For decades, Larry Glass dispensed U.S. medications as a pharmacist, but today the retired Mesa resident turns to Canada for his heart drugs.
"What you’re getting for all intents and purposes is the same medication you’re getting at a local pharmacy," he said. "It’s the only place seniors can go to get something they can afford."
Glass is part of a wave of seniors who say they have been driven out of their own country in search of affordable prescription drugs.
Many are buying their medications from Canada, and they want it to be legal.
The issue has been heating up in Arizona and elsewhere.
Earlier this month, Illinois asked federal officials to allow the state to purchase cheaper prescription drugs from Canada to offer current and former state employees. The request was denied, with the U.S. Health and Human Services Department saying it could not ensure the safety of the drugs.
The action brought to light the sharp divisions that have surfaced in the United States as seniors flock to the cheaper alternatives in Canada.
In Arizona, several "storefront" operations have set up shop, but state officials have actively discouraged consumers from turning to such outlets.
That has some Valley consumers puzzled.
"I feel more comfortable getting drugs from Canada than from the U.S.," said Robert Huber of Scottsdale, who saves $700 a month buying drugs from Canada to treat his chronic intestinal disease. "I’m not the Lone Ranger on this. I’m not pleading for myself, I’m pleading for millions of Americans."
Despite recent passage of a Medicare prescription drug benefit, some seniors say they will still depend on Canada for medication. They don’t expect the Medicare benefit to beat the savings they get from Canada, given the limits on coverage and prohibitions on the federal government’s ability to negotiate lower prices with drug manufacturers.
But regulators and law enforcement say drug reimportation, which involves the shipment of U.S. medications overseas and then back into the country, is unsafe and violates federal law because the drugs are not shipped back to the United States by the manufacturer. Seniors are getting their medications in the mail from Canadian pharmacies, often through local businesses that act as brokers.
Such shops have set up in the East Valley over the past two years. The companies receive referral fees from pharmacies or membership fees from customers for sending seniors’ prescriptions across the border. Those companies, called facilitators or storefronts, have turned drug re-importation into a growing, high-profile business. A handful of states, like Illinois, are seeking ways to cut costs by offering Canadian drugs to public employees. A bill that would legalize drug re-importation passed the U.S. House this year and awaits app roval in a Senate committee.
In Arizona, the Silver-Haired Legislature, a senior activist group, plans to push state lawmakers to introduce legislation supporting Canadian drug re-importation.
State Sen. Carolyn Allen, R-Scottsdale, chairwoman of the Senate Health Committee, would not yet commit to supporting such a bill. But Allen said she sympathizes with those who turn to Canada for affordable medication. "I would certainly have an open mind because I have friends who get drugs from Canada," Allen said.
The groundswell of interest in drug re-importation has sparked a backlash by the U.S. Food and Drug Administration and local regulators.
The Arizona Board of Pharmacy has sent warning letters to eight facilitators and a physician since December 2002, telling them to stop operating as pharmacies — an allegation that storefront operators deny. Facilitators said they do not sell medications. They are simply an intermediary between the customer and Canadian pharmacies.
"I am not really sure why the pharmacy board and pharmacists hate us so much," said Lawana Blandin, whose storefront in Mesa recently got a warning letter from the board. "We have doctors who send patients to us. They know their patients won’t get their prescriptions" if they can’t afford them.
The board has also urged the Better Business Bureau to warn consumers against purchasing medications from facilitators, and is working with the Arizona Attorney General’s Office for further enforcement actions.
"It’s a threat to the drug supply in the U.S.," said Hal Wand, executive director of the pharmacy board.
Such warnings, however, mean little to seniors whose health and wallets have been helped by medications from Canada.
"I think it’s a big movement among the people," said Dr. John Molina, who received a warning letter from the board for offering office space to a Scottsdale-based facilitator, Prescription Drugs Canada. "People always move policy and people will very rightly do what they can to take care of themselves despite regulations and policy."
Seniors such as Glass and Huber say they remain skeptical of the FDA’s warnings about public health risks associated with drug reimportation. They are leery of the pharmaceutical industry’s influence on the FDA, retail pharmacies and local pharmacy boards.
"(FDA officials) are just trying to protect pharmaceutical sales," said Huber.
While there may be legitimate safety concerns about prescription drugs from other foreign countries, the FDA has hurt its credibility by including Canada among countries that pose risks, said Huber.
Neither the FDA nor Health Canada, which regulates Canada’s prescription industry, have found a single case of an American injured or killed by a drug imported from Canada. And a recent report by the Congressional Research Service found that medications manufactured and distributed in Canada meet or surpass quality control guidelines set by the FDA.
Still, the lack of harm is not enough, said Paul Draugalis, president of the state pharmacy board. The real harm may not emerge until patients have taken ineffective medications for years, he said.
Glass said the sevenmember board, which has two public members and five pharmacists, is dominated by people whose work involves the U.S. drug business.
"It’s the only drum they have to beat," Glass said.
According to the National Association of Chain Drug Stores, 21.1 percent of the average prescription drug’s cost in 2002 went to the pharmacy retailer.
"We commend the Arizona State Board of Pharmacy and all of the state boards that are working to attack the serious and risky business of illegally importing prescription drugs into the United States," Craig Fuller, president and chief executive officer of the association, said in a May 12 letter posted on the association’s Web site.
The association represents more than 210 retail pharmacy chains and more than 34,000 pharmacies nationwide.
Draugalis said he is offended by any suggestion that the board’s position on drug re-importation is influenced by self-interest.
"We’re here to protect the public, not protect hospitals or retail establishments," he said.
The state pharmacy board has limited enforcement authority against unlicensed operators.
On Nov. 6, federal District Court Judge Claire Egan granted the FDA’s request to shut down Rx Depot, a Tulsabased facilitator that sells prescription drugs from Canada. Rx Depot has 85 storefronts, none in Arizona.
Roberto Pulver, an assistant attorney general representing the pharmacy board, said the decision could boost the federal government’s enforcement.