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Date Posted: 08:48:56 12/12/03 Fri
Author: Bennie
Subject: Canada: New Hampshire to put Canadian drugs mere click away for its residents

New Hampshire to put Canadian drugs mere click away for its residents

Friday, December 12, 2003

By Maeve Reston, Pittsburgh Post-Gazette

PORTSMOUTH, N.H. -- In just over a week, New Hampshire plans to become the first state to help its residents buy cheaper medicines from Canada. All it will take is the click of a mouse on a state Web site and a prescription from a licensed New Hampshire doctor.

The state also plans to buy prescription drugs in bulk from Canada for its prison inmates and some Medicaid recipients.

It's a politically popular move, and Gov. Craig Benson's aides are praising the savings taxpayers will realize. But it is also illegal under the guidelines of the Food and Drug Administration, and other U.S. states and cities poised to do the same thing are watching closely to see if New Hampshire gets away with it.

More than a dozen states are thinking about buying drugs from Canada, including Ohio, West Virginia, Illinois and Minnesota. Boston Mayor Thomas M. Menino announced this week that his staff will develop a voluntary pilot program for city workers and retirees. And the city of Springfield, Mass., has been allowing employees and retirees to purchase drugs from Canada since July. So far, the FDA has not cracked down on Springfield, although it has sent warning letters to the city's Canadian supplier.

Benson's administration is preparing to launch the biggest and boldest plan to date, however, which is likely to put New Hampshire on a collision course with the federal government, the powerful U.S. pharmaceutical industry and even small independent pharmacies in New Hampshire, who were surprised that their business-oriented governor didn't consult them before announcing his Canadian initiative.

As increasing numbers of Americans struggle to pay for their prescription medications, political leaders at all levels of government are feeling the pressure. The Medicare drug benefit that George W. Bush's administration pushed through Congress is seen as a key plank of his re-election bid.

On the campaign trail, voters frequently tell Democratic presidential contenders stories about having to split their pills in half because they cannot afford to take the full dose, and the candidates often get the loudest applause when they bash drug companies. Americans are trooping in ever larger numbers across the border or onto the Internet to buy Canadian drugs.

FDA officials have met with state and city leaders and tried to dissuade them from doing the same. But the force of the agency remains largely untested, even as it increasingly raises safety concerns and describes the difficulty in tracing the origins of some drugs sold in Canada.

"There is no question that this is growing topic," said Richard A. Cauchi, health care program manager for the National Conference of State Legislatures. "We have seen a proliferation of plans, but not a lot of action."

The city of Burlington, Vt., plans to start a Springfield-type plan in February, and when Mayor Peter A. Clavelle was asked in a telephone interview yesterday whether he was worried about punitive action from the FDA, his answer was a simple, "No."

"The FDA has a different opinion different days of the week," Clavelle said. "It's not clear. It's a question of interpretation of the law."

Clavelle also said one aim of the program is to pressure federal agencies to lower the cost of prescription medicines. "Part of this is about applying pressure on the federal government to access safe and affordable drugs," Clavelle said.

Adding to the confusion ? or what some states and municipalities see as wiggle room ? the FDA has said it is not interested in monitoring the busloads of senior citizens who cross the border to purchase drugs.

"We don't go after individuals," said Thomas McGinnis, the FDA's Director of Pharmacy Affairs, when asked about the policy.

Wendell H. Packard, Benson's spokesperson, said that's why his state is focusing mainly on helping individuals find cheaper prescription drugs. Packard said once the FDA sees the safety controls New Hampshire is putting in place, it might even approve the program.

When the FDA's McGinnis was asked what might trigger a crackdown, he said the agency is looking at each city and state initiative on a case-by-case basis to see if they are "clearly breaking federal law."

The FDA is currently waiting to see how long Springfield's program remains in place after the outgoing mayor leaves office, and it won't assess the legality of the Boston or New Hampshire programs until their details are finalized, McGinnis said.

"It seems like the governor is changing all the time, so we have to wait to see exactly what they do," said McGinnis.

The cost savings involved are still unknown. Canadian companies advertise savings of 40 percent to 60 percent on many popular medications ? savings made possible by government price controls and bulk purchases.

Benson's aides said they could not yet calculate the savings for New Hampshire. Aides to Springfield Mayor Michael J. Albano said the city has shaved about $1 million from its drug costs since July.

If all of the city's roughly 7,000 employees and 2,000 retirees and their dependents chose to get the Canadian drugs (a total of about 20,000 people), Springfield believes it could save $9 million a year.

Another open question is how the increasing demand from Americans and their local or state governments will affect Canada's drug supply.

Ronald Guse, registrar for the Manitoba Pharmaceutical Association, which oversees pharmacy regulation in the Canadian province, said the rise in U.S. demand over the last few years has been phenomenal. And it has resulted in about a half dozen U.S.-based drug companies threatening to reduce supplies in Canada if their discounted products continue to pour across the border into the United States, where the companies can fetch higher prices.

"Certainly on the individual level there is no difficulty in supplying to Americans," said David Gratzer, a Toronto doctor, a senior fellow at the Manhattan Institute and author of the 1999 book, "Code Blue: Reviving Canada's Health Care System."

"But the pharmaceutical companies are trying to restrict supply and they are trying to do it in a strategic manner so a Canadian can walk into a pharmacy and get drugs, but the mail order pharmacies are having a harder time.

"If states start reimporting what they'll find out pretty quickly is that the drug companies will get more sophisticated in restricting supply," Gratzer said. "The Internet pharmacies will run out of drugs. If Minnesota or better yet Illinois tries to reimport on a large scale, they are going to run into problems pretty quickly."

Representatives from Pfizer, the largest U.S. drug company, said yesterday that they have made their opposition to the importation of their drugs from Canada very clear to state legislators and members of Congress. Spending by the pharmaceutical lobby in the first six months of this year increased by 18 percent over the same period last year.

"It's a very important issue to the industry," said Jack R. Cox, spokesperson for New York-based Pfizer.

Small independent pharmacies, like Edward McGee's in Enfield, N.H., also are concerned about losing business and seeing their customers possibly end up taking the wrong drugs or doses.

"In a small town like this we know all customers and patients," McGee said. "We can serve them a lot better. When they have question they want to come in and talk to us. We actually answer our phones."

But he also said he doesn't expect the reimportation issue to be around for long given the political clout of the major drug companies.

"It's a fairy tale," he said. "It's not going to last."

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