Jumping the Border For Cheaper Drug Refills
While Washington fiddles with prescription drug coverage for Medicare beneficiaries, and drug companies offer meager discounts, many physicians with consciences are helping patients get their prescriptions filled for real savings in Canada. But that has presented new problems for doctors and patients.
Maureen M., of Smithtown, whose 81- year-old mother takes three brand-name drugs to survive her pulmonary problems, explains that she had arranged with one of her mother's doctors to fax her prescriptions and medical history to the United Health Alliance, a Bennington, Vt., physicians' cooperative that buys the drugs through Canadian pharmacies at substantial savings.
The drugs, most of them made in the United States or at U.S.-owned plants, are FDA approved and virtually the same as those sold here. But they are considerably less expensive in Canada because its national health system controls prices. And based on the patient's medical history, the UHA and its Canadian pharmacies screen the prescriptions with special computer software for possible drug- to-drug interactions, as druggists do here.
Because the Canadian drugs are intended only for the patient, the UHA and Canadian pharmacies have been shipping the drugs to the prescribing physicians rather than to the patients to avoid the possibility of resale. But the sharp growth in Canadian drug purchasing has become a problem.
Maureen's mother received two deliveries, her daughter wrote, but then her doctor balked. "He said he was sorry," said Maureen, "but his office just couldn't accept them anymore...Too much confusion. They could get lost." She tried another doctor who declined, because he feared a "liability" problem, in helping to obtain and keep track of the drugs. But we've heard that some U.S. doctors charge a fee for the service.
A spokesman for the American Medical Association told me that he knows of no legal problem for physicians who write prescriptions that are filled in Canada. The AMA, he said, has no policy on the use by doctors of Canadian sources to fill prescriptions for patients.
Generally, if a U.S. physician is not licensed in Canada, the prescription is usually re-authorized by a Canadian physician.
The re-importation of U.S.-made drugs from abroad for resale is illegal, although pending legislation would provide an exception for Canada. While obtaining prescription drugs from abroad for "personal use" is frowned upon by the FDA, it is not considered illegal, and the agency has not moved to stop the purchases - by mail or in person - in Canada, where the drugs are as safe as they are in the United States.
The UHA, which includes 115 Vermont doctors, has been among the busiest sources of Canadian drugs for American patients, as well as an advocate for prescription drug coverage and health care reform. Dr. Elizabeth Wennar, UHA's president and CEO, said her program has been using doctors to receive the drugs for their patients "because we wanted them to be aware of the problem of prescription drug costs. Cost is everything, and it makes no sense to have a prescription drug benefit in Medicare unless costs are controlled. We hoped that when doctors write prescriptions, they'll ask themselves if their patients can afford the drugs. And doctors should care enough to help their patients get more affordable drugs in Canada."
But she acknowledged that Maureen M. is not alone in having problems finding help from doctors. "Some doctors feel pressure from the drug houses, which provide drug samples. And the busy offices of many physicians have been flooded with packages from Canada they have difficulty handling safely and efficiently."
As a result, the UHA changed its procedure a couple of weeks ago to permit the shipment of prescription drugs to the patients, after their medical history and the doctor's prescriptions are sent via fax or mail. Under the new arrangements, Wennar said, the UHA is using three Canadian pharmacies to provide price competition, and all prescriptions will be screened by consulting Canadian physicians to spot potential drug- to-drug interactions. Several other Canadian pharmacies and prescription services also have begun shipping medicines directly to patients with similar safeguards.
These new shipping and handling (around $10 per delivery) arrangements may raise the prices of the drugs slightly, said Wennar, but they'll remain far below those in the United States. One random example: The UHA pharmacy price for 100 tablets of Celebrex, 100 milligrams, is $54.23. The price at my Safeway pharmacy is $154.49. The 65 percent savings is about average for Canadian drugs.
If you're considering the Canadian alternative and you have access to a computer, visit www.unitedhealthalliance.com and find the "Medicine Assist" section, which provides price comparisons and available dosages on hundreds of prescription drugs. Or call UHA toll free at 866-633-7482. Readers have also used canadameds.com, 877-542-3330.
Using a computer or the telephone, you'll have to print or ask for a medical information form, which your doctor must fill out and return with the prescriptions. And I'd be suspicious of any Canadian prescription drug service that does not ask for a medical history.
A final thought: While Congress and the drug companies have focused on Medicare beneficiaries, let's not overlook the uninsured and the millions of younger working Americans with families, with insurance through employers, who are paying soaring fees for shrinking benefits and skimpy drug coverage. And the younger self-employed pay a small fortune in insurance coverage for inadequate drug benefits. The Canadian drug store is open to medically besieged Americans of all ages.
close window