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Date Posted: 07:50:18 01/16/05 Sun
Author: Repost
Subject: Canadian government may close Internet pharmacy pipeline

Canadian government may close Internet pharmacy pipeline
By ROBERT M. COOK

Staff Writer

Diane Lefebvre of Rochester has always feared that the affordable prescription drugs that she has been buying from a Canadian mail-order pharmacy wouldn’t last forever.

Sooner or later, Lefebvre worried the same big pharmaceutical companies that forced millions of seniors like herself to go north of the border to buy medicine would get their way.

"I thought something would interfere with it eventually," Lefebvre said. Now, that may be about to happen.

Last month, Canadian Health Minister Ujjal Dosanjh said he would draft a proposal to ban the sale of Internet prescription drugs to people living outside of that country. The demand for Canada’s price-controlled prescription drugs has become so great, that Dosanjh has concluded the country cannot afford to jeopardize its national supply for Canadian citizens.

It isn’t a done deal yet, but Lefebvre is already thinking that any debate that could take place in the Canadian Parliament in Ottawa could be just a formality.

"I’m going to wait for it to happen and I really don’t know where I am going to go from here," she said.

In the fall of 2003, Lefebvre decided to purchase blood pressure and cholesterol medications from Canada. She researched the Internet pharmacy she selected in British Columbia.

Ultimately, Lefebvre saved more than $400 by purchasing three-month supplies of her prescriptions from www.doctorsolve.com for $276.30. She calculated the cost of the same quantity of medications from Walgreens in Rochester at $659.70.

The FDA and Department of Health and Human Services refuses to guarantee as safe or effective any drugs imported from Canada, a trade the pharmaceutical industry estimates was worth nearly $700 million in 2003.

Lefebvre said the only way to know if the drugs she is buying work safely is when she has her periodic blood tests.

Like many Americans, Lefebvre believes the drug companies and the U.S. government are to blame for creating a situation where seniors living on fixed incomes have to buy prescription medicine from other countries to survive.

"I am frustrated with many, many things," she said. "I really feel my country is not standing behind me 100 percent now that I am elderly and out of the work force."

When asked if she would try to buy affordable prescription drugs from other countries if Canada is no longer an option, Lefebvre said she would not feel as comfortable doing that. She felt safe buying her medicine from Canada because she feels that country is more akin to the U.S. Even if other countries take Canada’s place as major suppliers of cheaper drugs, Lefebvre believes the pharmaceutical companies eventually also will pressure them.

Girding for battle

North of the border, several Canadian Internet prescription drug firms are determined not to let the Canadian government shut down their businesses.

Robert Fraser, a member of the Manitoba Pharmaceutical Association and pharmacy director of CanadaDrugs.com of Winnipeg, Manitoba, said the province’s premier recently told the firms that he will stand behind them and not let the federal government supersede their right to do business across the border.

He doubts any changes in the Canadian federal Food and Drug Act would override the country’s 10 provinces’ right to oversee medical and pharmaceutical policies.

Canada’s constitution would have to be amended before that could happen, and Fraser stressed there is no way the country’s 10 provinces and three territories would approve such a measure.

"There’s nothing imminent. There’s nothing that’s going to happen," Fraser said. As far as he is concerned, Americans who rely on Canadian prescription drugs have nothing to worry about.

"It will be business as usual," Fraser said.

If approved, Dosanjh’s proposal would prevent Canadian doctors from co-signing prescriptions for U.S. patients without examining them in person, according to information provided via e-mail from Adele Blanchard, the health minister’s press secretary.

Dosanjh’s proposal would also prohibit prescriptions for foreigners who are not present in Canada, and create a list banning certain drugs that are widely used by Canadians from being exported.

Currently, a prescription from a U.S. doctor is faxed to a Canadian doctor who reviews the patient’s health history. The Canadian doctor then signs and faxes the prescription to an Internet pharmacy, which then ships the drug. Dosanjh feels it is unethical for Canadian doctors to sign prescriptions without examining patients.

Dosanjh was expected to present the proposal to Canadian Prime Minister Paul Martin’s cabinet by the end of this month. Blanchard said the proposal would also be reviewed by HealthCanada, which would then recommend which parts of the proposal should be adopted.

When asked if Internet businesses in the provinces could continue selling prescription drugs to the U.S. if changes are made to the Canadian Food and Drug Act, Blanchard said her understanding is that they could not because the act governs the legal sale of prescriptions drugs within and outside the country.

Fraser said the Canadian drug supply has not been jeopardized.

The Canadian government negotiates with the pharmaceutical drug companies for Canada’s socialized medical system.

The way the law is now written, Fraser said an America doctor can go to any Canadian province and be licensed to practice medicine almost immediately. How could the Canadian government then turn around and say the provinces could not honor prescriptions signed by American doctors?, he wonders.

"The Canadian doctor’s involvement is a secondary review," Fraser said.

For companies like CanadaDrugs.com — which the State of New Hampshire has a link to on its Web site for residents looking for affordable prescription drugs — there is a lot at stake.

According to the Associated Press, even though current U.S. law prohibits re-importing prescription drugs, laws are not enforced.

Ten million illegal shipments of prescription drugs worth $1.4 billion entered the United States in 2003, about half of them from Canada. About 1.5 to 2 million prescriptions are filled in Canada each year via this method. Fraser said 90 percent of Canada’s Internet mail-order pharmacies are located in Western Canada.

After he learned about what was afoot in Ottawa, Winnipeg pharmacist Darren Jorgensen of Canadameds.com launched the Web site, www.Americaputmeoutofbusiness.com, to urge Americans to get their elected officials to provide lower-cost drugs if the Canadian government no longer allows his company to help them.

"While Mr. Dosanjh says it is unethical for doctors to write scripts for patients they don’t see and for pharmacists to fill these, I would say it is more unethical to not permit patients to take their prescribed meds due to the fact that they cannot afford them ... Shame, shame, shame, on the Health Minister in Canada and the U.S. for trying to jeopardize the health of under privileged or under-insured U.S. citizens," Jorgensen wrote in a press release issued via an e-mail sent by Betty Maytwayshing, a Canadameds.com spokesperson.

Dave Robertson, president of Total Care Pharmacy Ltd. in Calgary, Alberta, is also upset that Dosanjh wants to stop the mail order pharmacy business.

"American citizens have been crossing the border to purchase lower cost medications for over a decade. My company has just allowed them to now purchase these medications from the comfort of their own home. Many of my customers are seniors, or people who are under-insured or have no health insurance at all. The fact that they purchase medications from my company allows them to do it from the safety of their own home, without having to travel miles across the border, which for seniors is a big issue," Robertson wrote in a press release issued via e-mail by Shelley Tennant-Way, a company spokesperson.


Buy American

As far as the Pharmaceutical Research and Manufacturers of America trade group is concerned, Canada is doing the right thing.

Jeffrey Trewitt, a representative of the Washington, D.C.-based group, said the safety of Americans buying prescription drugs that are not governed by the FDA has been a real problem.

Trewitt said about one-third of the drugs bought online are not really from Canadian Internet pharmacy companies, but are really from other countries whose safety standards are much lower than Canada and the U.S.

There is compelling evidence that some of the medicines that American bought were made and shipped from other countries to Canada before they were transshipped to the United States, Trewitt said.

"That has been happening over the last several years," Trewitt added.

Last spring, Wanda Moebius, who is also a group spokesperson, said Canada is turning into a post office box for drugs from countries like Pakistan, Romania, Bulgaria and Thailand, whose drug exports are up 100 to 300 percent, according to a study published in 2003 by Equity Research, a division of Prudential Financial.

A lot of them display a Canadian flag, false licensing credentials from the Canadian government and even cite a Canadian name in their URL address, Moebius said then.

"There are some bad actors in that segment who know there is some money to be made," she said then.

Trewitt said the U.S. cannot permit people to keep buying lower cost drugs from countries like Canada because it will eventually compromise the pharmaceutical industry’s ability here to develop new medicines and biotechnology treatments. Currently, 60 to 70 percent of the world’s pharmaceutical research and development of new medicines is done in the United States and countries like Canada that have price controls are not able to do as much in that area, Trewitt said.

He said pharmaceutical companies spent $33.2 billion in 2003 on research and development, up from $2 billion in 1980. The industry expects to spend even more on research and development in 2004.

Prescription drugs are a big business. In an Associated Press story, a recent federal report said prescription drug sales totaled $179.2 billion in 2003, which represented 11 percent of all health care spending and represented 23 percent of individuals’ out-of-pocket expenses.

Trewitt acknowledges that the U.S. needs to make more prescription drugs affordable.

He said people who were accustomed to buying their medicine from Canada will have to explore the hundreds of patient assistance programs and medicine discount programs available in the U.S.

His group gave 18 million free prescriptions to 5.5 million people in 2003 and they think that number will grow in 2004 and beyond. The new Medicare drug discount cards approved by Congress will provide seniors with a 15 to 30 percent discount and the poorest seniors can receive that in addition to $600 in credits to pay for their medicines, Trewitt said.

The generic drug marketplace is another alternative that could provide some people with more affordable medicines. Trewitt said Congress has to do more to provide health insurance coverage for an estimated 25 percent of the population that has no plan.

He also urged people to shop around when they have to fill their prescriptions, because a lot of competition exists at many chain pharmacies and retailers.


States not giving up

Regardless of what happens, the three northern New England states that border Canada — New Hampshire, Maine and Vermont — are not giving up.

Shortly after his election, Gov. John Lynch pledged his support for citizens to have the right to buy affordable prescription drugs online.

Pamela Walsh, Lynch’s communication director, said the Democratic governor also believes the U.S. should legalize re-importation so people aren’t forced to break the law when they buy Canadian drugs online.

He plans to join a federal lawsuit filed by Vermont calling for the FDA to legalize re-importation of Canadian prescription drugs, Walsh said.

Former Gov. Craig Benson put a link on the State of New Hampshire’s Web site to CanadaDrugs.com, to give residents a place where they could buy affordable drugs online and Walsh said the link is still there.

Attempts to obtain comment by U.S. Sen. Judd Gregg, R-N.H., were unsuccessful.

Meanwhile, Maine Gov. John Baldacci has requested permission from the federal government to re-import prescription drugs from Canada. If approved, Baldacci would have the drugs shipped to the Penobscot Indian reservation and then distributed statewide.

U.S. Sen. Susan Collins, R-Maine, hopes that Canada will remain a viable option for her constituents.

"I am a strong proponent of proposals to expand Americans’ ability to legally import lower-cost prescription drugs from Canada, and I would encourage the Canadian government not to erect further barriers to international price competition," said Collins in a prepared statement issued by Elissa Davidson, her press secretary.

Fearing that Canada may no longer be an option for its residents, Vermont officials are already looking at which European countries could pick up the online slack.

According to the Associated Press, Vermont lawmakers are looking at a plan adopted by Illinois to re-import drugs from the United Kingdom and Ireland.

U.S. Rep. Bernie Sanders, I-Vt., who staged high-profile bus trips to Canada five years ago to help seniors get access to lower cost prescription drugs, is also pushing the federal government to open up more foreign markets, the Associated Press reported.

"While we don’t think it would necessarily be bad if it was just Canada, we think it is important that the state of Vermont as well as the federal government open as many markets as possible so you don’t give the government and pharmaceutical companies so much power to manipulate the situation," Sanders spokesperson Joel Barkin told the Associated Press.

As they did with Canada’s prescription drugs, the Pharmaceutical Research & Manufacturers of America is already cautioning states not to go this route because of safety concerns.

European imports could threaten safety because they could carry labels in languages that consumers don’t speak, said Wanda Mobius, a group spokesperson, in an Associated Press story.

"There’s no guarantee English will be used. When you start going outside the U.S., you are opening yourself up to a number of safety issues," she said.

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