Analysis: Foreign pharmacies no U.S. threat

Worries of U.S. pharmacists that their jobs might be exported to Canada as more U.S. consumers go on the Internet to buy cheaper prescription drugs are overblown.

A total of 5,299 people in Wisconsin and Minnesota went online to order prescription medicines from Canada in the first six months state-approved Rx Web sites were in operation, and the number of consumers using the sites is declining, Wisconsin public health officials report.

Only 765 prescriptions were filled via the Internet from pharmacies and suppliers in Canada in February, the first month Wisconsin's site was up, but Gov. Jim Doyle is not disappointed.

Doyle said Wisconsin has one of the highest percentages of residents with health insurance of any of the 50 states and that its Medicaid, BadgerCare and SeniorCare programs cover thousands more elderly residents.

Minnesota, which launched its prescription-drug Web site in January, found Canadian pharmacies had filled 3,000 prescriptions at the end of the June.

About 17,000 residents of Illinois and Wisconsin have signed up for the I-Save-Rx program announced by Illinois Gov. Rod Blagojevich last month. Missouri also joined the plan, which links consumers to CanaRx, an online clearinghouse that handles refills only of the 120 most commonly prescribed prescription drugs. The prescriptions are filled by a network of 45 pharmacies and suppliers in Canada, Ireland and the United Kingdom.

More than 1 million people in the United States purchase about $795 million worth of prescription drugs from Canada each year. Slow adoption of Internet pharmacies is not because more people have health insurance. About 65 million Americans don't have prescription-drug coverage; more than 44 million have no health coverage at all.

Maybe consumers lack the confidence to order drugs online? The paperwork may be too complicated, or people may be heeding warnings from the U.S. Food and Drug Administration and several state pharmacist associations that raise concerns about the safety of drugs obtained outside the United States.

A survey by the Pew Internet and American Life Project found 4 percent of people in the United States have used the Internet to buy prescription drugs. Sixty-two percent said they don't trust drugs sold on the Web. Consumers who bought drugs online tended to be upper income and have six years of Internet experience. Three-quarters of online drug purchases were for blood pressure and arthritis medicines.

Online drug sales reached $407 million last year.

Some prescription drugs are 30 percent to 80 percent cheaper in Canada than in the United States because of government price controls limiting price increases to inflation. The FDA says the programs of Wisconsin, Minnesota and Illinois are illegal and that it cannot guarantee the safety of foreign drugs, but federal officials have made no effort to shut the state Web sites down.

Vermont Gov. Jim Douglas is suing the FDA over its refusal to authorize a state drug-importation program. The FDA is reviewing Oregon's request for a waiver to permit re-importation of prescription drugs from Canada that would be tested by the state's Board of Pharmacy.

About 14 states and nine municipalities facilitate drug importation or plan to do so, according to Thompson Financial's Employee Benefit News.

Wisconsin and Minnesota link consumers to three state-approved Canadian pharmacies, but the Pharmacy Society of Wisconsin repeatedly warns that drugs from Canada may be unsafe.

The Illinois Pharmacists Association launched an ad campaign called "Waive Goodbye To Your Rights" last month to alert consumers they lose their consumer rights when they use the new I-Save-Rx program.

"When you purchase drugs from any foreign Internet pharmacy, including the governor's I-Save-Rx site, you are forced to agree to a waiver that basically gives away all your rights as a consumer," IPHA's ad says.

The group introduced the Illinois Pharmacy Patients' Bill of Rights to educate consumers of their rights when buying FDA-approved medicines from state-licensed pharmacists.

The pharmacists' group said drug buyers on the Internet forfeit the right to get a refund for bad medicine, give up any legal recourse against the state, may not receive detailed information about drugs they are shipped, and will not be reimbursed for health problems caused by taking the wrong medicine.

"Illinois is urging consumers to be confident that they can buy drugs safely through the I-Save-Rx Web site, while at the same time asking them to sign a waiver that says the State of Illinois can't assure a drug's safety," said Thomas McGinnis, the FDA's director of pharmacy affairs. "You can't have it both ways. Either the state of Illinois stands behind the safety of the products it recommends or it doesn't."

Consumers could sue the drug manufacturer but not the state.

Some Canadians are not happy that people from the United States are buying up their supplies of medicines. Last month a group of Canadian seniors, pharmacies and patients asked Ottawa to ban the export of prescription drugs by "cross-border" online pharmacies.

Some fear shortages of vital medicines for chronic illnesses if pharmaceutical giants cap supplies to Canada.

Health Canada said it monitors prescription-drug sales and that sales to U.S. consumers have not caused any shortages. The Canadian International Pharmacy Association said Internet pharmacies are no public danger.

"Should there be any evidence of shortages as a result of cross-border drug sales or the actions of drug manufacturers, Health Canada will take appropriate action," a Health Canada spokeswoman told CTVNews.

Pharmacists say consumers can save by buying generic drugs in the United States.

More than 20 patient and healthcare advocacy groups Tuesday launched a new discount-medicines Web site and hotline for uninsured and underinsured residents called Rx for Illinois that has information on about 1,800 medications and 275 patient-assistance programs.

"Few situations are more frustrating for physicians and their patients than to have treatment available and not be able to access it," said Dr. Hugo Alvarez, a board member of Community Health Clinic.

The program cuts paperwork by allowing consumers to answer 10 simple questions on a Patient Assistance Program to find out which discount prescription-drug programs they qualify for. Ohio, Rhode Island and Wisconsin have similar informational programs.

"The challenge has been finding a convenient, single point of access that will help patients easily determine which programs they qualify for," said Susan Tybon of the Leukemia and Lymphoma Society of Illinois.

--

(Please send comments to nationaldesk@upi.com.)