Seniors put relief ahead of drug law
By Deborah Adamson
Advertiser Staff Writer
There may be a drug user in your home who is getting her prescriptions illegally: Your beloved tutu.
Consumer tips in purchasing prescriptions from other countries: • Make sure the online or direct-order company lists its address and phone number. Be suspicious if they communicate only by e-mail. • Look for an affiliation with a pharmacy association. • If they don't require a prescription, avoid the company. • Legitimate companies let you call pharmacists if you have questions about their medications. • Check up on a Canadian firm by contacting its province's pharmaceutical association. • Look for any complaints filed with the Canadian Better Business Bureau. Go to www.canadiancouncilbbb.ca. Click on "online reports." Choose the province and type in the company name. Source: Jupiter Research, National Association of Boards of Pharmacy
In an age of high prescription costs, many senior citizens are buying their medications from abroad to save money. They use direct mail, the Internet or travel to save 30 percent to 60 percent off their prescriptions.
It has been a practice on the Mainland for years, with thousands of people driving across the border each day to Canada or Mexico to get cheaper drugs.
Now, more people in Hawai'i are turning to the Internet and the mail for their medication.
Canada Discount RX Inc. of Winnipeg, Manitoba, recently took out a full-page newspaper ad targeting the senior market in Hawai'i, advertising discounts as high as 86 percent. Another company, Canada Discount HealthCare Centre of Hawai'i, began operating in Honolulu a year ago, as a locally owned nonprofit group helping consumers buy drugs at Canadian pharmacies.
Federal law makes the practice of buying prescriptions abroad illegal, but there is little enforcement by authorities, who are reluctant to target customers who are mostly elderly and on fixed incomes. The practice is not against state law.
Charles Malm, president of Canada Discount HealthCare Centre of Hawai'i, said he realized the plight of seniors after having to drive his 87-year-old mother from Grand Forks, N.D., across the border to Canada to get her medication.
After moving to Hawai'i in 1978, Malm started a nonprofit that helped seniors apply for free medication given out by drug companies to the indigent. He started Canada Discount HealthCare because there were seniors who didn't qualify for the free drugs program.
The financial burden of prescription drugs, especially for the elderly, can be significant.
Scott Allen of Hawai'i Kai said his 70-year-old father pays $140 for a three-month supply of Lipitor, the cholesterol-lowering drug, through a Canadian pharmacy. At Costco, they cost $200, he said. Allen's father could use the savings; he depends mainly on Social Security to live, which isn't much money.
The "reimportation" of prescription drugs is illegal, with some exceptions, said Jason Brodsky, a spokesman for the U.S. Food and Drug Administration, because the federal government can't ensure the drugs aren't adulterated, counterfeit or improperly handled.
"Generally speaking, it is illegal for individuals to buy pharmaceuticals from foreign sources," he said. "There's no way to assure consumers what exactly they are going to get and whether the product is safe."
It's also against federal law for a company to help Americans buy prescription drugs abroad, Brodsky said. Moreover, there is no such thing as a "personal exemption" for a 90-day supply, which some companies have been telling seniors, he said.
In Hawai'i, state law does not prohibit residents from purchasing prescription drugs abroad, according to the state Department of Commerce and Consumer Affairs. Only controlled substances, such as heroin, are illegal.
But an out-of-state pharmacy needs a permit to sell to state residents, according to the Hawai'i Board of Pharmacy.
Canada Discount RX and Canada Discount HealthCare are not pharmacies, but they help consumers buy from Canadian pharmacies.
Canada Discount RX is affiliated with McKnight's Pharmacies, which does not have a permit in Hawai'i, according to the state pharmacy board. But McKnight's is licensed in Manitoba, where it has its headquarters, according to the Manitoba Pharmaceutical Association.
Canada Discount HealthCare, which is local, works with several Canadian pharmacies. Malm said he doesn't know if any of them have state permits, because it's up to the pharmacies to make sure they comply with the law.
As middlemen, Canada Discount RX and Canada Discount HealthCare help consumers fill out paperwork and send their prescriptions to a Canadian pharmacy. A Canadian doctor rewrites the prescription, a Canadian pharmacy fills it and ships the drugs to the U.S. customer. Canadian drugs are cheaper because the Canadian government places a cap on prices and that nation's currency is presently weaker than the U.S. dollar.
But federal prosecutions of consumers have been limited because no one wants to arrest senior citizens or cut off their supply of inexpensive medications, according to the Manitoba Pharmaceutical Association. Manitoba is home to 55 of Canada's estimated 150 international mail order pharmacies.
"The FDA is not enforcing that law," said Ronald Guse, registrar of the Manitoba trade group. Also, because it's a U.S. law that these companies are breaking, enforcement does not fall to Canadian authorities, he added.
As for drug safety, Canada has its own regulatory controls like the FDA, he said.
The FDA said it's not taking action against consumers, but instead sends warning letters to companies that assist in obtaining the drugs. The agency also works with U.S. Customs to seize drug shipments by mail. Still, Brodsky admits that enforcement is tough because of the "sheer volume" coming into the country.
In 2002, consumers spent $700 million online to buy prescription drugs from foreign pharmacies, most of them Canadian, said Monique Levy, an analyst at Jupiter Research. While that's just 0.4 percent of the total U.S. drug market, she expects online drug purchases to double this year, barring the passage of a Medicare prescription drug plan that could lessen the need to look abroad for savings.
JoAnn Uchida, chief enforcement officer at the state Regulated Industries Complaints Office, Department of Commerce and Consumer Affairs, said Hawai'i hasn't received complaints from consumers that might trigger an investigation.
You won't hear senior-citizen groups complaining about the lack of federal enforcement.
It costs the elderly between $300 to $700 a month to buy drugs if they don't have prescription drug insurance, said Greg Marchildon, state director of AARP Hawai'i.
At present, Medicare does not pay for prescription drugs. Medicaid offers a discount off retail, but to qualify for the program a senior must be nearly destitute.
High drug cost is "bankrupting our senior citizens who live on a fixed income," Marchildon said. "They might have to choose between buying food and medicine. These are choices we don't think they should have to make."
The senior citizens' group does not condone the practice of buying prescriptions abroad, but acknowledges its practicality.
"People are frustrated, scared and overwrought by the cost of prescription drugs," Marchildon said.
Canada Discount HealthCare's Malm said prescription drug shipments facilitated by his agency have never been stopped; but if any future shipments are seized, his Canadian partners will refund the money or reship the medication.
But drug makers warn that medications from abroad aren't always safe, said a spokeswoman for the Pharmaceutical Research and Manufacturers of America, an industry trade group. They may not be the same dosages, they could have been tampered with or expired, she said.
Malm, who buys only from Canada, disputes those concerns.
"Most of (these drugs) are made in America. That's why pharmaceutical companies are freaking out," he said. "These people, they need help and these drug companies are ripping them off."
Contact Deborah Adamson at dadamson@honoluluadvertiser.com or 525-8088.
