14 June 2004

Canadian drugs still entice Pharmacists try to slow prescription sales even as politicos ease opposition

The flow of cheaper prescription drugs from Canada isn't likely to slow down.

Not if people like 73-year-old Felix Calkins of Portland are set on saving money and having easy access to northern druggists. That's despite Oregon pharmacists warning, as they do in a new public education campaign unveiled Wednesday, not to buy the medications.
 
Health Canada, Canada's equivalent of the U.S. Food and Drug Administration, is "not about to allow drugs that are counterfeit to be sold by pharmacies there," says Calkins, who found that by buying blood pressure medication from Canada, he could save about $800 a year on his medications.

"That seemed worthwhile to me," says Calkins, who led a small group of local seniors to Canada last year to fill their prescriptions. "It's a heck of a lot better than the Medicare discount card."

On his doctor's advice, Calkins has switched to a drug that costs far less, but he still buys it from the Vancouver, British Columbia, pharmacy that saved him money "out of a sense of loyalty."
 
The Oregon pharmacists' campaign -- a joint effort with the U.S. Food and Drug Administration, Oregon State Pharmacy Association and Canadian pharmacists concerned about suspect drug sales -- comes as national and state politicians such as U.S. Sen. Ron Wyden, D-Ore., are backing off their opposition to the illegal purchase of Canadian prescription drugs.
   
"It's a disgrace that it has come to this, this spectacle of older people having to traipse all over the world to get medicine, when they ought to be able to get it in their own country," says Wyden, who supports efforts to import safe, FDA-approved, less expensive medications from Canada.
 
He says the best route would be to change the new Medicare law to let the agency negotiate lower prices with drug companies. The law prohibits that.
 
Meanwhile, Gov. Ted Kulongoski has a three-part plan that would contain drug costs, including a measure to let Oregon pharmacists fill orders with state-approved Canadian pharmacies. That measure requires federal approval first, and it calls for the administrator of Oregon's Office of Health Policy and Research to go to Canada to scout out pharmacies and establish a working relationship with them.
 
Tom Holt, executive director of the Oregon State Pharmacy Association, says he and the governor's office have "agreed to disagree" on Kulongoski's plan to buy through Canadian pharmacies. However, Holt does credit the governor with including safety measures in his proposal.
 
The association's "Looks Can Be Deceiving" campaign seeks to steer people away from buying drugs from uncontrolled sources outside the United States, which a 2003 report found had increased 300 percent across the Canadian border and other countries. FDA inspectors have found recalled drugs, drugs containing addictive substances and other unsafe drugs sold across the border.
 
Holt says it's an urgent health issue that could escalate if patients have an adverse reaction to foreign-made drugs.
 
"There's a growing momentum over the idea of importation," he says. "We believe those who advocate it don't understand the risks."
   
Local connection
  
Hundreds of Portlanders have bought medications from Canada via local storefront operations that fax prescriptions to Canadian pharmacies or place the orders online. The medication then is mailed directly to the patient. Federal and state authorities have threatened to shut down the enterprises.

The owner of Rx for Less in Hillsboro is riding out the threat. Bruce Lilly says he plans to stay in business as long as he can and believes in the service he provides, which he says saves customers an average of 50 percent on their medicine.

"I've got customers who aren't taking all their medications because they can't afford them. ... If not for me, a few of these people wouldn't be getting their medications, period," Lilly says.

The state Board of Pharmacy's executive director, Gary Schnabel, says he trusts that Canadian-made and -sold drugs are safe, but the concern is ensuring that a safe drug is delivered.

"People aren't dropping dead in Canada" from unsafe medications, Schnabel says -- but, he asks, "Is there a guarantee that what that person receives is the same as what they'd get at a drugstore in Canada?"

He says a problem would be difficult to trace because the original prescription is sent to the Canadian pharmacy, where it's out of the reach of authorities in this country.
 
About 15 local enterprises fax prescriptions to Canadian pharmacies or place orders online, and Schnabel estimates that a similar number have escaped the board's attention. He says most of the businesses told the pharmacy board they'd shut down rather than face an investigation.
   
Case sets precedent
   
State authorities' concern is legitimate. A Portland woman recently settled a lawsuit with Medicine Shoppe Canada Inc.for an undisclosed sum after allegedly receiving the wrong prescription medication.

The woman's lawyer, Dale Dixon, says his client became sick within days after taking what she thought was the prescription drug tamoxifen, which had come from the pharmacy's South Surrey, British Columbia, store. The drug was part of her treatment for breast cancer.

The patient discovered after reordering a new supply of the pills that they were not the cancer drug but a hypertension medicine; she had suffered a severe and common allergic reaction to the medication.

Medicine Shoppe's Web site lists a package of 100 20-milligram tamoxifen citrate generic drugs at a cost of $54.41 in U.S. dollars. The American Association of Retired Persons says a package of almost twice that many pills, 180 20-mg. tamoxifen citrate, can sell for $279.39 in this country.
 
The AARP is supporting the legalization of the importation of drugs from Canada. The 35-million-member group's chief executive officer, William Novelli, wrote to 16 drug companies this spring, urging them to "cooperate with secure, reasonable, drug importation legislation."
 
"We favor re-importation of drugs from Canada, but as long as it's illegal, we can't support it," says Virginia Garrison, a spokeswoman for the Portland AARP.
 
Price controls in countries such as Canada put a ceiling on drug costs, while the United States lets the market set prices. The drug-makers' trade group and lobbyist, Pharmaceutical Researchers and Manufacturers Association, or PhRMA, defends the market pricing, saying it's the only way to ensure a return on the hundreds of millions of dollars invested in each new drug.
PhRMA spokesman Jeff Trewhitt accuses countries with price controls, such as Canada, of getting a free ride.

 "They are not paying their fair share of the research and development costs. And consumers in this country are subsidizing research and development costs and subsequent profits of their own industry. And that's wrong."
   
By NEVILL ESCHEN  
The Portland Tribune
6/11/04

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