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Canada Pharmacy lure Utahns
By Steven Oberbeck
The Salt Lake Tribune
Utah senior citizens and others desperate for affordable
medicine increasingly are turning to pharmacies in Canada to
fill their prescriptions.
The practice, which mirrors a trend among cost-conscious
consumers nationwide, frustrates Utah regulators.
They worry that Utahns are gambling with their health by
purchasing low-cost prescriptions outside the United States that
may not be the same as those they buy at home. Yet they
recognize that, aside from issuing warnings about the perils
they perceive, they are powerless to stop the practice.
"All states are confronted with a flood of prescription drugs
brought in from outside the country," said J. Craig Jackson, a
pharmacist and director of the Utah Division of Occupational and
Professional Licensing. "There is not a lot we can do, though.
We have no control over the economics of the situation."
Canadian pharmacies can sell medications for less because the
Canadian national health-care system uses the buying power of
that country's entire population to negotiate prices and limit
how much drug manufacturers can charge for their medications.
Utahns prepared to travel north to get their prescriptions
filled or who deal with pharmacies in that country through the
mail can save 50 percent to 70 percent on their prescription
costs.
In the state's view, though, unseen dangers lurk everywhere.
"It is like playing Russian roulette. It is just not a good
idea," Jackson said. "You don't know where those drugs have
been, how they have been stored or whether they are counterfeit
or outdated."
However, many consumers and senior citizen groups argue
pharmacies in Canada provide the same medications produced by
the same drug manufacturers that supply U.S. pharmacies.
Canadians, they point out, are not exactly falling down dead
from using the medicines available to them.
"If they were dropping dead, we would know about it," said
Louene Nakagawa, a 53-year-old Orem resident who is waiting for
her first order of medications to arrive in the mail from a
pharmacy in British Columbia. "My brother-in-law has been
driving up to Canada to get his prescriptions filled for several
years now. My mother has been getting prescriptions filled in
Canada for several months. And they are both fine."
The Food and Drug Administration estimates approximately 2
million parcels containing prescription medicines for personal
use are shipped into this country every year, a figure that does
not include thousands of prescriptions brought back by elderly
Americans who journey outside the country to pick up their
medications.
In addition, an estimated 70 pharmacies in Canada shipped nearly
$500 million worth of prescriptions into the United States last
year.
While it is technically illegal for U.S. citizens in most
circumstances to bring back drugs from other countries, FDA
policies now in place and enforced by the U.S. Customs Service
allow individuals to import medicines personally, provided they
have prescriptions and bring only a three-month supply for
personal use.
"Going to Canada to get prescriptions filled is not prohibited,
but people need to know what the restrictions are," said Jim
Michie, spokesman for the U.S. Bureau of Customs and Border
Protection.
Despite those policies, Carmen Catizone of the National
Association of Boards of Pharmacy, which represents state
pharmacy boards across the county, maintains the potential for
harm exists even with medications obtained in Canada.
The reason is that foreign prescription drugs are outside the
oversight of the FDA, Catizone said. "They have left the control
of U.S. manufacturers."
Ironically, the U.S. Senate two weeks ago voted 62-28 to allow
pharmacies and wholesalers to import drugs from Canada. Although
the FDA signaled before the Senate vote that it might use its
authority to block the proposed change because it "cannot
guarantee the safety of the drugs," that stand was immediately
challenged by Sen. Byron Dorgan, D-N.D., the bill's primary
sponsor.
The Canadian drug supply chain is practically identical to the
supply chain in this nation, Dorgan said. "It's virtually
impossible . . . to make a safety issue" out of this proposal,
he said.
The issue the Senate dealt with, though, concerned U.S.
pharmacies and wholesalers bringing in large shipments of
Canadian medications.
Utah regulators face another problem: how to discourage Canadian
or other pharmacies operating outside the reach of state law
from cooperating with individual Utahns who request to receive
medications through the mail.
"Utah law is very clear on that point," said DOPL's Jackson. "It
is illegal for any Canadian pharmacy to mail drugs into the
state. There are no Canadian or foreign mail-order pharmacies
licensed to do business in Utah."
Even if a Canadian pharmacy licensed by that country's
pharmaceutical regulators wanted to do business legally in Utah,
it couldn't. State law does not contain any provisions that
permit the licensing of foreign pharmacies.
But as a practical matter, there is not much the state can do
about a pharmacy in Canada sending medications in by mail. It is
illegal under Utah law but permitted by U.S. Customs. "About all
we can do is send them a letter letting them know that what they
are doing is illegal. We have no enforcement power over them,"
Jackson said.
Still, that hasn't stopped Utah regulators from trying to do at
least something.
Earlier this month a state licensing enforcement agent tried
unsuccessfully to shut down a fledgling American Fork company
that promises to save Utah seniors money by helping them import
prescription medication from Canada.
The company, MedsDirectPlus, remains in business and is adamant
it is operating within the bounds of Utah law. Instead of acting
as a pharmacy, the company maintains it operates by helping its
mostly elderly clients, for a $15 fee, fill out paperwork so
they can personally import their prescription medications -- a
practice permitted by the FDA. MedsDirectPlus puts its clients
in touch with Canadian doctors who can expedite the process of
getting prescriptions filled by a pharmacy in British Columbia.
"Anyone who says that it is dangerous to get their prescriptions
from a pharmacy licensed in Canada is doing nothing but trying
to scare old people," said MedsDirectPlus founder and owner Eric
VanBrakel.
Yet VanBrakel, senior citizen groups and regulators all agree
that Utahns need to be wary of purchasing medications over the
Internet.
The World Wide Web is making it easy for consumers to find
mail-order pharmacies operating outside the country that promise
prompt shipment of prescriptions at prices far below what most
Americans pay at their neighborhood druggist. At the same time,
it can be difficult and even impossible when dealing over the
Internet to determine the actual country where a pharmacy may be
based.
"They may say they are in Canada but they could be operating out
of Sri Lanka," Catizone said.
And the risks that all consumers take when purchasing products
through the Internet -- the threat that a company here today may
be gone tomorrow -- are heightened when purchasing foreign
drugs.
The National Association of Boards of Pharmacy noted in a March
2003 position paper that the FDA and U.S. Customs Service two
years ago conducted a survey of imported drugs entering the
United States at a Southern California mail center.
Agents opened 1,908 packages for review with 721 packages
containing 197 different drugs from 19 countries. Eight percent
of the packages contained drugs that could not be identified
because they lacked labeling or the labels were in a foreign
language. Most of the drugs were packaged in plastic bags and
one shipment contained drugs taped between magazine pages.
The Alliance for Retired Americans, a Washington-based senior
citizen organization that runs what it calls the "RX Express"
bus trips into Canada, discourages anyone from dealing with
Internet pharmacies. "You just don't known who you are dealing
with," said Ed Coyle, executive director.
Coyle added, though, that "until our government does something
to help control drugs costs, there will be a continuing problem,
and there will be organizations [like the Alliance] that will
continue to take people to Canada."
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