago. My PA is 100% in favor of prescribing V for patients. She believes in the science.
But wow, what a price diff! $21 in the US but $34 in Canada - even if that price is loonies that's $27.61 USD - maybe the shipping tariff you mentioned? Note that's the price for 1000 mg EPA for 30 days, need to multiply by 4 to get actual cost to your cousin.