04 July 2004

Seniors struggle with Canadian drug dispute

Loyal customers of cheaper Canadian drugs say Florida's recent attempt to close neighborhood storefronts won't deter them from finding other ways to save on their prescriptions.

Despite state and federal warnings that drugs purchased from foreign and unlicensed pharmacies cannot be regulated for safety, residents are turning to the Internet or direct mail ordering to fill their much-needed prescription medications.

Customers were aghast last month when they heard the state shut down 12 businesses -- including one in Bonita Springs and one in Punta Gorda -- that connected customers with Canada. The state accused them of acting as unlicensed pharmacies.

Following public outrage, Florida health officials last week took a softer stance against the Canadian storefronts, saying they will assist these businesses to get licensed in Florida.

This may come as a relief to the thousands of Southwest Florida residents who buy their medicine from Canadian pharmacies. One Lee County storefront alone serves more than 2,000 customers, the owner said, and there are at least four other similar businesses here.

Fort Myers resident George Troester, for one, said he has never set foot in a Canadian pharmacy storefront.

He has a toll-free number, a credit card and an order form to an established pharmacy in Canada and figures he has saved at least $1,500 each of the past three years by filling prescriptions north of the border.

"I have to give them actual prescriptions, and I agree with that. The only thing I don't agree with is the high prices in this country," said Troester, 68. "It makes a big difference in my life, too. I'm retired and on a limited income."

Florida health officials said online pharmacies are just as unregulated as the storefronts.

For customers, there is little recourse for bad experiences or bad drugs when ordering online or by mail from foreign or unregulated pharmacies, said Lindsay Hodges, a spokeswoman for the Department of Health.

"It is the equivalent of selling drugs out of the trunk of a car," she said. "If you're utilizing services of an unlicensed practitioner, you don't have anybody you can turn to, nobody in your court, no assurance, no monitoring and no recourse ... if something goes wrong."

Canadian health officials agree regulated drugs are only guaranteed safe within the country of origin, but say Canada's review process is among the best in the world.

"Obviously, we approve all products on the market ... on quality and safety and how effective they are," said Jirina Vlk, a spokeswoman for Health Canada, the federal department that governs drugs and other health issues affecting Canadians.

Technically, it is illegal under current U.S. drug importation laws for residents to order prescription medications through a foreign pharmacy.

But no one is going to prosecute them if they do, U.S. Food and Drug Administration officials said.

"We never go after the individual, we go after the commercial operations trying to make money off importing these illegal drugs," said Tom McGinnis, FDA director of pharmacy affairs, citing last November's federal closure of Rx Depot's 85 storefronts, including ones in Fort Myers and Port Charlotte.

"(But) this puts people in a buyer beware type of situation," he said. "There's no safeguard. We don't know anything about the strength, quality or purity of those drugs and that bothers us."

Congress continues to consider legislation and studies that could ease restrictions and, in some cases, legalize the reimportation of Canadian and other foreign drugs by standardizing safety measures.

The Medicine Equity and Drug Safety Act of 2000 essentially authorizes the federal Health and Human Services secretary to permit importation of foreign prescription drugs if certain safeguards were met. That has not yet happened, as health officials have said the safety of those prescription drugs could not be guaranteed adequately.

The Medicare Modernization Act of 2003 also contains a passage that directs the secretary to study and report on ways that would guarantee the safety of drugs from Canada. The final report is due this December.

Until then, residents who are comfortable filling prescriptions from Canada won't lack for choices.

Retired Dr. Thomas Wiley Jr., a former Lee County pediatrician and later peer-review physician for Lee Memorial Health System, said he continues to save about $2,000 a year buying his diabetes, cholesterol and other medications from an established Canadian pharmacist.

"I know it's good and safe medicine because I have had blood studies over the last three years I've been buying my drugs from Canada," said Wiley, 82. "I know it's safe, I know it's cheaper and I know it all ought to be available to Americans."

The FDA's McGinnis points out that the government is working hard to find ways to lower prescription costs for Americans.

Besides the roll-out of Medicare discount drug cards this year, the FDA is "pumping out generic medications," and pharmaceutical companies have created liberal discount or free-drug programs for low-income residents, he said.

While Canadian price controls keep name-brand drugs much cheaper there than in the United States, American generic medicines by far beat out brand-name drugs anywhere, especially at wholesale clubs such as Costco, which don't require a membership to buy prescriptions.

"We're trying to tell consumers that last year, Congress gave us $8 million to beef up our generic drug program," McGinnis said. "Today, generic drugs are available for almost any disease you may have."

And, he said, they're certified safe.

BE A SMART CONSUMER

PharmacyChecker.com, a company that evaluates online and mail-order pharmacies (and receives a fee from some companies who meet the criteria and want to be included), said there are a number of ways residents can ensure they are being smart and safe shoppers. The site, which has had more than half a million hits since it launched about a year ago, rates mostly Canadian pharmacies -- and also includes popular U.S. outlets such as Costco.com -- on five key safety criteria: · Consumers should only shop at pharmacies that exist as licensed brick-and-mortar companies in the state or province in which they operate. · Reputable online or mail-order pharmacies will require an original prescription, preferably faxed by a doctor's office. · An online pharmacy should clearly state contact information with a working telephone number. · A patient privacy policy should exist and consumers should read it and decide if they agree with it. · Any online financial transaction should be encrypted for security. Five-star pharmacies must meet
each safety measure. "If they don't meet this criteria, they don't have our highest rating and they don't have our seal," said PharmacyChecker.com's Gabriel Levitt, director of research. For folks not comfortable with computers, the company in the next few weeks plans to publish a print version of its ratings.

PRESCRIPTION DRUG DISCOUNT ALTERNATIVES Some residents on fixed or limited incomes may qualify for free medications or liberal discounts on their prescription drugs directly from the manufacturer. Following is a list of some of the most popular discount drug programs available from the manufacturers: · What: GlaxoSmithKline's The Orange Card · Covers: Most of the manufacturer's drugs, saving an average of 20 percent to 40 percent at participating pharmacies. · Qualify: For uninsured Medicare-eligible seniors or disabled residents who have an annual income below $30,000 a person or $40,000 a couple. · Information: (888) 672-6436 or www.orangecard.com .

· What: Eli Lilly's LillyAnswers Card · Covers: Most retail-distributed Lilly drugs except controlled substances. $12 co-pay per prescription for 30-day supply. · Qualify: Must have annual income below $18,000 per individual or $24,000 per couple. · Information: (877) 795-4559 or www.lillyanswers.com .

· What: Novartis drugs through Together Rx (a discount card program with several participating manufacturers covering more than 155 FDA-approved medicines. Replaces Novartis' CareCard). · Covers: Select Novartis drugs. Tier 1 has a $12 co-pay per prescription for 30-day supply, and Tier 2 receives a 25 percent or more discount. · Qualify: Tier 1 must have annual income below $18,000 per person or $24,000 per couple. Tier 2 must have annual income below $28,000 per person or $38,000 per couple. · Information: (800) 865-7211 or www.togetherrx.com .

· What: Pfizer (and other) drugs through U Share Prescription Drug Discount Card, a Medicare discount drug program that includes much of the same benefits as the old Pfizer Share Card (no longer effective after Aug. 31). · Covers: Many Pfizer drugs with a $15 co-pay per prescription for a 30-day supply. · Qualify: All Medicare-eligible beneficiaries with additional benefits to low-income Medicare beneficiaries. If 2003 income was $12,569 (if single) or $16,862 (if married) or less, then beneficiaries may qualify for a $600 credit on the discount card to help pay drugs. · Information: (800) 274-0344 or www.usharerx.com .

· What: Together Rx Card · Covers: More than 155 select drugs from a group of manufacturers, saving people at least 20 percent to 40 percent. · Qualify: Medicare-eligible residents who are uninsured and have annual incomes below $28,000 per person or $38,000 per couple. · Information: (800) 865-7211 or www.togetherrx.com .

· What: Medicare-Approved Drug Discount Cards · Covers: Many prescription drugs with savings ranging from 16 percent to 30 percent, on average, off the retail price of brand-name drugs at participating pharmacies. Consumers must choose one program among dozens of cards, deciding which will give them the best discount off the drugs they use. · Qualify: Anyone enrolled in Medicare is eligible for one of the new Medicare-approved discount prescription drug cards, with additional benefits to low-income Medicare beneficiaries. If your monthly income for 2004 does not exceed $1,047 if you are single or $1,404 if you are married, you might qualify for a $600 credit on your discount card. · Information: Sort through different card programs by calling (800) MEDICARE or visit www.medicare.gov. Since none of the businesses actually dispense medicine, licensure could be difficult and future closures may be imminent. But some customers aren't worried at all.

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