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Patients turn to Canadian Web sites for cheaper drugs
© St. Petersburg Times When his insurance stopped covering prescription drugs, Robert Bayne of Brandon was shocked at how steep his out-of-pocket costs would suddenly become. Lipitor, a cholesterol drug for which insurance had paid all but a few dollars, would now cost him almost $95 a month. Actos, for diabetes, would run nearly $150 a month. So Bayne started buying by mail from Canada, through an Internet company called the Canadian Drugstore Inc. Bayne estimates he pays 40 percent less for the two drugs -- saving hundreds of dollars a year -- compared to the cost in the United States. "I'm very pleased," said Bayne, 67. "I just wish they had a bigger selection." Ontario regulators don't share his enthusiasm. Last week, the Ontario College of Pharmacists said it has filed numerous charges against the Toronto company and its president for allegedly operating an unaccredited pharmacy. And the action could be just the start of a crackdown on similar Internet sites aimed at U.S. customers, many of them senior citizens unable or unwilling to pay sky-high drug prices at home. "This is of great concern to us," said Layne Verbeek, spokesman for the college that regulates pharmacists in Canada's largest province. "I don't believe this is the last time we'll issue charges for an illegal pharmacy Web site operation." Also named in the charges, which carry hefty fines and jail time, are a doctor, a pharmacist and a wholesale drug company. Since the Ontario charges were filed, the Canadian Drugstore has shifted some of its operations to British Columbia, and president Billy Shawn vows to remain in business. "We really help Americans and we provide a valuable service," he said. "We were the first to do this, and if you talk to any of our customers you'll find out what a difference we've made in their lives." Shawn said he had been advised not to discuss specifics, but called the college's action "a classic example of shotgun charging. You throw a bunch of stuff up on the wall and see if it sticks." As Congress struggles to rein in high prescription drug costs, Americans have increasingly turned to other countries for affordable medications. A favorite is Canada, where many common drugs like Prozac and Celebrex are far cheaper because of price controls and limits on advertising. Americans living close to Canada can simply drive across the border to get their medications. Those farther away can buy from Internet sites that have sprung up in the past two years, despite questions on both sides of the border about the safety and legality of such transactions. "We're the first to lay charges but I believe it's a concern of all regulators," Verbeek said. "We all exist for the same function -- to protect the public." Canada forbids the sale of prescription drugs unless prescribed by a Canadian-licensed physician and filled by a registered pharmacist in an accredited pharmacy. To meet these requirements, the Internet sites typically ask a customer to fill out a "health profile," listing conditions and medications, and to fax in a copy of a prescription signed by a U.S. doctor. The information is reviewed by a Canadian doctor, who writes a new prescription for the medication. The drugs are usually shipped in a week to 10 days. According to the charges, the Canadian Drugstore Inc. is not licensed and has "unlawfully" dispensed drugs without a pharmacist's personal supervision. "The reason we have trained pharmacists is to ask what you are taking to make sure the dosage is correct, and to ask what side effects you may be having," Verbeek said. "It's not uncommon for a physician to write down the wrong dosage -- pharmacists daily correct typos. They're the quality control." Among those named in the charges are Stephen Bederman, a registered pharmacist, and Stanley Gore, a licensed physician. Both are accused of unlawfully helping supply medications to U.S. residents. Neither answered calls seeking comment: Gore's voice mail is the same as that for a Toronto hair transplant center. Shawn, whose own background is in marketing, said his 18-month-old company "is the gold standard of the industry" and puts patients' safety first. However, he acknowledged that the company had shipped drugs outside of Canada despite an Ontario law that forbids such a practice. "At the end of the day we'll probably be fined $10,000 for the small regulatory (violation) of shipping out of here," he said from his Ontario base. "That is where the college took issue." Shawn said the company now ships drugs from a British Columbia pharmacy. Regulators have been working closely with the store, in suburban Vancouver, to make sure it complies with the law. "We require a dialog between the pharmacist and patient for every prescription that is dispensed," said Linda Lytle, registrar of the College of Pharmacists of British Columbia. "We're essentially saying that they need to call each patient each time they dispense a prescription." The college also is helping devise an identification system to make sure the mail-order drugs are going to the person for whom they were prescribed. Lytle said a patient tends to benefit more from a "face-to-face personal relationship" with a pharmacist because the pharmacist can often detect problems that might otherwise be missed. "But there's no fundamental reason why a telephone relationship wouldn't be adequate," she said. "It depends a lot on the complexity of the patient's medication." While drugs shipped from licensed Canadian pharmacies are as safe as those sold in the United States, Lytle said, customers should be wary of other aspects of Internet transactions. "If I were a patient dealing with a Web site, I'd want to know the exact name of the pharmacy dealing with that Web site and where it's located," Lytle said. "And if I were really diligent I would contact the province's regulatory agency to find out if it's licensed. "If it were me, I'd also want to know how my personal information was being stored and who had access to it. We've heard of some situations where information ends up with a courier-type person who brings it into the pharmacy as though he were an agent of the patient. I wonder if patients know how those things are being managed." Back in Florida, Bayne said he has had no problems buying over the Internet and plans to keep ordering from the Canadian Drugstore. But he wishes Congress could find some way to lower prescription drug prices in this country so he and millions of other Americans could afford the medications they need. "I have nothing against Canada," he said. "But I'd really prefer to do business with people in my own country and in my own state, if possible." -- Susan Taylor Martin can be contacted at susan@sptimes.com.
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