News Article

Worth The Trip: Seniors Say Cheap Medication Worth the Trip to Canada
Newsday  

The journey took her across the U.S.'s northern border to Montreal where the 74-year-old retired secretary bought a six-month supply of prescription drugs for $600 less than what she would have paid at her neighborhood drugstore in Maine.

"Something is not right here in the United States," said Dennison, who joined 35 other silver-haired passengers from Maine, New Hampshire and Massachusetts last month on a search for cheaper medicine in Canada. "These drugs come from the same place. Why are they sold here at a higher price than in Canada?" Faced with soaring drug costs, Dennison and other senior citizens desperately search for ways to save money on their annual health care bills, which can eat up to 30 percent of their fixed incomes-much of that on prescription medication.

From Maine to Minnesota and Texas to California, seniors are crossing into Canada and Mexico to buy medicine because Medicare, the federal health insurance program for the elderly and disabled, doesn't offer prescription drug coverage and many seniors cannot afford supplemental insurance to cover those costs.

Across the country, seniors also are staging protests, organizing conferences and raising the issues at town hall meetings, in state legislatures and in Congress. A senior advocacy group in New York recently spread word about a program run by Pequot Indians in Connecticut that offers discounted mail order prescription drugs to seniors nationwide.

Other seniors are rationing their medicines in hopes of stretching their supply, advocates say.

"It's an underground problem," said Bruce Stuart, a professor at the University of Maryland's School of Pharmacy in Baltimore and director of the Peter Lamy Center on Drug Therapy and Aging. "What you see is individuals trying to cope with the problems of high cost and finding a lot of different ways of trying to do this." In Congress, lawmakers have proposed several bills to add prescription drug coverage for Medicare recipients, allow drugs to be re-imported into the United States at cheaper prices and force drug companies to sell medicine to seniors at the discounted rates offered to some government agencies.

But supporters of such measures face an uphill battle against the powerful drug industry lobby that has teamed up to launch a $30 million ad campaign to kill most of the proposals.

Pharmaceutical companies acknowledge that drug prices have increased, but say much of that is due to a dramatic rise in the cost of research and development for new medicines, with the cost of developing a single drug having climbed four-fold to $500 million since 1976. Drug companies contend that such innovations that reduce the need for costly hospitalizations would only be stifled by government price controls.

"We want to have a Medicare system that is reformed that includes a prescription drug benefit," said Greg Reaves, a spokesman for Merck & Co. Inc., a drug company based in New Jersey. "But it's got to be done in way that protects innovation for pharmaceutical companies." Nationally, the cost of drugs has become an important component of the health care debate. And as the 2000 elections heat up, senior groups vow to make prescription drugs a key campaign issue. In New Hampshire, the American Association of Retired Persons, a potent lobbying force, launched a campaign to ensure the issue is a priority in the key primary state.

One reason the issue has come to the forefront in recent years is that the growing number of seniors are living longer, many with long-term illnesses that require multiple medications. Spending on prescription drugs rose 11 percent per year from 1992 to 1997, according to the General Accounting Office, the congressional watchdog agency. The prices of new brand drugs are almost twice those of older medications, the report found.

Beyond that, experts on aging say supplemental prescription drug coverage is becoming more costly and less available for Medicare beneficiaries.

And even though many seniors have turned to managed care organizations, which do offer prescription drug coverage, many of those plans are reducing drug benefits or raising premiums and copayments.

Meanwhile, employer-sponsored retiree plans that once offered generous benefits, including drug coverage, have steadily declined.

Dennison's bus left Portland, Maine, one Tuesday morning last month, picking up seniors along the way as it made the six-hour trip to Montreal. None of the participants had prescription drug coverage nor qualified for Medicaid, the federal insurance program for the poor that offers drug benefits.

"People are going up to Canada and buying the same damn drugs," said John Marvin, president of the Maine Council of Senior Citizens, which organized the trip. "The FDA Food and Drug Administration will not allow Americans to import from Canada through the mail. Well, it's damn ridiculous because these are drugs made in America." It's perfectly legal to fill a prescription in Canada, as long as a doctor there signs the order, and even that requirement is often waived for seniors.

A few years ago and hundreds of miles away in Minnesota, Kate Stahl and her ailing husband joined seniors for a bus trip to Canada to buy medicine and bring attention to the cost differences.

"We did get a lot of publicity," recalled Stahl, 80. "But it didn't change anything of course it didn't change the manufacturer's prices any." Despite price controls in Canada, American companies still sell drugs there.

"It is a marketplace and we have to deal with it," said Jeff Trewhitt, spokesman for the Pharmaceutical Research & Manufacturers of America, a Washington-based trade group for drug companies. While the U.S. drug industry supports proposals pending in the Senate to expand drug coverage under Medicare, it wants the benefit limited to private insurance plans and opposes government regulations that could freeze prices.

U.S. drug companies say Canada's experience shows that government controls keep prices artificially low in that country. They argue that while the cost may be lower, it comes at a price: less research and development of drugs and years of delay before a new drug is available.

In the United States, for every five medicines used in clinical trials, only one is approved by the FDA, Trewhitt said, leaving companies with no immediate return on their investment for those rejected.

In upstate New York, Logan McCurtis sidestepped the cracks in the sidewalks, quickening his pace as he walked past a mix of well-kept homes and boarded-up buildings in his Buffalo neighborhood.

The 82-year-old had just finished lunch for seniors at the Friends to the Elderly Youth & Family Center and was making an afternoon stop at the Rite Aid Pharmacy where he dropped off three empty medicine bottles. McCurtis left relieved. Now that he's in a state program for the elderly, he pays only about $3 for each prescription.

For years, McCurtis paid full price for his medicine, once shelling out $300 for 100 pills to treat a prostate problem. "I went ahead and did it because I knew I had to do it," said McCurtis, a retired chemical plant worker who also has arthritis, high blood pressure and gout.

There were times, particularly at the end of the month, when money fell short and McCurtis put off refilling his medicine. "I was neglectful to myself," he said.

Nationwide, 38 million people are enrolled in Medicare. Most have drug coverage through private insurance, Medicaid or employer retiree plans, but one-third have no coverage at all.

Of the nation's Medicare beneficiaries with supplemental drug coverage, nearly half spend $500 to $999 a year for drugs while another 42 percent spend more than $ 1,000, according to a recent study by the AARP. Poor beneficiaries who are not eligible for Medicaid spend 13 percent of their income on drugs, the AARP study found.

Only 14 states, including New York, have programs to help seniors who don't meet income cutoffs for Medicaid. Many of them however, require co pays and high cost sharing.

Responding to the problem, Rep. Bernie Sanders (I-Vt.) proposed legislation that would allow American pharmacists and distributors to re-import prescription drugs sold in other countries, like Canada, at lower cost.

"We have a totally absurd situation in which American companies are selling their products all over the world, including Canada and Mexico, at far lower prices than here," said Sanders.

Another bill, introduced by Rep. Tom Allen (D-Maine), would allow seniors to buy drugs at the negotiated discount prices offered to federal government programs, such as Medicaid.

In New York, state Sen. John Marchi (R-Staten Island) has proposed legislation that would force drug companies to sell medicine in New York at no more than what it is sold for in other places.

Jim Martin, president of the 60 Plus Association, a nonpartisan conservative group, and other senior groups fear proposed solutions would cost too much and instead support measures that channel federal aid to low-income seniors.

To counter the pharmaceutical industry's campaign to stop legislative proposals, consumer groups from Buffalo to Wisconsin also are planning bus trips to Canada. Senior groups are also urging members to flood lawmakers with calls, faxes and even copies of their prescription drug receipts.

"Until congressional representatives wake up and see these ... maybe the cost of the drugs won't sink in," said Michael Burgess, executive director of the New York Statewide Senior Action Council, which is hosting a conference in Albany this week.

With borrowed money from family and friends, Lena Sanford also boarded Dennison's bus and later paid $975 for a three-month supply of medicine in Canada that usually runs $1,365 for each month at home in Massachusetts.

Initially, the retired factory worker felt guilty about leaving the country to buy drugs, but with her savings, she said, "I was singing all the way home."