May 24, 2010
Arkansas Democratic-Gazette
8,000 Arkansans ignore U.S. law, buy neighbor's cheaper online prescriptions.
WASHINGTON - When Keith Nelson began living on a fixed income as a retiree in Hot Springs Village, he instituted a few lifestyle changes to make every penny count.
"I had to get street-smart", he explained.
To cut down on the monthly expense of prescription drugs that most older Americans face, the former factory manager turned to the Internet - and quickly found he could buy his medicine cheaper online from Canadian pharmacies.
The practice is not uncommon, but it is illegal. A million Americans are doing it anyway.
"I do it for money," Nelson said succinctly.
When Nelson compared prices for some of the medications he or his wife, Susan, need, he said, the decision was "a no-brainer."
The Nelsons - he's 74, she's 77 - have Medicare as well as supplemental insurance. But that doesn't cover all their medication costs, so they pay that out of their own pockets.
They purchase their medicine from CanadaDrugs.com, a pharmacy affiliated with the Canadian International Pharmacy Association, or CIPA, whose member pharmacies currently ship 25,000 packages of medications a year to 8,000 customers in Arkansas.
CIPA is a national association of more than a dozen licensed retail pharmacies in Canada, said the group's general manager, Tim Smith, who is based in Winnipeg, Manitoba.
The association formed in 2002, Smith said, to provide medication to people in situations like the Nelsons'.
Retail pharmacies in Canada, he said, realized there was "significant need in the United States where many elderly residents on fixed incomes were not able to afford the medications that they need for their various health conditions, and of course, also recognizing that [there] are millions of uninsured people in the United States."
The pharmacies affiliated with the association distribute about 3.2 million packages of medications a year with a value of about $500 million to more than 1 million U.S. patients, Smith said.
Those drugs, from the same manufacturers with the same name barnds, come at prices the association says are up to 80 percent lower than in the United States. That's possible because the Canadian government, like many industrialized nations, negotiates pharmaceutical prices on behalf of its citizens.
"There's no comparison," Nelson said.
ENFORCEMENT DISCRETION
But there is that catch. The practice is illegal, according to Sandy Walsh, a spokeman for the federal Food and Drug Administration, although it rarely is enforced when it comes to an individual who purchases medications for personal use.
"Purchasing drugs online from other countries is illegal; however, the FDA has said that it will use enforcement discretion regarding importation of certain drugs under our personal importation policy," Walsh said in an e-mail.
The FDA's guidelines outline specific circumstances when the agency "should consider not taking enforcement actions against importation," and those who mail-order prescriptions for their own use would generally meet these criteria.
The FDA recommends that Americans who buy medications online use state-licensed pharmacies that are located in the United States and that require prescription. But the agency acknowledges that "a growing number" of Americans are obtaining medications from foreign locations, including Canada.
"The FDA cannot ensure the safety of drugs bought from these sources," Walsh said. "The FDA is very concerned about the safety risks associated with the importation of prescription drugs from foreign countries. Those drugs can be fake, tainted, expired, etc. As well, drugs from other countries will not have the FDA-approved label."
But that's a risk that Nelson and the other million Americans are willing to take. Nelson is an informed consumer, he said, who has done the research and knows where his medications are manufactured. "I don't have a problem with it," he said.
CIPA lists numerous written prescautions on its website, www.ciparx.ca, to reduce risks, Smith said.
The Canadian government licenses and regulates each member pharmacy, the association encourages American customers to verify the pharmacy before ordering a prescription, and the customer must provide a written prescription for the medications.
LEGISLATION LANGUISHING
Allowing importation of medications from Canada has been discussed for years in Washington. The concept had support last year from the White House. In his 2010 budget proposal, President Barack Obama proposed allowing Americans to import prescription drugs from foreign countries.
But when Congress passed the health-care overhaul earlier this year, it specifically omitted such a proposal - a point which drew the ire of 1st District Rep. Marion Berry, a Democrat, and factored into his decision to oppose the legislation.
Berry, the only licensed pharmacist in congress, once took a group of friends from Arkansas to Maine, where they made a three-day trip to Canada to buy a three-month supply of medications - a practice that is legal.
"We bought our medicine that we were all taking at that time," he said, "and, gosh, we saved enough to pay for the trip - and that's from Arkansas to Bangor, Maine."
Berry has sponsored legislation throughout his seven terms in the House that would legalize the importation of medications. His most recent effort was the Pharmaceutical Market Access and Drug Safety Act of 2009, which he introduced along with Republican Rep. Jo Ann Emerson of Missouri. It drew 35 bipartisan co-sponsors.
A companion bill was introduced on the Senate side that year by Democrat Byron Dorgan of North Dakota and Republican Olympia Snowe of Maine, which drew 29 bi-partisan co-sponsors ranging from Democratic Sen. Blanche Lincoln of Arkansas to Republican Sen. John McCain of Arizona.
But neither bill made it out of committee.
When Berry introduced his own version of a health-care overhaul bill earlier this year, a key element was the legal importation of medications by Americans - individuals as well as pharmacies and wholesalers, who could offer the lower-cost prescriptions to their customers.
Currently, Congress is not considering similar proposals, although Dorgan has said he would continue trying to legalize the practice. He and Democratic Gov. Brian Schweitzer of Montana recently asked federal officials to allow their states to purchase prescriptions from Canada under a pilot project they contend could lower costs for their residents by 35 percent to 50 percent.
Berry laments the situation. "People shouldn't be put in a position where to stay alive and eat at the same time, that's their only option," he said.
Nelson, the Hot Springs retiree, said he has been so pleased with his mail-order medications - not just the lower price, but the personal service - that he recently recommended it to a friend. After she did some checking, he said, she also begain ordering her prescriptions online from Canada.
The combination of the price and the service, Nelson said, should provide an example for lowering drug costs in the United States: "We need to do a better job here. If they can do it, why can't we do it?"