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Prescription for drug prices: Canada?
By WES ALLISON, Times Staff Writer Verna and Ray Briggs, retirees who spend $200 a month on prescriptions, thought the offer sounded too good to be true, let alone legal: buy their medication at a fraction of the cost from a pharmacy in Canada and have it mailed right to their home in Brooksville. They have good reason to wonder. For several years, Americans have been driving across the border to buy prescription drugs at much lower Canadian prices. Recently, however, Canadian drugstores have begun marketing mail-order drugs directly, offering anyone in the United States with a valid prescription a chance to benefit from Canadian price controls. The target audience is senior citizens who take expensive maintenance drugs each month, and people across the Tampa Bay area have raised questions after seeing ads for such pharmacies in fliers, magazines and newspapers. "We just wondered if it was on the up and up. It sounded too good to be true," Mrs. Briggs said after seeing an ad in the Elks magazine for a guide to Canadian pharmacies that discount up to 84 percent off U.S. prices. "It just didn't seem possible." It is possible, and Canadian pharmacies say it has become quite popular. But it's not entirely on the up and up, either: Federal regulators say it's illegal to import prescription drugs because the government cannot guarantee their safety. Customers who order through the mail also risk having their drugs confiscated by U.S. customs agents, and some also have received letters from the U.S. Food and Drug Administration warning they may have broken the law, spokespeople for the FDA and U.S. Customs Service say. However, any real crackdown appears unlikely because it would be politically unpopular, and the trade seems to be flourishing more or less unfettered. Some members of Congress even encourage it. Rep. Gil Gutknecht, R-Minn., says the current restrictions are unfair, especially since some Americans can scarcely afford their medicine, and he says the FDA has little cause to enforce them. Last year, he sponsored an amendment that would have allowed Americans to buy drugs from abroad. It died in the Senate. He and other advocates of importing drugs complain Congress has been unable, or unwilling, to provide either price caps on prescription drugs, as is done in Canada and Western Europe, or a prescription benefit for Medicare, the federal insurance program for the elderly. So seniors and the free market are discovering their own solutions. "All of a sudden, people are realizing that we live in a global market, and major suppliers are just a double click away," Gutknecht said. Rep. Tom Allen, D-Maine, includes links to several Canadian pharmacies on his congressional Web site. "It's like Prohibition. Here you have people desperate for affordable drugs. Is the FDA going to check every package?" Allen said. "Basically, what we would tell people is to try this system. That other people have tried it, and it's worked, and see what happens." The idea for Billy Shawn's business venture was hatched as he watched a TV report of Americans taking bus trips from the Pacific Northwest to British Columbia to buy medicine. Most were saving 25 to 80 percent on 90-day supplies of pills for high blood pressure, high cholesterol, diabetes, acid indigestion and other chronic conditions. Canada has a federal health care system, and medication is less expensive largely because the government negotiates lower prices with drug companies. Similar excursions have become popular in states bordering Mexico, which also has less expensive drugs than in the United States. "I thought, what about the people in Kentucky? What about the people in Oklahoma?" Shawn said. So he opened the Canadian Drugstore in Ontario and began taking orders from Americans via phone, fax and the Internet. Just 15 months later, his staff has grown from two to 38, and he says his clients, mostly seniors, live throughout the United States. The Customs Service and the FDA did stop and hold several early shipments, but the agencies eventually released them, he said. That's the last he has heard from U.S. regulators, he said. "They know who we are, obviously. We are a responsible party. We're not guys selling Viagra out of the back of a truck," Shawn said. "If someone would tell us that we're not in compliance with the exact letter of the law, we are certainly in compliance with the spirit of it." Here's how it works at most Canadian pharmacies selling to U.S. citizens, including the Canadian Drugstore, www.canadarx.net, www.rxnorth.com and others: You or your doctor fax or mail your prescription and fill out a basic health questionnaire. A Canadian doctor paid by the pharmacy reviews the information, then writes a Canadian prescription for the same medication and dose. The pharmacy mails you a three-month supply, and refills generally can be handled over the phone. Pharmacies will not ship narcotics or sedatives. Advocates of the system say it's no different than taking organized bus trips from border states, which are legal. But the law does not address mailed drugs, and the FDA has declared the practice off-limits. Kevin Bell, a spokesman for the Customs Service in Washington, said the FDA recently asked customs agents to confiscate drugs sent from abroad. But neither agency keeps records of such seizures, and Canadian pharmacies say their orders are reaching customers. Gutknecht and Allen, the congressmen, say they have heard scattered reports of medication being seized, or of citizens who received warning letters from the FDA, but they know of no arrests. "My own opinion is the FDA understands they're on very thin legal ground," Gutknecht said. "I'm sort of chafing to find a case to get the FDA to come down on, to force this issue into a court." Gutknecht's proposal would have allowed Americans to buy medication from Canada and other industrialized nations where drugs are cheaper, provided they had a valid U.S. prescription. It breezed through the House in July by a vote of 324-101, but in December the Senate version died without a vote. Opponents, including the FDA and drug companies, contended there's no way to prevent tampering while drugs are in another country. And, they warned, Canada could become an entry point for lesser-quality drugs seeking access to the U.S. market. "Nobody wants to see Grandma and Grandpa cuffed in the back of a squad car, but no one wants to see them injured because they bought drugs that weren't safe," said Anne Esposito, health policy coordinator of the House Energy and Commerce Committee. Esposito works for U.S. Rep. Mike Bilirakis, R-Tarpon Springs, chairman of the committee's Health Subcommittee, who voted against Gutknecht's proposal, citing safety concerns. "I buy a purse off the street. Is it really a Fendi?" she asked. Joe McMorrow, 75, of New Port Richey, called Bilirakis' office after seeing ads for the Consumer's Pharmacy Guide, which offers tips and contact numbers for buying drugs from Canada via mail, phone or in person. The ad, which ran in Parade, USA Weekly and other newspapers and magazines, including the St. Petersburg Times, boasted savings of up to 84 percent and said the practice was legal. Bilirakis' office warned him the law was murky, and "that you cannot guarantee that (the drugs) are not counterfeit. That's the hairy part," said McMorrow, who along with his wife spends $3,000 a year on prescription drugs. "I don't know. I'm thinking. I might consider doing it, yes, if it isn't a hassle." Not even the most staunch supporters of legalizing drug importation from Canada believe it's a realistic, long-term solution to the inability of many older Americans to afford medication. That will take price controls, which are unlikely, or a prescription drug benefit for Medicare, lawmakers say. With the federal budget surplus having been lost to the war on terrorism and a sagging economy, however, that's not likely this year. In the meantime, Gutknecht and supporters in the Senate, led by Sen. Byron Dorgan, D-N.D., again plan to ask their colleagues to allow Americans to purchase drugs from Canada. "We're always hopeful" about a prescription drug benefit, Barry Piatt, a spokesman for Dorgan, said Friday. "But this is certainly a good stop-gap." Risks to considerFor people considering ordering prescription drugs from a pharmacy in Canada, here are some things to consider, aside from the risk of having them confiscated: Just as people can misrepresent themselves on the Internet, so can businesses. A pharmacy that says it's in Canada might not be, and it's a good idea to check them out. Each Canadian province has a regulatory body, called a college of pharmacists, that licenses pharmacies. Those pharmacies should be licensed. Jackie Cottrell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, which opposes drug importation, said there have been reported cases of pharmacies in countries with less stringent safety requirements sending bad medicine to U.S. consumers. Patients often make mistakes when they send medical information to mail-order or online pharmacies, especially about the dose and types of medications they are taking already. These errors can lead to dangerous drug interactions. "These Internet pharmacies, where someone is just sending up a form, there's more room for error than if someone is actually seeing the patient," said Dr. John Erb, a physician in Edmonds, Wash., who is licensed in both the United States and Canada. His business, Cross Border Rx Service, specializes in writing Canadian prescriptions for Americans who want to get their drugs in Canada, but he insists on seeing each patient. Not all drugs are less expensive in Canada, especially some generic versions, said Billy Shawn, president of The Canadian Drugstore, which sells to U.S. citizens. Erb said markups vary, and some pharmacies charge more to Americans than to Canadians. It's a good idea to shop around.
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