Medicines Without Borders
By early fall, Maurice Brown usually has to choose between skipping doses of his heart and asthma medicines or cutting back on other necessities. But not this year. Thanks to a bus trip organized by Representative Bernie Sanders (I-Vt.), the 65-year-old retired Vermont businessman has been getting medicine over the border, where prices are lower. He has bought several months' worth of U.S.-made medicine that would have cost $1,200 at home for only $500. And he wonders why the U.S. doesn't allow pharmacies and distributors to reimport drugs from Canada and elsewhere, giving other Americans the same opportunity to save big bucks.
Why not indeed? Making medicine affordable to America's elderly is an issue that tops the political charts. But with Al Gore and George W. Bush pushing competing Medicare plans, the chances of enacting a drug benefit plan before November are virtually nil.
"RIPPED OFF." So members of Congress are pushing for a quicker fix. Already, both the House and Senate have overwhelmingly passed amendments to spending bills that would allow distributors and pharmacies to import cheaper drugs from countries such as Canada and Mexico. And despite fierce opposition from drugmakers, the provision is likely to become law after legislators hammer out the differences between the House and Senate versions. Although funding for Food & Drug Administration oversight and implementation would take some time, "This is a measure we can implement now that will bring prescription drug prices down for all Americans," says sponsor Senator Jim M. Jeffords (R-Vt.).
Thanks to price controls, many drugs cost two-thirds or half as much in Canada as in the U.S., and even less in Mexico. Americans can't take advantage unless they cross the border and, in the case of Canada, get a prescription from a local doctor. Since seniors buy more drugs than any other group, "the current system leaves the drug companies' best customers feeling like they've been ripped off," says Senator Slade Gorton (R-Wash.). Representative Sanders figures allowing reimportation could cut retail prices on many drugs by 30% to 50%, even if middlemen pocket some of the savings. "In an increasingly globalized economy, why can't prescription-drug distributors and pharmacies purchase FDA safety-approved drugs from anywhere in the world?" he asks.
Drugmakers counter that buying from abroad would leave Americans vulnerable to unsafe drugs--and some experts agree. How could buyers be sure drugs aren't the products of some shady foreign lab, for example? "It's a public- health issue," says Dr. Michael A. Friedman, former acting commissioner of the FDA and now an executive at Pharmacia. He says allowing imports "would expose the American public to medicine that may be adulterated or fraudulent, or to legitimate medicines that have been stored or handled improperly."
To supporters of the measures, that rationale smacks of a smokescreen. "The industry is just trying to protect its huge profits," says Senator Jeffords. And Dr. Thomas L. Kurt, professor of internal medicine at the University of Texas Southwestern Medical Center and former FDA medical officer, argues that ensuring the safety and legitimacy of drugs coming across the border would be far easier for the FDA to do than its current task of monitoring imported food.
Still, the safety issue offers a backdoor way of blocking reimportation. With lawmakers eager to show voters they've done something to rein in drug prices, drugmakers face an uphill battle keeping the measure from being enacted. But preventing it from being implemented is another matter.
REAL DEAL. When the Senate passed its amendment, Senator Thad Cochran (R-Miss.) added a provision saying importation wouldn't be allowed unless the FDA certifies that drugs coming back in aren't bogus or unsafe. The FDA, which is responsible for oversight, says it can do that--if Congress gives it $90 million more per year. But that wouldn't be appropriated until the fiscal 2002 budget, at the earliest. By then, it might be blocked by the industry's lobbyists.
Nothing would please drugmakers more. And seniors like Maurice Brown would have to keep making those trips to Canada.