The war on (affordable) drugs 

Will Montana “just say no” to Canadian med ban?

Under the recently passed Medicare bill, Americans will be allowed to purchase prescription drugs from Canada only after the Food and Drug Administration (FDA) certifies imported drugs as safe. Because the FDA has publicly stated that it has no intention of certifying foreign drugs, this policy adds up to a de facto U.S. ban on foreign prescription drugs—medicines which are, on average, 50 percent less expensive in Canada, with some prescriptions running as much as 80 percent cheaper across the border.

The vast difference stems from the fact that Canada’s socialized health care system puts the government in control of price caps, whereas in the U.S., under the new Medicare bill, the federal Department of Health and Human Services is not allowed to negotiate drug prices with pharmaceutical corporations on behalf of Medicare’s 41 million beneficiaries. In this war on drugs, the federal government has lined up not against Joe Crack Dealer, but against mid-income senior citizens and a growing number of state officials who are beginning to blatantly ignore the FDA rules.

Montgomery, Ala., for example, saved over $400,000 in 2003 by allowing city employees and retirees to get their drugs from a Canadian pharmacy. The state of New Hampshire and both Boston and Springfield, Mass., have told the FDA that they do not intend to obey the law. Illinois’ Democratic Gov. Rod Blagojevich is seeking federal permission to set up a pilot program to import Canadian drugs, and he and Minnesota’s Republican Gov. Tim Pawlenty have scheduled a prescription drug summit at the National Governor’s Association conference on Feb. 24 to discuss the matter further.

Chuck Butler, a spokesman for Montana Gov. Judy Martz, was tight-lipped about whether Montana would consider joining other states in defiance of the FDA.

“The issue’s on our radar screen in terms of the cost of prescription drugs and what can be done about it, but that’s about it at this moment,” Butler says.

Montana’s only known supplier of Canadian medicines was Rx Depot, which operated in Billings before being shut down in November 2003 for aiding and abetting an illegal act (the sale of uncertified Canadian meds) and acting as a pharmacy without a license.

Becky Dayshaw, executive director of the Montana Board of Pharmacy, says it’s the second charge that concerns her—buying medications through an uncertified pharmacy is “like playing Russian roulette,” she says—but she’s not so sure about the first charge, because she questions the idea that Canadian medicines are somehow less safe than their American counterparts, and, by inference, that Canadian medicines should be illegal in the U.S.

“The Canadian authorities do look at their own pharmacies,” Dayshaw says. “If the feds said it’s legal, we would probably feel comfortable with what the Canadian authorities have done.”

No one has identified a single case of a U.S. citizen dying or getting sick due to use of Canadian prescription drugs.

“When they find bad guys, they shut them down just like we do,” says Dayshaw.

But Dayshaw says her hands are tied by the federal government when it comes to providing Montanans access to less expensive Canadian drugs. Dayshaw isn’t eager to steer the board in the direction of civil disobedience like other states and municipalities, but she isn’t ruling it out either.

“We’ve always considered that a line we can’t cross,” Dayshaw says. “However, the more government entities that begin [disobeying the FDA] and the longer it happens and the more prescriptions that are used and seeing that no one or very few get hurt—I imagine it’s going to perk up the antennas of most state boards of pharmacies.”

But can a ban on Canadian prescriptions be enforced in the first place?

“I suppose what we’ll have to do is challenge it,” says Betty Beverly, director of the 3,000-member Montana Senior Citizens Association (MSCA), a group which ran cross-border bus trips for medication five years ago before turning to the Internet.

Lynne Solomon, a public information officer in Montana Attorney General Mike McGrath’s office, says enforcement of the rule will be a local issue. But is local law enforcement seriously concerned with busting rings of senior citizens seeking to spend less money on their monthly pills?

“Frankly, it wouldn’t be a very high priority,” says Missoula County Sheriff Mike McMeekin, adding that he doesn’t agree with the law at all, but that his job doesn’t allow him the leeway to enforce only those laws he approves of. “Priority is based on threats and damage to a victim. While it would be enforced, I wouldn’t assign that a very high priority because I don’t have a victim here,” McMeekin says.

Yet there is a potential victim in the covert purchase of Canadian drugs: the bottom line of American pharmaceutical corporations.

Dayshaw wonders if Americans are paying more for their drugs so that manufacturers can afford to advertise—a taxpayer expense she says pharmaceutical companies rarely tout as loudly as their research costs.

“You can’t turn on TV without seeing ads for some medication with someone hopping through a green field.

“It’d be interesting to see what drug companies contribute to Congressional campaigns,” Dayshaw says. “I’d hope our Congressmen would be of enough moral character that they wouldn’t let that influence them.”

In 2002, the most recent year for which data is available, pharmaceutical and health product corporations gave over $21 million to Republican election campaigns and over $7 million to Democratic election campaigns, according to the Center for Responsive Politics. All three members of Montana’s congressional delegation voted in favor of the new Medicare bill.

MSCA’s Beverly calls the bill co-authored by Montana Sen. Baucus “a tax dodge for the wealthy,” due to its reliance on non-taxable health savings accounts, and questions the American Association of Retired Persons’ (AARP) support of the bill.

“Is the AARP grassroots like we are, or are they a front for insurance companies?” Beverly asks, noting AARP’s possible financial benefit from the bill via its own supplemental insurance and Medicare tie-ins with insurance companies such as Ovations.

Pat Callbeck Harper, associate state director of AARP Montana, says she can’t comment on AARP’s relationship with Ovations, claiming her agency supported the Medicare bill because it will help low-income seniors and rural hospitals.

“States aren’t going to be able to support the Rx help through Medicaid. This program will be a lifesaver for our dual [Medicaid and Medicare] eligibles.

“But we’re not stupid enough to think the big winner of this isn’t the pharmaceutical companies,” Callbeck Harper says, pointing to the ban on Canadian drugs and the U.S. government’s lack of a bargaining capacity with the pharmaceutical industry.

While Beverly says she applauds the stated intention of Sen. Ted Kennedy (D-Mass.) to overturn parts of the new Medicare bill, she hopes Montana seniors will make Montana senators Burns and Baucus and Rep. Rehberg pay for their support of the bill in votes.

“The whole Montana delegation didn’t listen to seniors,” Beverly says. “It’s like they think we don’t know what’s good for us, that they know better. That’s not who Montana seniors are. We need to change this at the ballot box.”

Callbeck Harper agrees.

“Pharmaceutical companies spent an estimated $70–100 million lobbying this bill,” she says. “AARP can’t fight that, so we need to elect different leadership in Washington.”

In the meantime, Beverly’s not about to tell members to stop buying Canadian drugs.

“I don’t see any big headlines saying, ‘Canadian seniors dying from bad drugs,’” she says. “Do you?”

While Montana holds a reputation as a state willing to go against the federal grain when it sees fit, no Montana officials have yet to issue solidarity calls to join Montgomery, Boston, Springfield and New Hampshire in ignoring federal law to save seniors money. But Chuck Butler in the governor’s office says Martz hasn’t made up her mind on the issue one way or the other, and notes that cheaper Canadian drugs are sure to be “a hot topic” at the National Governor’s Association meeting on Feb. 23 and 24.

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