She's a 70-year-old grandmother and retired hospital social worker who requests anonymity because earlier this year, she committed the first crime in her life: She had drugs smuggled in from Colombia. Not cocaine or marijuana, but Lamisil tablets to treat a stubborn toenail fungus.
"At my local pharmacy, it cost more than $7 a pill -- and I needed a three-month supply," she tells WebMD. "I can't afford that, so I wrote to a friend who lives in Colombia. The same prescription that cost $440 at the Target pharmacy cost $180 down there. And when she mailed it to me, it came in the same bottle that my pharmacist had.
"It's a sin what they're doing to us here," she says with a sigh.
That "sin" is the inability to cover the cost of their prescription drugs in the U.S., prompting growing numbers of Americans -- and in particular, seniors like her -- to get their medications outside of our borders.
Canada is the most popular destination, where many brand-name prescription drugs cost up to 80% less than in America -- and from where this suburban Philadelphia granny now gets her TriCor, a medication to lower triglyceride levels.
"I have a PPO drug plan, but it only covers generics. If I need a brand-name drug, I have to pay for it out-of-pocket. Neither Lamisil nor TriCor has a generic equivalent covered by my insurance. And TriCor costs half as much in Canada as it costs here -- almost $100 less per prescription."
She recently learned of the Canadian pharmacy from a friend, who buys her own prescription drugs there at the advice of her son -- a doctor. Both mail their prescriptions northward and the drugs are mailed back to them. "I took it to my doctor after getting it and he said it was the same drug that is manufactured and sold here."
And that's why, technically, she's a criminal: Federal law prohibits the "reimport" of U.S. drugs by anyone other than the manufacturer.
The authorities aren't about to arrest her -- officials acknowledge this is illegal activity but say they won't act on individual citizens who are securing prescription drugs for their personal use. However, there is concern about growing numbers of these "border buys," which especially came to light in 2003.
Concerns About Safety
"Our specific concern is that we don't know what consumers are getting, like we do when products are purchased from state-licensed pharmacies in the U.S.," says Thomas McGinnis, PharmD, FDA director of pharmacy affairs. "If you're going to order medications from outside the U.S., you may get the same thing as what's at your local pharmacy, but you may not. It's a 'buyer beware' situation. We're concerned about the safety of these drugs."
Still, McGinnis admits there isn't a single documented case of an American killed by prescription drugs bought from licensed Canadian pharmacies, a finding echoed by Health Canada, which regulates the country's prescription industry.
"Unless you walk into the store, you really don't know if it's really a licensed pharmacy," McGinnis tells WebMD, adding that such information would be hard to track. "We've had consumers complain to us that they thought they were ordering from a Canadian web site -- it had a maple leaf -- and the package was postmarked that it came from India, and the product inside was manufactured in India. We really worry about drugs from India."
The majority of drugs sold in state-licensed American pharmacies are manufactured in Puerto Rico, with backup facilities in the U.S. and elsewhere, says McGinnis. "The FDA goes to these manufacturing facilities, no matter where it is in world, and inspects it to make sure there's the right active ingredients and right equipment to make the product. We monitor the shipment and storage, we monitor the product from warehouse to pharmacy. We're comfortable with products sold in the U.S."
City Finds a Way
Michael Albano, the mayor of Springfield, Mass., says he feels the same way about the insulin he buys for his diabetic son and the other drugs purchased for his 2,200 current and retired municipal employees. His city is the nation's first to initiate a program for municipal employees to buy prescription drugs from Canada. They fax or mail prescriptions and the products are sent to their homes. Boston recently announced it would begin a similar city-run program in coming months, and politicians in other states, including most recently Illinois, are considering the same.
"In six months of operation, our city has already saved $1 million in employee drug costs, and we believe we can save $4-$9 million a year in the future," Albano tells WebMD. "This was primarily done as a cost-savings measure, and it's working out great. There have been no complaints (about drug quality) from anyone and we're all very happy."
But the FDA is investigating CanaRx, the supplier to Albano's Springfield Meds program, and recently persuaded a federal judge to shut down Canadian prescription drug sellers operating within the U.S. -- sometimes in strips malls or other storefronts.
"Many products are cheaper in Canada and elsewhere, but there are laws in effect and breaking the law shouldn't be an option," McGinnis says. "I can also save money getting my automobile from Canada, but that doesn't mean it would have the EPA controls that we require."
Yet he tells WebMD that border police have been instructed not to arrest citizens making personal-use prescription drug buys elsewhere. "It's the commercial entities making money off these illegal operations we're after."
Lower the Price?
Why not focus on those other commercial entities -- and pressure pharmaceutical companies to lower prescription drug costs for American citizens? "We don't have that authority, but the (FDA) commissioner has been saying that prices need to come down," explains McGinnis. "It's an inequity, but it's free enterprise."
Prescriptions from Canada are less expensive because its socialized medicine allows the government to control prescription drug prices, and the U.S. dollar goes further there.
As for the predicted effects of the new prescription drug bill signed into law on Dec. 8 by President Bush?
"From what I can tell, attempts to prevent senior citizens from getting drugs in Canada go into effect immediately while the new coverage for their prescription drugs doesn't go into effect until 2006," says Joe White, PhD, chairman of the department of political science at Case Western Reserve University and a Medicare expert who wrote the academic book, False Alarms: Why the Greatest Threat to Social Security and Medicare is the Campaign to Save Them.
"The bill appears to be more interested in changing the nature of Medicare than in providing prescription drug benefits for seniors who need them," he tells WebMD.
Not everyone agrees. The AARP, which endorsed the legislation, says on its web site that the new law "strengthens, not undermines Medicare by adding a long overdue prescription drug benefit and preserving the basic structure of the program."
What seniors will pay under the new plan is in fact complicated and varying. For instance, the current plan calls for seniors to pay the first $250 of drug costs in one year, then pay 25% of the costs until the bill reaches $2,250. Then there is a payment gap; the plan pays none of the next $2,850 in drug costs. Then, when drug costs reach $5,100 in one year, the benefit begins again and pays 95% of additional costs.
The plan is even much more complicated than this, though, prompting a letter from Health and Human Services Secretary Tommy Thompson to older people next month to explain the law.
In the meantime, the next time that grandmother needs her TriCor prescription refilled? "I'm calling Canada," she says.