Stroke survivor Edmund Lising is supposed to take four tablets of two medicines each day, including the anti-hypertension drug Norvasc. But to save money, the 58-year-old retiree takes only two a day, supplementing the dose each time with a fervent prayer.

Lising is luckier than most Filipinos. According to government statistics, 70 percent of the 85 million Filipinos have no regular access to lifesaving drugs.

Next to affluent Japan, the cash-strapped Philippines has Asia's second most costly medicines, with some drugs priced 5 to 45 times higher than the same medicines sold in India or Pakistan, the data shows.

Fed up with the situation, officials, consumer groups, health workers and fair trade advocates have teamed up in Effective Medicine at Affordable Prices, a coalition targeting multinational pharmaceutical companies with the aim of cutting the staggering cost of medicines in the country. The group is supporting legislation that would make importing cheaper drugs possible and encourage the production of generic drugs.

The campaign's launch came as the Philippine government is battling the pharmaceutical giant Pfizer over plans to import cheaper Norvasc from Pakistan.

In March, Pfizer sued two government agencies -- the Philippine International Trading Corp. and the Bureau of Food and Drugs Administration -- for alleged patent infringement.

It asked a suburban Manila court to order BFAD to revoke an approved import registration for the anti-hypertension medicine covered by Pfizer's patent. The 17-year patent expires in June 2007.

PITC head Roberto Pagdanganan said his office submitted last year to BFAD 80 sample tablets from Pakistan so that the government could be ready to import the cheaper medicine once Pfizer's patent expires.

A 5-milligram tablet of Norvasc sells for 86 cents in the Philippines, nearly five times more than in Pakistan, where it costs 19 cents, Pagdanganan said. Another Pfizer brand, the painkiller Ponstan, is priced 14 times higher in the Philippines than in Pakistan.

Pfizer's case has angered officials and consumers in the Philippines, where a third of the population lives in poverty and where hypertension is a major killer.

Government data show multinational drug companies hold 70 percent of an estimated $1.9 billion Philippines pharmaceutical market.

Rep. Ferjenel Biron, in a speech in the country's House of Representatives, recently called for a boycott of all Pfizer products. He accused the company of ''persecuting millions of Filipinos who simply could not afford to buy the said medicine and are left with no choice but just to die.''

Pfizer said its actions upheld the importance of encouraging innovation by protecting intellectual property of companies who discover and develop lifesaving drugs.

''This is simply a matter of protecting our patent for amlodipine besylate (Norvasc) through its expiration date of June 2007,'' Pfizer responded in a statement. ''We are seeking legal assurance that there will be no importation of an unauthorized amlodipine besylate product for the duration of this patent term.''

Pagdanganan called the Pfizer suit ''a harassment case,'' and filed a countersuit.
''It's greed and arrogance,'' he said.

He said it takes more than a year to get BFAD's import approval, and by suing, Pfizer was effectively extending its patent. Every year's delay in the entry of the drug from Pakistan translates into $23 million in Pfizer sales of Norvasc, he said.

Pagdanganan said PITC had not sold a single amlodipine besylate product in the Philippines and has promised not to do so until Pfizer's patent expires. The only issue, he said, is whether importing samples of patented drugs for registration purposes constitutes patent rights infringement.

The practice is allowed under the ''Bolar Provision'' of the World Trade Organization's trade-related aspects of intellectual property rights, known as TRIPS. But the provision is not spelled out in the Philippines' Intellectual Property Code.

TRIPS also allows countries to do ''parallel importation'' of a medicine, sold at a cheaper price in another country, even without the approval of the patent holder.

Philippine officials blamed the country's high drug prices on a pharmaceutical marketing and distribution cartel, the myth that cheaper generic drugs are less effective, a patent system skewed in favor of multinational companies and heavy dependence on imported raw materials.

''The system has been so co-opted, if not corrupted, by some of these companies that the people are not left with so much choice,'' said Pagdanganan, whose office aims to cut in half by 2010 prices of medicines commonly bought by the poor.

Sangeeta Shashikant, a researcher for the Third World Network, a Malaysia-based non-governmental organization, said big pharmaceutical companies often have a monopoly of patents and often, there is not much innovation to add to the cost, because drug companies are able to obtain new patents for only slightly modified versions of a drug -- a practice known as ''evergreening.''

A World Health Organization report issued in April said in developing countries with inadequate technological capability, the fact that a patent can be obtained may contribute nothing or little to innovation. ''Patents may contribute to increasing the prices of medicines needed by poor people in those countries,'' the report added.

Jim Nibungco, a stroke survivor and officer of the Stroke Survivors Support Foundation, said he has seen so many stroke survivors unable to buy needed medicines.

''Once they see the price of the medicines, they just close their eyes because they could not afford to buy them,'' he said.

The coalition for cheaper medicine supports a bill that would amend local patent laws to keep them in sync with WTO rules, including clearly allowing parallel importation of drugs. The bill has been endorsed by a joint Senate committee for plenary approval.

A staffer of the main proponent, Senator Mar Roxas, said the bill has been supported by majority of the senators, and it may be sponsored on the floor by July.

The bill also seeks to shorten the period of patent protection, empower the local generics industry to experiment on drug formulas even before their patents expire, and deny new patent protection for slightly modified versions of a patented medicine.

The PITC said government will put up more ''people's drug stores'' selling cheaper medicines to provide competition to big pharmaceuticals. Price controls for off-patent medicines, and a cap to spending on pharmaceutical advertising, also are being considered.

Proponents of the bill said it has a good chance of being passed. A majority of the senators, including Senate President Franklin Drilon, have already signed the bill as co-sponsors.

Nibungco, the stroke survivor, said he hopes that with the passage of the bill, hard-up Filipinos will no longer need to close their eyes, unable to buy needed drugs.