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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.

    '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.

    Drug prices in America vary greatly depending on who pays the bills. Insurers and employers pay most prescription costs, but this is changing as managed care plans impose caps on prescription reimbursements. Some companies are putting expensive drugs off- limits or reducing drug benefits, requiring workers to make larger copayments. And people who rely on Medicare, which serves senior citizens, are on their own, since Medicare does not currently pay for any outpatient medications.

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