# PRICE GOUGING LEADS PATIENTS TO CANADA FOR CHEAPER PRESCRIPTIONS



## Mike NoLomotil (Jun 6, 2000)

THE DRUGSTORE RIGHT NEXT DOOR By DeNeen L. BrownWashington Post Foreign ServiceSunday, October 8, 2000; Page A24 TORONTO ï¿½ï¿½ There's another drug war. It's fought quietly by Americans, often bent and in pain, who climb aboard buses and head across the border into Canada, where they can buy prescription pills at prices they say help them survive. "I've been up in Montreal three times," said Lucille Danyvow, 79, who is recovering from breast cancer and has trouble walking. "I think it's a shame how much drugs cost in America."The last time she took the ride to Montreal, she bought a bottle of the cancer drug tamoxifen for $34. It costs $241.67 near her home in Vermont. She bought some cholesterol medication, Zocor, for $60, another bargain--the small bottle costs $101.82 at home. The money saved, she said, is the difference between soup and solid food.The cost of prescription drugs emerged Tuesday night as a core issue of the first presidential debate, with Vice President Gore identifying a man in the audience who goes north to buy medicine. As Gore and his Republican opponent, Texas Gov. George W. Bush, continue to spar over the issue, Canadians look with disbelief at the prices Americans pay and worry that those who come here to buy drugs will upset the bargain prices in the country's $6.4 billion-a-year market for low-priced pharmaceuticals.The basic reason for the lower prices here is a firm Canadian government policy that manufacturers cannot charge "excessive" amounts for patented medicines. Drug companies, therefore, sell their products at lower prices and take less profit. Although generic drugs are not regulated in this way, Canada's approach to health care in general is that it cannot be left to market forces.It's part of a universal health care system that promises that, regardless of how much money you make, if you go to hospital, you will get treatment.A price review board, created as an independent agency in 1987, oversees the cost of drugs. It regulates prescription and over-the-counter drugs to make sure prices never rise at a rate faster than the consumer price index does.Before the price review board was created, "Canada's drug prices were the second-highest among comparable developed countries," said Tara Madigan, spokeswoman for the federal Department of Health. "And today, Canadian drug prices are third lowest."Geoff Bell, a spokesman for the provincial ministry of health and long-term care in Ontario, said access to drugs and service "shouldn't be based on your ability to pay. . . . We don't have any indication that the public would want to see that changed to go to an American-style system."Many drugs on sale here come from the United States. But because of the regulations, U.S. drug companies are often obliged to sell to Canadian wholesalers at lower prices than they get in the United States.The Pharmaceutical Research and Manufacturers of America, the Washington-based trade association that represents the drug industry, opposes price controls. Market-based pricing is needed to ensure that drug companies can cover the huge cost of developing and testing new drugs, it contends.In its view, price controls are part of the reason that Canada is not developing many new drugs on its own. "We think that innovation will best flourish where markets and customers are able to decide prices rather than government," said executive vice president Judith H. Bello. "Price controls discourage private investment in innovation."While Bush and Gore debate what if anything to do about drug prices in the United States, other politicians are trying to help Americans tap into the Canadian system.Last week, congressional Republicans reached a deal to pass a bill that would make it easier for Americans to "re-import" U.S.-made medicines from Canada and other countries where the prices are lower than those charged for the same drug sold in the United States. The bill would lift a ban on U.S. pharmacists re-importing drugs from other countries.Rep. Bernard Sanders, an independent from Vermont who last year started taking senior citizens on bus trips into Canada to buy prescription drugs, has said it is a moral outrage that U.S. pharmaceutical companies can charge Americans three times what they charge for drugs in Canada."Now you have every politician in America holding up two bottles of medicine, one from here, one from Canada," Sanders said. "And every one is saying it's become the issue."Almost every drug is cheaper in Canada," he said. "Some of them are significantly cheaper. Given the reality, if you are sitting in Burlington, Vermont, and you are an hour from the border, what would you do? You would go over the border."Some economists contend that because Americans pay higher prices, they are subsidizing inexpensive drugs for people whose countries control prices.Canadian pharmacists are critical of the U.S. legislation. "It could undermine our whole health care system, where we manage to maintain some price control," said Noelle-Dominique Willems, a spokesperson for the Canadian Pharmacists Association. "We consider that an attempt by the U.S. to avoid controlling their own drug markets to try to push people to go and get cheaper drugs elsewhere without consideration for the impact that it would have on the country from which they are trying to get that medication."Willems said the law would be at odds with Canadian laws that attempt to preserve low prices by preventing Canadians from selling wholesale to the United States. "When a multinational sees there is a small market that would like to control costs, there is no skin off its nose," she said. But "when you undercut that market, I think we would see a cost increase in Canada."Canadian pharmacists also have concerns about the part of the legislation that requires the U.S. Food and Drug Administration to "ensure the quality of goods" imported from Canada. "In order to do that, you would have to do site visits," she said. "We are still a sovereign nation. You don't just do this."U.S. critics of the legislation have said that opening the borders to imported drugs could prompt counterfeiting and tampering. Alan F. Holmer, head of the Pharmaceutical Research and Manufacturers of America, has expressed concern about the safety of imported drugs.In the meantime, Americans continue to go north, shopping for drugs in Montreal; Niagara Falls, Windsor and Sarnia, Ontario; and Winnipeg.Ronald Guse, registrar of the Manitoba Pharmaceutical Association, the licensing body for pharmacists and pharmacies in Manitoba, said members are receiving dozens of calls from Americans who want to get prescriptions filled in Canada. But no one knows precisely what the total numbers are.Americans cannot simply take their U.S. prescriptions to Canadian pharmacies and fill them. They must be sent there by a Canadian doctor. But that's not difficult to arrange. Americans show up at walk-in clinics, carrying their medical records and notes from their doctors, and ask Canadian doctors to examine them and write prescriptions."Some Americans have doctors here. They come to see the doctor, then they come to my drugstore," said Kevork Ohanian, a pharmacist in Montreal.Some are seniors so frail they must be lifted on and off buses. Elizabeth Wennar, president of United Health Alliance, a Vermont physician-hospital organization that has created a system for physicians to order drugs by mail from Canada for individual patients, recently took a trip to Canada with seniors."It was about a 90-degree day. This trip took about 12 hours from beginning to end," Wennar said. "I was totally exhausted."So were many of the patients. Wennar said she was saddened by the need for sick people to make trips out of the country to buy medication they cannot afford at home."These people had arthritis so bad they had to be lifted on and off the bus. But one said to me, 'I don't have a choice. I can barely move as it is without my medication, I'm homebound. I have to go to another country to get my drugs.' One woman on the bus had seven medications. She was saving $2,000 a month."


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