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How Far Would You Go for Cheaper Drugs?

Thousands of Americans are crossing the border to get the best deal on their prescriptions. Our reporter tags along.

Taking Half-Doses to Save Money

Cliff Bates, a 60-year-old retired paper mill worker, pays about $300 per month for five medications he needs to treat knee problems, high cholesterol, and high blood pressure, and hopes to save quite a bit. He says he's tried to save money by splitting his pills and taking half a dose, but that "doesn't work so good -- I got dizzy."

Technically, the Food and Drug Administration (FDA) prohibits the importation of prescription drugs from other countries. But the Canadian trips take advantage of an FDA loophole that allows individuals to import a limited supply of approved drugs for personal use. Still, the agency has broad enforcement discretion, and as the bus approaches the border, there are jokes about what reasons to give for going to Canada. The "drug czars" opt for the truth and explain the mission to sympathetic border guards. The guards wave them through, noting that plenty of people are doing the same thing on their own.

While the FDA is not currently trying to prevent drug-buying in Canada, that could change. In an effort to head off an FDA crackdown and to draw attention to the huge price differences, the House of Representatives on July 10 overwhelmingly approved a bill barring the agency from enforcing the general ban on drug reimportation.

'My Job Is to Take Care of Patients'

It's noon when the group arrives in Montreal. They troop up a winding stairway to the packed waiting room of a health clinic where the Americans fill out forms, see a doctor (for a $24 fee), and present their American prescriptions. Nii T. Quou, MD, the clinic's medical director, says he's been warned about possible legal liability from seeing American patients, but he welcomes them all nonetheless. "I'm a physician," he says simply, "and my job is to take care of patients."

The Vermont organizers hand out the sandwiches and sodas, then begin ferrying batches of people to a family-run pharmacy nearby. The pharmacist and his family welcome the group with pastries in a homey back room where the travelers rest and wait for their precious supplies.

Drug Companies Offer a Caution

Drugmakers have been angered and embarrassed by the publicity the bus trips have drawn. They warn consumers against crossing the border for medications, saying they can never be sure what they're getting, even when drug labels are the same as in the United States. The companies also say higher U.S. prices are justified because of the high cost of research that has produced so many wonder drugs. They've been fighting back with television ads and a web site to make the case that the U.S. health care system is preferable to Canada's.

The industry has also worked hard to fend off attempts by Congress and some states to impose price controls on prescription drugs. Indeed, the United States is the only industrialized country without some form of controls on drug prices. In Canada, provincial authorities negotiate bulk discounts with pharmaceutical companies and establish allowable prices for most prescriptions. The Mexican government also sets price ceilings for medicines.

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