Cheap
Drugs From
Canada
: Another Political Hot Potato
By
Gardiner Harris, The
New York
Times
October
23, 2003
For years, just about the only Americans regularly buying drugs in
Canada
were thrifty gray-haired New Englanders. Now, with state budgets squeezed,
it is the nation's governors who are demanding access to
Canada
's cheap drugs. Here in
Kentucky
, the issue has become central to a tight governor's race.
The state's Democratic attorney general, Ben Chandler, has spent much
of his remaining funds on an ad campaign that reminds voters that his
Republican opponent, Representative Ernie Fletcher, voted in Congress
against legalizing drug imports from Canada.
In a televised debate Monday night, Mr. Chandler accused Dr. Fletcher
of "being in the pocket of prescription drug manufacturers."
Dr. Fletcher, a nonpracticing family physician, denies the charge. But
he has had to spend precious money and time explaining why he voted
against legalizing drug imports.
"I knew when I voted against it that it would be an attack
issue," Dr. Fletcher said in an interview after the debate. "But
as a physician, I took a Hippocratic oath to do no harm, and some of these
drugs are dangerous."
Drug makers long ignored the trickle of patients who trooped across the
border to buy drugs cheaply, but that trickle is threatening to turn into
a flood. The growing political support for drug imports has galvanized the
industry against one of the most serious threats to its profits since the
Clinton
health care proposals of 1993.
The governors of
Minnesota
,
Illinois
,
Iowa
and
Wisconsin
have said in recent weeks that they want to import cheaper medicines from
Canada
, saving state budgets and their citizens millions in the process.
"The reason you have the beginnings of a prairie rebellion here is
that there is a crisis and nobody has properly responded," said
Minnesota
's governor, Tim Pawlenty, a Republican.
Illinois
's governor, Rod R. Blagojevich, a Democrat, is stumping for an online
petition to persuade federal officials to allow drug imports.
"There's nothing that can stop an idea whose time has come," he
said.
State officials in
Massachusetts
say they are also considering imports, and the city of
Springfield
,
Mass.
, is using a Canadian pharmacy for its employee health plan. John Taylor,
the top enforcement official of the Food and Drug Administration — which
opposes such efforts — calls the push for drug imports a
"tsunami" that the agency is having trouble tracking.
A measure legalizing imports is part of the Medicare prescription drug
legislation that House and Senate negotiators are trying to reconcile in a
conference committee. The proposal passed the House in July, but 53
senators signed a letter circulated by the drug industry saying they
oppose drug imports. Since the measure is also opposed by the House's
Republican leadership, its prospects in the conference committee at first
seemed dim.
But F.D.A. officials and industry lobbyists say that conference members
are searching for a compromise that would allow drug imports for a trial
period, perhaps a year. That such a deal is being considered at all is a
measure of how far the politics of the issue have evolved, after years in
which the drug industry's determined opposition seemed the final word.
Drug makers remain adamantly against any compromise. "A pilot
program with American patients as guinea pigs is a proposition that no
responsible lawmaker should support," said Jeff Trewhitt, a spokesman
for the drug industry's trade association, PhRMA.
But support for the industry has eroded as the gap between drug prices
in the
United States
and the rest of the industrialized world has grown. Surveys by a Canadian
health agency have found that American prices are, on average, about twice
those in
Canada
and nearly three times those in
Italy
. With price controls in most other countries, the industry last year made
half its sales — $200 billion worth — in the
United States
for the first time.
In
Kentucky
, the drug price gap has many people grumbling. Mark Nickolas, Mr.
Chandler's campaign manager, said that the campaign had focused on the
issue of drug imports because polling found that it resonated with voters.
Last month, Mr. Chandler filed suit on the state's behalf against five
of the nation's largest drug makers, claiming they had cheated
Kentucky
out of millions of dollars. With the suit, the state belatedly joined a
longstanding effort, spearheaded by federal prosecutors, to crack down on
certain drug-pricing practices.
Mr. Chandler castigates drug makers at almost every opportunity. He
tells voters that he intends to cut $150 million from the $700 million
that
Kentucky
spends on drugs for Medicaid beneficiaries by "taking it out of the
hide of drug companies." He supports efforts to obtain drugs from
Canada
and wants to establish a drug buying pool with other states.
On the stump, he also points out that Dr. Fletcher, in his 2000
Congressional campaign, benefited from more than $500,000 in ads paid for
by the drug industry.
In an interview Monday, Dr. Fletcher said he did not believe that the
drug-import issue would sway many
Kentucky
voters. He said that he was concerned that American consumers were the
only ones being asked to pay for drug research, and said the state's drug
bill could be cut by reducing the number of prescriptions that some
Medicaid recipients receive.
Drug prices are by no means the only issue in the campaign. Taxes,
gambling and a fierce fight over negative campaigning are in the
foreground, too. A recent poll by The Courier-Journal of
Louisville
found the candidates virtually tied.
Dr. Fletcher's worries about the safety of drug imports are echoed by
the F.D.A., which has begun a very public effort to illustrate the
dangers. Last month, the agency announced that spot inspections of 1,153
mailed packages containing drugs from abroad found that most were
counterfeit and many were dangerous. The F.D.A. is seeking to shut the
largest chain of stores that helps Americans buy drugs from
Canada
.
But many import proponents say that the F.D.A. is exaggerating, and
they point to the growing popularity of imports as proof of their
benefits.
Governor Blagojevich of
Illinois
said in a telephone interview Tuesday that the state spent $340 million
last year on prescription drugs for 230,000 state employees and retirees
— a tab he said could be cut by tens of millions with drugs from
Canada
. Mr. Blagojevich said that
Washington
gave the drug industry steep tax breaks to support research and asserted
that drugs sold in
Canada
were as safe as those sold in the
United States
.
Governor Pawlenty of
Minnesota
said that the states could resolve any safety worries by identifying
Canadian pharmacies that can be trusted to provide safe products. "We
could bring some due diligence to the process and help bring about
consumer protection," he said.
Bob Leitman, a pollster with Harris Interactive, said that a recent
survey found that 7 percent of Americans said they had purchased drugs
from
Canada
, up from 5 percent last year. With more Americans aware of the sharp
cross-border price differences, he said, the issue will only grow in
political importance.
Should a bill legalizing drug imports pass Congress and be signed by
President Bush, the drug industry still could defend its profits. Already,
some drug makers are limiting sales to Canadian pharmacies so they can
only get enough drugs to fill prescriptions written in
Canada
.
"I think there'd be a longtime game of cat and mouse in which the
industry limits the damage," said Richard Evans, an analyst with
Sanford C. Bernstein. Even if its tactics lead to drug shortages in
Canada
and
Europe
, he added, "the industry is clearly going to defend its most
profitable market at the expense of less profitable markets."
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