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Mail-order medicine.

Byline: STORIES BY TIM CHRISTIE The Register-Guard

DOROTHY STROME of Springfield would rather get her prescription medications from the neighborhood pharmacist she trusts and has been seeing for decades.

But she can save about $78 a month by getting two of her most expensive medications from a Canadian Internet pharmacy. U.S. drug prices are simply too high, she says.

"It's obscene," says Strome, 73. "It's morally blackmailing people."

Bob Friedman, a 60-year-old Florence retiree, saves about 30 percent on his $500 monthly drug bill by buying from

"I'm forced to go to a foreign country to afford what I need to stay alive, while my own government spits in my face," he says.

Francis Linklater, a 74-year-old retired Eugene attorney, saves more than 50 percent off U.S. prices by getting his allergy and cholesterol drugs from

"It's absolutely reprehensible what (drug companies) are doing with pricing in the U.S.," he said.

While Congress wrangles over a prescription drug benefit for Medicare recipients, countless American seniors aren't holding their collective breath. They're voting with their wallets, jamming the Internet sites of Canadian pharmacies to buy drugs that can cost two to three times as much at U.S. pharmacies.

"Until we resolve this pricing issue between what American consumers pay and consumers outside the United States pay, that will fuel and drive people to these sites," said Carmen Catizone, executive director of the National Association of Boards of Pharmacy, a Chicago group representing state pharmacy regulators.

More than 1 million shipments of prescription drugs are coming into the United States each year from foreign sources, according to the U.S. Food and Drug Administration. The cheap prices of Canadian drugs provide a safety valve for elderly Americans on fixed incomes who have no insurance and rely on expensive medications.

Strome is retired from a working life that included stints as a certified nursing assistant, legal secretary and bookkeeper. She and her husband, Martin, look for any way to save a dollar.

By buying Celebrex, an arthritis medicine, and Zoloft, an antidepressant, from thecanadiandrugstore. com, Strome saves $236 on a three-month supply of medicine.

"The difference it makes is we can eat out once in a while or maybe go to a movie," she said.

No price controls

Americans pay more for prescription drugs because the United States is the only wealthy nation without some form of price controls on medications, said Deborah Socolar, co-director of the Health Reform Program at Boston University's School of Public Health.

About 70 million Americans have no insurance coverage for medicine, she said, including about 17 million older Americans on Medicare.

"It's unfortunate that people have had to turn to other countries," Socolar said. "In a sense it's a matter of Americans having to take advantage of price controls and bulk purchasing and other discounting efforts that other governments have implemented for their own citizens because our government hasn't yet acted to protect our own citizens."

Friedman, the Florence man, took a medical retirement from a large corporation in the East. He paints the issue in blunt terms.

"I turn to my own government and I just get bitter, because my own government is in the hands of these drug manufacturers and they don't give a rat about me," he said. "I'm tired of my government mollycoddling to the drug company lobbyists and not paying attention to the needs of their citizens."

Drug costs are the single fastest growing part of health care, rising about 17 percent a year and doubling in the past 10 years, according to AARP, which lobbies Congress on behalf of retired Americans.

Congress may pass a Medicare drug benefit this year, though the House and Senate plans have big differences in how much to spend and how to structure such a benefit.

A bill that passed the House last month would spend $320 billion over 10 years on a drug benefit that would be administered mainly by private insurers. Seniors would pay a $33 monthly premium and an annual deductible of $250. Out-of-pocket expenses would be capped at $3,700 a year. The Senate version now being debated would cost $500 billion over 10 years. Seniors would pay a $25 monthly premium with no deductible, plus a flat $10 co-pay for generic drugs and $40 for brand-name drugs. Out-of-pocket expenses would be capped at $4,000 a year.

Both the House and Senate plans would require no co-payments or premiums - or charge a reduced rate - for low-income seniors.

The pharmaceutical industry is lobbying for a Medicare drug benefit.

"That's the answer to this issue: Get drug coverage for seniors," said Alan Holmer, president of PhRMA (pronounced FAR-ma), the Pharmaceutical Researchers and Manufacturers of America.

PhRMA is aggressively lobbying against congressional efforts to provide cheaper drugs to Americans by permitting the reimportation of U.S.-made drugs and importation of foreign-made drugs. The group released a poll Monday that showed that public support for such measures weakens when people are told of the concerns of governmental and public health officials.

Those concerns include the possibility that reimported and imported drugs could be counterfeit, old, contaminated or subject to tampering. U.S. drug regulators have no control over another country's drug distribution system.

Down on foreign pharmacies

The U.S. Food & Drug Administration, drug makers, pharmacy regulators and pharmacists all advise people not to buy drugs from foreign Internet pharmacies.

"We don't know where they're located," said Gary Schnabel, executive director of the Oregon Board of Pharmacy. "We have lots of sites that say they're pharmacies that we have no evidence that they are a pharmacy."

"The first advice we would give to consumers is not to use any foreign sites," said Catizone of the national pharmacy regulators group. `If, however, the consumer says, `I'm going to use them anyway because I have to pay the rent,' we suggest they verify the pharmacy is registered with the Canadian provincial pharmacy.'

The American Pharmaceutical Association, which represents pharmacists, also recommends against foreign pharmacies. If people choose to use the foreign sites, they need to be aware of the dangers, association spokeswoman Susan Winckler said.

Consumers risk not being told about a drug recall; they risk getting a counterfeit or adulterated product; they risk not being able to sue or get satisfaction if something goes wrong.

"It gets back to the concept, the most expensive drug is the drug that doesn't work," she said.

Service can be shoddy

American consumers say the Canadian sites aren't without problems.

Friedman, the Florence retiree, said his experience with Canadian pharmacies has been mixed at best.

"Their prices are good; their service is terrible," he said. "It's not a magic bullet."

When Friedman called to find out why his prescriptions hadn't been refilled or shipped 20 days after he ordered them, the person he talked to was "lackadaisical in noting my concern," he said.

"Their customer service was arrogant."

Frank Faria of Sutherlin and his wife, Lorraine, had problems with It took about four weeks to receive one delivery, and two months for another. His wife got a six-month supply of one drug, but she ended up getting allergic to the drug after 30 days.

Dorothy Strome tried to be vigilant in buying from thecanadian - "I still have most of my smarts, and one doesn't buy just anything from just anybody" - but was surprised by a letter she received from the company's president, William Shawn.

He described a raid in mid-May by Ontario pharmacy regulators who seized the company's computers, all its drugs, brochures and files.

In May, the Ontario College of Pharmacists filed 15 charges against Shawn and his company, alleging that they were operating an unaccredited pharmacy without registered pharmacists on staff. The charges are pending.

After rebuilding the computer files and buying more drugs, Shawn said, he moved part of the company's operations to British Columbia because, he said, "British Columbia regulators fully support the type of mail order service we provide."

In an interview, Shawn called the Ontario charges "a whole bunch of nothing, a whole bunch of noise."

"What Ontario did was come in here with an atom bomb and tried to blow us up," he said. "It was the first shot in the war to try to stop this industry, and we were a target."

He said thecanadiandrugstore .com was targeted because it was the first Canadian company to sell prescriptions to Americans over the Internet, starting about 22 months ago.

Layne Verbeek, spokesman for the Ontario College of Pharmacists, denied that his agency was trying to drive Internet pharmacies out of business. Prescription drug laws are intended to ensure that only licensed doctors write prescriptions after examining a patient and that only licensed pharmacists fill them, he said.

"The Internet provides alternate ways of delivery," he said. "It doesn't change the need for all those steps in the care process."

Shawn, whose background is in marketing, said he got the idea to open an Internet pharmacy after seeing a news story about busloads of American seniors from border states traveling to Canada for their medications. has changed the way it does business, which may satisfy regulators. Originally, it would get the prescriptions filled by licensed pharmacies back in its Toronto facility and ship them from there. Now, it's taking orders in Toronto, but having a B.C. pharmacy fill and ship the prescriptions.

Linda Lytle, head of the B.C. College of Pharmacists, said her office is not working directly with, but rather with the licensed B.C. pharmacy that fills its orders and ships prescriptions.

Lytle said her regulatory agency is trying to keep close tabs on pharmacies doing business in the United States.

Among other safeguards, her staff requires pharmacists to talk to each patient before shipping drugs to make sure the patient understands potential adverse reactions. Shawn said his pharmacists attempt to call all patients to counsel them about their prescriptions.

"We're trying to work with them," she said. "It's kind of new to us as well. Rather than moving to close them down we tell them what the right thing is and help them, as long as they're cooperating."

Nothing in Canadian or provincial law prohibits a pharmacy from sending medicine to someone who has a legal prescription, she said.

"What responsibility does our regulatory board have to make sure our pharmacies are complying with the laws of the land to which drugs are shipped?" she said. "Our governing board has said, for the moment, it's not our responsibility."

For now, U.S. and Oregon pharmacy regulators are not making any attempt to enforce laws against individual consumers buying personal medications from foreign pharmacies. FDA officials have said they take a compassionate approach by not enforcing the law.

"Everyone's in the middle of it trying to figure it out," said Schnabel of the Oregon Board of Pharmacy. "You can't say yes, because it's technically illegal, but it's hard to say no."

ON THE WEB The U.S. Food and Drug Administration's Web site has tips for consumers; under "hot topics," click on "buying medicines online." This site, operated by the Ontario College of Pharmacists in Toronto, offers advice to consumers buying from Internet pharmacies. It also includes contact information for every provincial pharmacy board in Canada so consumers can verify whether they're dealing with an accredited pharmacy. The Oregon Board of Pharmacy warns consumers about foreign pharmacies; click on "news," then "Canadian drug imports." Click on "Internet Pharmacy" for information about the National Association of Boards of Pharmacy's VIPPS program.

- The Register-Guard


ON THE WEB The U.S. Food and Drug Administration's Web site has tips for consumers; under "hot topics," click on "buying medicines online." This site, operated by the Ontario College of Pharmacists in Toronto, offers advice to consumers buying from Internet pharmacies. It also includes contact information for every provincial pharmacy board in Canada so consumers can verify whether they're dealing with an accredited pharmacy. The Oregon Board of Pharmacy warns consumers about foreign pharmacies; click on "news," then "Canadian drug imports." Click on "Internet Pharmacy" for information about the National Association of Boards of Pharmacy's VIPPS program. - The Register-Guard
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Title Annotation:High costs drive some seniors to foreign pharmacies; Health
Publication:The Register-Guard (Eugene, OR)
Date:Jul 14, 2002
Previous Article:Understand risks of buying abroad.
Next Article:Cuts lead to call for autonomy.

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