Feature Archive

How Far Would You Go for Cheaper Drugs?

Thousands of Americans are crossing the border to get the best deal on their prescriptions. Our reporter tags along.

WebMD Feature

July 14, 2000 -- It's 7:45 on a steamy Friday morning in June, and the commuter parking lot on the outskirts of Montpelier, Vermont's capital city, is filling up with people in need of drugs.

Ramona and Peter Christensen, dairy farmers from East Montpelier, approach the crowd around the two 15-passenger buses that will take them on the two-and-a-half-hour ride across the border to Montreal. "I'm a little nervous with all this money on me," says Ramona, 45, as she flashes a fat wad of cash. "Are the drug czars here yet?"

The Christensens aren't here to score marijuana or cocaine; they're after drugs for Ramona's high blood pressure, diabetes, and heart disease. And they're not alone. Drawn by prices that can be a fraction of the cost in this country, more and more Americans are crossing the border into Canada or Mexico to buy prescription drugs they cannot afford to buy at home. Indeed, the high cost of medicine in the United States is emerging as a leading political issue of the new decade: Congressional and presidential candidates alike are promising to somehow make pharmaceutical drugs affordable here, in one of the wealthiest nations of the world.

A Huge Difference in Price

Because other nations have price controls on drugs, savings across the border can be dramatic: A one-year supply of tamoxifen, a cancer suppressant widely prescribed for survivors of breast cancer, costs about $1,400 in the United States but just $125 in Canada. Ramona Christensen's 30-day supply of Lipitor, a drug used to lower cholesterol, costs $144 here and $85 in Canada.

While debate rages in Congress on how to lower U.S. drug costs, seniors and other people in need of affordable medications are moving ahead with their own underground solution.

At the parking lot in Montpelier, the "drug czars" -- three organizers from the Central Vermont Council on Aging (CVCOA) -- pull up in a minivan and begin transferring coolers full of sandwiches and sodas into the waiting buses. The three began making drug runs to Canada in April after Vermont's U.S. Congressman, Bernie Sanders, led several well-publicized trips there to help people buy affordable prescription medications. Similar trips have been organized from several other border states, inspired by the huge price differences. Overall, seniors in Vermont pay an average 81% more than Canadians for the 10 most widely used prescription drugs, according to a new Congressional Research Service study.

As the green hills of Vermont roll by their windows, the 17 people on the bus pull out their prescriptions and compare notes. Delores Remington, 66, a former newspaper clerk, needs five medications, which would cost $825 in the United States; she went on the last trip to Canada and bought them all for $475. Ramona Christensen has 35 pages listing the prescriptions she needs for the next 14 months. The total, if purchased here: more than $20,000.

Christensen was covered by Medicaid (which provides prescription drugs) until May 31, when her benefits were cut off after government social workers disqualified her because she'd made too much money on her farm. Now, she says, her family is trying to live on an income of $1,000 a month. To pay for her medications, Ramona and her husband have sold 11 of their 85 dairy cows. At $1,200 per cow, they figure they'll have enough to pay for a year's worth of medicines.

Taking Half-Doses to Save Money

Cliff Bates, a 60-year-old retired paper mill worker, pays about $300 per month for five medications he needs to treat knee problems, high cholesterol, and high blood pressure, and hopes to save quite a bit. He says he's tried to save money by splitting his pills and taking half a dose, but that "doesn't work so good -- I got dizzy."

Technically, the Food and Drug Administration (FDA) prohibits the importation of prescription drugs from other countries. But the Canadian trips take advantage of an FDA loophole that allows individuals to import a limited supply of approved drugs for personal use. Still, the agency has broad enforcement discretion, and as the bus approaches the border, there are jokes about what reasons to give for going to Canada. The "drug czars" opt for the truth and explain the mission to sympathetic border guards. The guards wave them through, noting that plenty of people are doing the same thing on their own.

While the FDA is not currently trying to prevent drug-buying in Canada, that could change. In an effort to head off an FDA crackdown and to draw attention to the huge price differences, the House of Representatives on July 10 overwhelmingly approved a bill barring the agency from enforcing the general ban on drug reimportation.

'My Job Is to Take Care of Patients'

It's noon when the group arrives in Montreal. They troop up a winding stairway to the packed waiting room of a health clinic where the Americans fill out forms, see a doctor (for a $24 fee), and present their American prescriptions. Nii T. Quou, MD, the clinic's medical director, says he's been warned about possible legal liability from seeing American patients, but he welcomes them all nonetheless. "I'm a physician," he says simply, "and my job is to take care of patients."

The Vermont organizers hand out the sandwiches and sodas, then begin ferrying batches of people to a family-run pharmacy nearby. The pharmacist and his family welcome the group with pastries in a homey back room where the travelers rest and wait for their precious supplies.

Drug Companies Offer a Caution

Drugmakers have been angered and embarrassed by the publicity the bus trips have drawn. They warn consumers against crossing the border for medications, saying they can never be sure what they're getting, even when drug labels are the same as in the United States. The companies also say higher U.S. prices are justified because of the high cost of research that has produced so many wonder drugs. They've been fighting back with television ads and a web site to make the case that the U.S. health care system is preferable to Canada's.