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Health
on the border US
News, May 31, 2003 It's become something of a joke
along the Maine-Canada border. So many busloads of retired people
crisscross the line looking for affordable drugs that the roadside stands
should advertise, "Lobsters. Blueberries. Lipitor. Coumadin."
Except, of course, that such a market in prescription drugs would be
illegal. These senior long-distance
shopping sprees fall in a legal gray zone. But as long as people cross the
border with prescriptions from a physician and have them filled for no
more than a three-month supply for personal use, customs and other federal
officials leave them alone. The trip might be tiring, but people can save
an average of 60 percent on the cost of their prescription drugs. For
some, that's the difference between taking the drugs or doing without.
"The last bus trip I was on six months ago had 25 seniors," says
Chellie Pingree, former Maine state senator and now president of Common
Cause. "Those 25 people saved $19,000 on their supplies of
drugs." Pingree sponsored a bill known as Maine Rx, which authorizes
a discounted price on drugs for Maine residents who lack insurance
coverage. The law was challenged by drug companies but recently upheld by
the U.S. Supreme Court. It hasn't yet taken effect. For years, field trips of
senior citizens who live near the borders have been organized to roll
north to Canada and south to Mexico. People in the middle of the country
sometimes found, if their prescription drug costs were especially high,
that they could save money on medications even if they flew to Europe. The
Internet has made it even easier for people to fill their prescriptions
from mail-order pharmacies. Figuring out ways to spend less
on prescription drugs has become a multi-faceted national movement of
consumers, largely senior citizens. The prescription drug bill in America
is $160 billion annually, and people over 65 fill five times as many
prescriptions as working Americans on average. "But they do it on
health benefits that are half as good and on incomes that are half as
large," says Richard Evans, senior analyst at Sanford C. Bernstein,
an investment research firm. What's more, seniors account for 20 percent
of the voting public. Face-off.
It's little wonder that the May 19 Supreme Court ruling got the attention
of drug manufacturers and politicians across the country. The
often-overlooked state of 1.3 million tucked in the northeast corner of
the country became David to the pharmaceutical industry's Goliath. The
face-off began three years ago when state legislators like Pingree began
questioning why Maine's elderly population had to take all those bus
trips. Americans who are elderly and
uninsured pay the world's highest prices for prescription drugs. That's
because they buy their drugs individually, without the bulk bargaining
power of an insurance company or the federal government. Other
industrialized countries, like Canada, France, Germany, and Japan, have
national healthcare systems and can use the bargaining power of their
entire populations to negotiate drug prices and set limits on how much
drug manufacturers can charge. Though Congress has been
debating a prescription drug plan for years, seniors today still have no
drug coverage under Medicare. The Maine plan does not provide a drug
benefit. Seniors and the uninsured would still purchase their own
medicines, but the plan helps them get a discounted price on drugs similar
to that available to Medicaid recipients, in effect bringing hundreds of
thousands of individual (and powerless) consumers into a powerful
negotiating block. Teaming the elderly and
uninsured with Medicaid recipients gives them bargaining power they've
never had before. Drug manufacturers are required to give Medicaid a
discount of about 15 percent below the list price or match the lowest
price on the market. That creates an incentive to keep the market price as
high as possible, says Katharine Greider, author of The Big Fix: How
the Pharmaceutical Industry Rips Off American Consumers. But most
consumers don't notice the high drug prices, because with health insurance
they only pay a small copayment. Only those lacking prescription drug
coverage--including many elderly--end up paying full retail price for
drugs. The law's leverage disturbs the
drug industry. It would create a formulary, or list of preferred drugs,
for this block of patients, similar to those used by many managed-care
organizations. If a manufacturer did not lower its prices, it would not be
on the state's formulary. Drug companies oppose the law as a
quality-of-care issue. "Under Maine's program, government officials,
rather than doctors and patients, would effectively decide which medicines
will be available for Medicaid and non-Medicaid patients," says a
statement from Pharmaceutical Research and Manufacturers of America, the
industry's trade organization. The Maine drug plan was crafted
three years ago, and health officials are now refining a draft of the law
to send to the Legislature. But the pharmaceutical industry is far from
ready to give up the fight. "I don't go to any meetings anymore that
don't have five lawyers sitting around the table," says Peter Walsh,
acting commissioner of the Maine Department of Human Services. Even when
it goes forward, one small New England state's law won't solve the
nation's prescription drug crisis. The greater hope for
consumers--and the greater threat to the industry--is the clout of about
18 other states that have filed bills similar to Maine's. "The point
at which you get half or more states to do this, it becomes a more and
more significant intrusion into the market. And it becomes harder for the
pharmaceutical industry to fight back. That's why they had to fight so
hard against Maine's law," says Sara Rosenbaum, professor of
health-policy law at George Washington University. Going south.
Meanwhile, individual consumers are figuring out their own ways to bypass
steep American drug prices. For example, Bill Goff goes to Tijuana,
Mexico, four times a year. He flies from his home in Reno, Nev., to San
Diego, stays in the Travelodge, rents a car for a day, and crosses the
border to visit Carlos Cortez of Farmacia Internacional with a fistful of
prescriptions. He has a host of medical disorders, including rheumatoid
arthritis, diabetes, asthma, glaucoma, and osteoporosis. He would spend
$32,000 a year on prescription drugs in the United States, but he has cut
his annual cost to $9,500, even including travel costs. "It's not a
matter of saving money. It's a matter of living," says Goff. "If
I didn't go to Mexico, I couldn't afford the drugs. I'd be dead." Others are skipping the travel
altogether, some with the help of 84-year-old Kate Stahl. She is not above
using the "grandmother" image to further a cause. "I'd like
nothing better than to be thrown in jail. People would say, `Oh, the poor,
frail old granny,' " she says with a laugh. "I can be very frail
if I have to." Stahl volunteers with the Minnesota Senior Federation,
helping people get the forms and information they need to get mail-order
prescriptions from Canada. The plan, called the Canadian Prescription Drug
Importation Program (www.mnseniorfed.org), is open to anyone in the United
States. But while no one seems ready to throw the likes of Stahl in the
slammer, the program's legality is murky. Though the Food and Drug
Administration says it cannot guarantee the safety of imported drugs (even
if they're exported from the United States, then reimported, as many are),
individuals filling their personal prescriptions are generally left alone.
But the agency has sent warning letters to profit-making drugstores in the
United States that help consumers get mail-order prescriptions from
Canada, saying that reimporting cheap drugs is a violation of the law and
a risk to public health. Since Stahl and her
organization do not profit from their efforts, so far no one has hassled
them. Rep. Gil Gutknecht, a Minnesota Republican, is trying to pass
legislation that would make it easier for people to get their drugs from
Canada or overseas. Laws to that effect have passed twice before, but both
times the FDA protested that it could not guarantee the safety of drugs
reimported from Canada, and so the law has not taken effect. Still,
Gutknecht is not alone in interpreting present laws in a way that allows
people to buy personal three-month supplies of drugs overseas without
problems. Cortez has a conference table
display of brand-name prescription drugs in his Tijuana office. One by one
he holds them up. Pfizer's Lipitor. Eli Lilly's Prozac. Merck's Fosamax.
They're not loose pills; they are individually bubble-wrapped within
sealed boxes. "We have no doubt that what we're buying is what it is.
It comes from world-class labs," he says. And the 30 percent of his
customers who are American seem to agree. He's aware of the irony: a businessman from the developing world profiting on sales to desperate citizens of the wealthiest country on Earth. "It doesn't get more stark than right here. You can see so clearly: Third World," he says, pointing to the roadside squalor in Tijuana, the concrete barriers at dusk crowded with men waiting for nightfall and a risky dash across the border. "First World," he finishes, pointing toward the city of San Diego across the border. "My business thrives on people coming here from the States. But I shouldn't have people thanking me for making it possible for them to survive when they are from a country like the United States." Copyright
© 2002 Global Action on Aging
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