By Clark Howard (Action News 2 WSB TV )

August 29, 2001 -- The fastest growing expense in medicine is the cost of prescription drugs. What can you do about it?

Well, you can take your prescriptions to Canada. Iif you can't get there in person, you can go on the Internet.

With web sites like this one you can order your prescriptions for 30 to 70 percent less than you pay at the drug store.

In Seattle, Washington, seniors board a bus bound for Canada. They're destination: discount prescription drugs. Now, metro Atlantan's can do the same without the bus, thanks to the Internet.

Bill Hall found great deals on the Internet from a company called canadameds.com. "Oh, I was shocked," he said. "I just couldn't believe the difference in prices. I figured something has to be wrong.

No, the price is right. Canadian pharmacies are selling medicines to Americans over the internet. And the savings are huge! 

For example, Vioxx, I pay on average here for 30 tablets, around $85. In canadameds, I pay $26.71 for the same thing. My wife's cholesterol medicine is $141 dollars. It around $85. (For the) same thing." 

So how does it work? All you need is a prescription from your doctor. You, then have to fill out a medical history and waiver form. You fax those forms along with your prescription. Give a credit card number and you're done. Two weeks later you get your medicines.

But you can only order a three-month supply each time, due to U.S. Customs and FDA rules.

"This is what they call free enterprise," said Brian Abrahams. Abrahams, like Bill, saves big buying Candadian medicines. He's creating a non-profit company called Medicines Cheaper.

"I want to help people get their drugs, and not have to worry about paying their rent at the end of the month," Abrahams said. "And I will help them do that at no charge." 

"Without this, we would be having a tough time," said Hall.

The savings mean a lot to Bill. He's retired and on a fixed income.

"I'm saving about $2,800 a year," he said. "You can't beat it by far." 

Why are these prices so low? Because of a good exchange rate between the Canadian and U.S. dollar. And Canada has price controls, and we don't."

By Benedict Carey and Linda Marsas

Law: Patient advocates favor legislation to make cheaper prescriptions from abroad easier to come by, but some worry it would mean attracting counterfeit sellers.

Stephen Arundel, a 50-year-old Minneapolis executive, was paying $350 a month for a drug to treat his chronic colon condition. This spring, he saw a newspaper story about importing drugs over the Internet.

"I'm not a computer guy," he said, "so I told my 14-year-old son to get on the Net and check it out."

The result: Arundel is now paying $140 a month to buy the same drug, Asacol, from an Internet site called Canadameds.com. Drug prices are often lower outside U.S. borders, because other countries apply different price controls. "When I'm running low, all I have to do is go online and hit refill, and a bag of pills comes to my door," he said. The savings are "dramatic"--about $2,500 a year.

If Congress passes a proposal allowing Americans to import legal, FDA-approved prescription drugs through the Internet or by mail-order, the ranks of people like Arundel will swell, lawmakers say. (The House approved a bill last week, and the measure next goes to the Senate, where its fate is uncertain.) According to the most recent estimate by the Food and Drug Administration, in fact, about 2 million parcels containing prescription drugs enter the country every year, ranging from growth hormones and steroids to garden variety medications. 

But while some patient advocates insist that the practice is safe and invaluable to many Americans, others say that the measure, if it becomes law, would open the door to unscrupulous operators. Drug purchases made over the Internet are very difficult to monitor, and the business is virtually unregulated.

"Consumers will be put at risk, because drug re-importation would be a welcome mat for crooks and frauds." said Rep. John Dingell (D-Michigan), ranking member of the House Committee on Energy and Commerce, in a statement released after the House vote. The committee has oversight over interstate commerce and has investigated online pharmacies.

Americans "take drug quality for granted precisely because we are well-regulated," said Lucinda Maine, a spokeswoman for the American Pharmaceutical Assn., a professional group for pharmacists in Washington that has been skeptical of import measures. The vast majority of drugs approved for sale in the United States, purchased from Canada and Western European countries, are safe, advocates say.

"The drugs coming from Canada seem very clean, we haven't heard of any problems," said Frederick Mayer, a pharmacist near San Francisco who runs the Pharmacists Planning Service, a nonprofit group advocating for lower drug prices. "But there are other countries, including Mexico and some Asian countries, which just don't have the same good manufacturing standards that we do here; we worry about sloppiness and about counterfeiting.

" Already, more than 100,000 Americans die each year as a result of adverse drug reactions, according to some estimates, many from U.S.-made products. Mayer thinks the growth of online pharmacies will only increase that number. "A lot of people, especially seniors, just don't know what they're getting," he says. "Sure, we're saving a lot of money, but what we really need to do is talk to a pharmacist about the drugs."

When 2 million bogus birth control pills flooded the U.S. market in the mid-1980s, for example, the pills and the packaging duplicated that of legitimate drug companies. But one product contained so much extra hormone that it caused excessive bleeding, while another had no active ingredient, which resulted in unwanted pregnancies.

The House measure encourages people to deal with legitimate suppliers and include their doctor in the process, to verify prescriptions.

Still, Bush administration officials worry that drug traffickers could camouflage shipments of contraband and escape detection by attaching a phony label to the package. The Food and Drug Administration and the Customs Service, which oversee the importation of pharmaceuticals, don't have the resources to check all of these packages. In a letter to Congress, DEA officials noted that the proposed legislation would place an "undue burden" on these already overtaxed agencies. 

But supporters of the bill said that, for some patients, it may be worth the risk. "This shows the lengths people will go to avoid paying high prices for drugs in this country," said Amanda McClosky, who studies drug pricing issues for Families USA, a Washington-based patient advocacy group. "We think it's important that the proposal in Congress becomes law because, technically, many of these people were illegally" importing the drugs.

While the measure passed easily in the House, 324 to 101, legislative analysts believe it faces a tougher test in the Senate.

But there's no lack of support among many people who are fed up with paying high prices for drugs used to treat their ailments. Karen Bergstrom, a Minneapolis secretary in her 40s, buys stomach medication for her mother over the Internet, also from Canada. "It's about half the cost, and it's very simple to do," she says. "My mom has some drug benefit in her insurance, but it's very confusing for an 83-year-old. It's confusing for me. Doing it online is much easier."

By Mike Norbut

AURORA - Right now, Edward and Alice Oliva spend about $250 a month for prescription medication. With prices constantly on the rise, the drugs aren't getting any cheaper for the Sugar Grove senior citizens.

"They're going up all the time," Edward Oliva said. "We don't see a reason for it, either."
"In fact, we were thinking about driving up to Canada to buy them," Alice Oliva said. If a program suggested by state sen. Chris Lauzen takes root, the couple won't have to make that drive after all.

Lauzen, R-Aurora has established a pilot program for people who feel they pay too much for their medication. The program would allow them to send their prescriptions to a Canadian pharmacy, which many times would be able to fill orders at a markedly reduced rate. "I've read about people taking busloads across to Canada." Lauzen said. "But we're six or eight hours away here, so that's not going to work. Eventually, there's got to be a better way."

The program will start with about 25 participants, how will place their orders through Lauzen's office. Their prescriptions will be faxed to the pharmacy in Canada, and the drugs will then be shipped to Shafer's;s Galena Pharmacy in Aurora.

The program will be open to anyone who has substantial prescription drug bills every month, Lauzen said, although he expects most of the particpants would be seniors. As far as he knows, this type of program is not being tested anywhere else.

Lauzen said they were starting with a small number of people "to shake the bugs out," but, if it were successful, he expected there would be more people willing to help expand it.

"We don't want to create unrealistic expectations right now, "he said. To even think that way is like celebrating before you've won. When no one is trying something like this, it makes you think there must be problems out there.

Lauzen is looking for volunteers to participate. To sign up, call the senator's office at (630) 264-2334.

An initial meeting will be held June 2. Because of the fees attached to the drugs, participants are encouraged to order all the medications they require at one time. 

On paper, the plan looks like a can't-miss opportunity for people who have to pay a lot for their medication out of their own pockets. Federal law allows for the reimportation of drugs - products that are shipped to other countries by American manufacturers and then sold back to American consumers - for personal consumption, provided they are approved by the Food and Drug Administration, Lauzen said.

Many well-known, FDA-approved medications have drastically different prices in the United States and Canada. For example, 90 doses of Actos, a Type II diabetes drug, costs nearly $425 in the Unites States vs. about $290 in Canada, according to a list provided by Lauzen's office. Meanwhile, 90 doses of Casodex, a drug to treat prostate cancer, costs almost $1,000 in the United states, while costing about $420 in Canada. "If we send it across the border and if it comes back, even in its original wrapper, that's great." Lauzen said. "I think that would be ideal."

Canadian law, meanwhile requires a physician to review each patient's case, meaning the concerns some people have about receiving tainted drugs because of an unregulated environment can be eased to some extent, according to Bill Murrin, a Geneva resident and volunteer who has researched the idea for Lauzen.

Even with physician's fees, shipping charges and the pharmacy's dispensing fee, the Canadian prices are substantially cheaper, Lauzen said. "There are restrictions in other countries," Murrin said. "But the view of most people is, let the market economy dictate the price."

Contact Mike Norbut at (630) 844-5829
mnorbut@scn1.com

WASHINGTON, Sept. 8 — Congress is taking steps to allow imports of prescription drugs from Canada, in the hope of giving American consumers access to lower-priced medicines.

The Food and Drug Administration and drug companies oppose the legislation, but many lawmakers said they know of no serious safety hazards with Canadian imports.

"It would be very hard for anyone to make a credible case that there is a risk in importing drugs from Canada," said Senator Byron L. Dorgan, Democrat of North Dakota, who is leading efforts to relax restrictions on such imports.

A law adopted last year allowed pharmacists, drug wholesalers and distributors to import low-priced prescription drugs from 26 countries including Canada, Japan, Israel and members of the European Union.

But the law gave broad discretion to the secretary of health and human services. The Bush administration and the Clinton administration both refused to issue rules to carry out the law. They said they could not certify that the import plan would be safe and would save money for consumers.

In an interview, Mr. Dorgan said, "We are narrowing the bill this year to focus on imports from Canada as a first step."

The broader proposal was included in a spending bill approved last year by votes of 86 to 8 in the Senate and 340 to 175 in the House. A measure dealing just with Canada could pass even more easily, Mr. Dorgan and other lawmakers said.

In July, by a vote of 324 to 101, the House approved a bill that would make it easier for people to import low-cost prescription drugs for their own use. Mr. Dorgan plans to offer his proposal on the Senate floor this month.

Proposals to allow drug imports appeared unexpectedly on the House floor last year without much study or analysis by the committees that usually handle health care legislation.

The idea has attracted serious attention in recent weeks as the federal budget surplus has shrunk, making it more difficult for Congress to add drug benefits to Medicare, the federal health program for the elderly and the disabled.

Senators James M. Jeffords, independent of Vermont, and Debbie Stabenow, Democrat of Michigan, are working closely with Mr. Dorgan to push legislation through the Senate.

Drug costs were one of the top issues in Ms. Stabenow's campaign last year. She organized bus trips to Canada for Michigan voters who wanted to buy prescription drugs at the lower prices available there. Prescription drugs are subject to price controls in Canada, as in many industrial countries.

The bill Mr. Dorgan and his colleagues are drafting, like the one enacted last year, says that imported drugs must comply with all the safety and labeling requirements that apply to drugs made and distributed in the United States. Each batch of imported drugs would have to be tested for purity, to make sure it was not adulterated or misbranded.

Stephen L. Giroux of Middleport, N.Y., a pharmacist who owns three drugstores about 40 miles from the Canadian border, said, "I would be totally confident and comfortable buying products from Canadian suppliers."

At a Senate hearing this week, William K. Hubbard, senior associate commissioner of the Food and Drug Administration, said he "would have a relatively high degree of confidence" in drugs purchased in Canada. But he said that large-scale imports from Canada would pose immense challenges to the F.D.A.

Drug manufacturers and distributors said they now had virtually complete control over the custody of prescription drugs, from the factory floor to the retail pharmacy. But after drugs leave the United States, they said, they could not be sure of the conditions under which the drugs are stored and handled.

Canada has a sophisticated system for regulating drugs. But Mr. Hubbard said he could not give assurances about the safety of products imported from Canada because he did not know how the drug distribution system worked there.

"Once a drug goes into the Canadian market, it's outside F.D.A. jurisdiction," Mr. Hubbard said, adding that "all sorts of malevolent things" could happen to drugs there.

Senator Dorgan said he considers the drug-import bill a tool to "put pressure on drug companies to lower their prices."

Congressional aides who have visited Canada and studied the pharmaceutical market there said it was unrealistic to think that the United States could solve its problems by giving United States consumers access to the Canadian market.

Canada has a population of 31 million, compared with the United States' population of 285 million.

Alan Sager, a professor at the Boston University School of Public Health, said drug makers could try to thwart Mr. Dorgan's bill by limiting the supply of drugs available in Canada for export to the United States.

Drug companies would, in effect, be competing with themselves if they sold large amounts of drugs in Canada, only to see the products shipped to the United States for sale here at discount prices.

Mary R. Grealy, president of the Health Care Leadership Council, a coalition of chief executives from large health care companies, said Canada could become "a trans-shipment point" for counterfeit drugs being sent to the United States from third-world countries. "You don't know where drugs in Canada came from," she said. "They could have been made or stored in third-world countries with no regulation at all."

Federal law says that a prescription drug made in the United States and exported may not be imported to the United States except by the manufacturer. The law, adopted in 1988, sought to end a "gray market" for drugs that were counterfeit, adulterated or too old to be used safely.

The 1988 law, drafted by Representative John D. Dingell, Democrat of Michigan, was widely seen as a consumer protection measure. Congressional investigators had documented many cases in which counterfeit drugs, including birth control pills, had been imported.