How Far Would You Go for Cheaper Drugs? (cont.)
'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.
The industry has also worked hard to fend off attempts by Congress and some states to impose price controls on prescription drugs. Indeed, the United States is the only industrialized country without some form of controls on drug prices. In Canada, provincial authorities negotiate bulk discounts with pharmaceutical companies and establish allowable prices for most prescriptions. The Mexican government also sets price ceilings for medicines.
Drug prices in America vary greatly depending on who pays the bills. Insurers and employers pay most prescription costs, but this is changing as managed care plans impose caps on prescription reimbursements. Some companies are putting expensive drugs off- limits or reducing drug benefits, requiring workers to make larger copayments. And people who rely on Medicare, which serves senior citizens, are on their own, since Medicare does not currently pay for any outpatient medications.
The growing outcry over high drug costs has forced both political parties to seek out ways to provide prescription coverage to seniors on Medicare. Republicans want to offer government subsidies to encourage private insurance companies to offer drug policies to the elderly. The Democrats would increase Medicare payments to hospitals and other health care providers, making a drug benefit part of the program.
But it is state governments, especially those that border Canada, that are taking the lead on establishing price controls. In May, a law was passed in Maine -- over industry objections -- that created a commission with the power to negotiate drug prices for uninsured Maine residents and to impose price limits in 2003 if drug companies don't lower costs.
In Vermont, a similar bill would have imposed price caps and taken other steps to make medications affordable. It was defeated after what Vermont House Speaker Michael Obuchowski called "the most intensive lobbying effort" that he'd seen in 28 years, mounted by drug companies and the Pharmaceutical Research and Manufacturers of America (PhRMA), the industry's trade organization.
Sanders, the Vermont Congressman who led drug-buying trips to Canada, says the issue of high prescription drug prices arouses more anger than any he has encountered in his career. Last year, he introduced a bill that would allow American distributors and pharmacists to re-import prescription drugs into the United States from Mexico and Canada at the lower prices offered there -- as long as the drugs meet strict safety standards and are approved by the FDA. "There is simply no reason why Americans should pay up to 10 times more than people in other countries for the exact same drug," Sanders argues. Similar legislation was introduced this year in the Senate by Vermont's Republican Senator, Jim Jeffords.
Who Should Pay for Costs of Drug Research?
The pharmaceutical industry is fighting hard against efforts to allow drug importation and to control domestic prices. The industry argues that drug prices are artificially low in other countries and that imposing controls here would limit the resources drug companies could put into the expensive research required to develop new drugs. "We totally oppose any form of price controls because it discourages innovation and investment in research and development," says Meredith Art, a spokesperson for PhRMA. "The solution to high prescription drug prices is to add an outpatient drug benefit to Medicare."
But the political jockeying over drug prices is not what concerns the bus riders; they're after the drugs they need to live. They know they can get those drugs cheaply in Canada, and they cannot in the United States. As the van makes the long trip back to Vermont, people compare notes on savings. Ramona Christensen saved about $1,600 on 11 prescriptions. Joe Arnell, a former corrections officer who is "almost 65," saved $256 on seven prescriptions, mostly heart medications. Everyone says they would return to Canada if necessary, though Christensen is apprehensive about taking the bus during the icy winter months. Delores Remington, the former newspaper employee, appreciates the bus trip, but is saddened by the need to make the trek.
"We shouldn't have to get on a bus and go to another country to buy the medications we need," she says. "We ought to be able to do that in our own home town."
Curtis Ingham Koren writes for national magazines about health, education, business, and travel from her home in Vermont.
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