12 May 2004
Democrats hit Bush on drug imports Ads portray him as ally of corporations
What started as a trickle of humble bus trips across the Canadian border by senior citizens looking for cheaper medication is picking up national momentum.
Democratic strategists have seized on the issue of importing low-cost prescription drugs and are launching a multimillion-dollar airwave assault on President Bush in 17 presidential election swing states, including Florida and Michigan, where imports are popular.
Influential senators from both sides of the aisle have signed on to support the concept, as have the nation's two largest drugstore chains. More states and cities, meanwhile, have launched illegal importation websites and pressured Washington to legalize imports for citizens and public workers. Boston Mayor Thomas M. Menino plans to embark on a pilot importation plan for city employees this summer, just in time for the Democratic National Convention.
Perhaps most significantly, there are signs the Bush administration's opposition is weakening.
"It's like a runaway train," said Frank Palumbo, executive director of the Center on Drugs and Public Policy at the University of Maryland School of Pharmacy. "Everyone is jumping on the bandwagon here. It's an election year and it's a big political issue for people who don't have access to drugs."
The Media Fund, an independent advocacy group funded by prominent liberals and led by Harold Ickes, a former aide to Bill Clinton, has identified prescription drug importation and the Medicare prescription benefit -- along with taxes and the economy -- as key issues in Massachusetts Senator John F. Kerry's campaign to unseat Bush.
The group spent $18.5 million on ads in the first quarter of 2004, according to public disclosures.
A narrator in its spots, which depict an elderly couple at a kitchen table, says Bush "sided with drug companies, blocking Medicare from negotiating lower prices and banning Americans from importing low-cost drugs from Canada. For President Bush drug company profits come first."
The Bush campaign said it would not respond to the Media Fund's spot on prescription drugs, calling it an "illegal use of soft money." It has asked the Federal Election Commission to declare the fund's activities a violation of campaign finance laws.
Strongly opposed to legalizing importation last year, the administration appeared to soften its stance on cross-border purchases last week. Health and Human Services Secretary Tommy Thompson predicted at a news conference that Congress would pass a bill legalizing prescription imports this year. Asked if he would urge Bush to veto such a bill, Thompson said he would not.
Thompson's staff has attempted to back off of those remarks, saying the secretary remains opposed to imports on safety grounds but is awaiting a report from a task force to see if there are safe options.
The day after Thompson's remarks last week, the nation's two largest drugstore chains, CVS Corp. and Walgreen Co., expressed support for imports. They said they were responding to popular demand from their customers -- especially seniors with no drug insurance.
"Large companies like CVS and even the federal government are beginning to understand that the extreme differences in price between what Americans pay and what citizens of other countries pay for drugs is simply unsustainable in a global economy," said Dr. Jerry Avorn, a Harvard Medical School professor.
Importing drugs from countries with price controls has been popular for several years among Democrats who want to put pressure on the drug industry to reduce the prices it charges Americans. It has also attracted conservative, free-trade Republicans who believe in open borders. This year, legalizing imports has important new bipartisan adherents in the US Senate, including such unlikely allies as Massachusetts Democrat Edward M. Kennedy and Mississippi Republican Trent Lott.
After helping to kill a House-approved measure last year, they are cosponsors of a bill that would legalize imports from Canada, the European Union, Japan, and Australia. Two other importation bills also will be in the mix as the Senate debates the issue this summer, including one that is expected to be introduced soon by Republican Judd Gregg of New Hampshire, the chairman of the Senate committee that oversees healthcare.
Only drug companies that operate foreign manufacturing plants are permitted to import drugs into the United States. Rising US drug prices, however, have sent millions of Americans to Internet pharmacies in Canada, where government price controls provide discounts of 20 to 80 percent off US prices. In many cases, they are buying the same drugs available on US pharmacy shelves but with different packaging and labels.
The cross-border trade is illegal, but the FDA has maintained a policy of looking the other way on individual imports. The lack of enforcement has contributed to a sense of normalcy around imports for seniors and has helped to popularize the concept, said Donald E. deKieffer, a Washington lawer specializing in trade issues.
"Politically, the idea of enforcing the existing drug law is a nonstarter," he said. "Can you imagine arresting grannies coming back from Montreal with their heart medications?"
Drug companies have fought vigorously to ward off importation. They say that if they cut prices sharply in the United States, their research and development pipelines would quickly dry up. According to industry figures, drugmakers spent roughly $33.2 billion on drug research and development in 2003.
"There is a direct correlation between margins and investment in research and development," Daniel Vasella, the chief executive of Novartis AG, said. "People have to make up their minds whether they want less innovation and less expensive treatments, or if they want to continue to have companies invest heavily in research and development."
Bush, Republicans in Congress, and drug executives had hoped popular anger over high drug prices in the United States would be defused with passage last year of the Medicare prescription drug benefit. But that hasn't happened.
Last week, the Bush administration unveiled a partial benefit contained in the law: Medicare discount cards, sponsored by the government and offered by private insurers. They are supposed to offer discounts of 10 to 25 percent, plus a subsidy of $600 for low-income seniors. But spot surveys last week showed drugs were still cheaper in Canada. What's more, the cards have lots of rules.
"I think they are pretty complex for many older seniors," said Robert Blendon, a Harvard University School of Public Health professor.
"The problem is that the cards are not good for all drugs. If I move to Florida, I have to get a different card. And what discount you get depends on which card you get. Older people will be annoyed by things that are quite complex."
By Christopher Rowland, Globe Staff | May 12, 2004
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