Health Biz: Drug import battle heats up

ELLEN BECK, United Press International

WASHINGTON, June 24 (UPI) -- The battle over prescription medications imported from Canada and other countries solidified this week on Capitol Hill.

The House Appropriations Committee's voice vote approval Wednesday moved forward an agriculture bill that contained language forbidding the Food and Drug Administration from enforcing its ban on prescription drug reimportation.


It's not likely the Senate will include the ban, and even less likely the language will survive a Republican-led conference committee.

Still, GlaxoSmithKline has taken an ad out in a Capitol Hill newspaper talking about the dangers of importing drugs -- arguing that consumers cannot be sure where the drugs actually come from.

Also Wednesday, the FDA and National Association of Boards of Pharmacy told reporters they strongly oppose importation of prescription drugs into the United States. Tom McGinnis, FDA's director of pharmacy affairs, said the agency consistently has helped states enforce importation laws and shut down storefront and Internet pharmacies illegally importing drugs. He said the FDA's concerns include the use of unregulated ingredients, quality control issues, shipment and authenticity of imported drugs.

Carmen Catizone, NABP's executive secretary, said the association supports state laws and action against importation and opposes federal legislation that bypasses state boards of pharmacy licensure and creates federal licensure, which would be too difficult to regulate.


Catizone said the NABP would support federal legislation that allows FDA-approved drugs from FDA-registered pharmacies, requires Canadian pharmacies to submit to state licensure and follow state regulations, provides that Canadian governments revoke licenses from pharmacies that violate U.S. or state laws, and provides resources for inspecting pharmacies.

The NABP certifies licensure through its Verified Internet Pharmacy Practice Sites program, which allows legitimate, U.S. online pharmacies to display the VIPPS seal. The program could be extended to certify Canadian online pharmacies if importation from Canada is legalized, but it would be impossible to extend to other countries effectively, Catizone said.

He also said the association, which represents U.S. state boards of pharmacy, has received 100 direct complaints from consumers about problems or injuries from imported drugs.

(Thanks to Science intern Elizabeth Suh for contributing to this item)


Crowd-out may seem to be a fringe issue for health insurers but it's one that has their attention. Crowd-out is when people drop private health coverage or employers change insurance offerings solely because they become eligible for a publicly financed program -- Medicaid or the State Children Health Insurance Program, for examples. Crowd-out also occurs when low-income workers decline an offer of employer-based health coverage because a government-sponsored program is available.


Linda Bilheimer of the Robert Wood Johnson Foundation is part of the Synthesis Project, which studied the crowd-out issue in hopes of being able to attach some statistics to a confusing and complex topic. It is very difficult to discern crowd-out from the other reasons why people might drop health coverage -- changing jobs, lack of affordability, etc.

"We haven't been able to analyze it and it's very difficult to analyze how far coverage offered is affected because public coverage is there," she told UPI's HealthBiz.

All of this adds to instability -- a major concern for health plans.

"One of the things health plans have to struggle with, especially with low-income families, is (that) health insurance coverage is often very unstable," she said. Crowd-out adds to the problem of low-income workers moving in and out of jobs that may or may not offer health insurance. They might be privately insured for half the year and on Medicaid the other half.

"One of the problems with unstable coverage is that it is difficult to provide, and there are fewer incentives to provide the preventive, comprehensive services to families who are moving in and out of coverage," she said.


Crowd-out, of course, is costly for state Medicaid programs, and some states have tried to corral it by instituting waiting periods for public program enrollment and cost-sharing.

Bilheimer said the problem then becomes a "two-edge sword" and a matter of fairness. The waiting period might prevent a crowd-out situation, but "making it harder to enroll makes it tough for people who really need it."


Sen. Max Baucus, D-Mont., wants physicians, hospitals and health plans participating in Medicare to have a pay-for-performance option. Baucus this week introduced the "Medicare Quality Improvement Act," which would set up PFP within Medicare Advantage, the managed care arm of Medicare.

The concept ties payments to quality improvements in structure or capacity, such as employing telemedicine.

Jack Ebeler, president of the Alliance of Community Health Plans, wrote to Baucus that although his group favors PFP programs, "we are very concerned about the bill's financing of payment for quality through a withhold," a reference to the language in the bill calling for a 2 percent withholding of funds from health plans to finance a payment pool.

"It is important to emphasize that we do not believe that a withhold provides the firm financial foundation for quality improvement that your legislation envisions," the letter said. "A new, dedicated stream of financing is required to stimulate and support the significant level of quality improvement necessary to transform health care for beneficiaries -- the objective that all of us share."



Fewer medical students aspire to be the next Dr. Ben Casey -- the famous neurosurgeon played by Vincent Edwards on the TV medical drama of the same name that ran in the early 1960s.

Medical students at the University of Texas-Houston said being a surgeon would cut too deeply into personal and family time. Dr. Susan Brundage, an associate professor of surgery at Stanford, conducted focus groups involving 29 med students.

Compared to past surveys, the interest in becoming a surgeon peaked in 1981 at 12.1 percent of senior med students surveyed and dropped to 5.3 percent by 2002.

"There is a concern," Brundage wrote. "Surgery is a highly valuable commodity and as the numbers of surgeons are on the decline, access to surgical care will be more difficult. Even at this time in the United States, there are waiting lists of six to eight months for some non-emergency surgical procedures."

Students who nixed a surgery specialty also listed family and personal time as their top priorities. In contrast, most students interested in surgery felt the sacrifice was necessary and acceptable.


The healthcare industry isn't winning any popularity contests these days, according to a new Harris Interactive poll. The survey ranked 15 industries and this year's list saw both the pharmaceutical and health insurance sectors continuing a multi-year slide.


In 1997, the survey found 79 percent of respondents thought pharmaceutical companies were doing a good job. That number has now slipped to 44 percent. In 1997, some 55 percent said insurers were doing a good job for consumers but that has dropped to 36 percent in 2004 -- and to 30 percent if just managed care insurers are considered.



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