World

"The Canadian Connection'

New England looks north to import cheap prescription drugs

Andrew Phillips February 28 2000
World

"The Canadian Connection'

New England looks north to import cheap prescription drugs

Andrew Phillips February 28 2000

"The Canadian Connection'

World

New England looks north to import cheap prescription drugs

Andrew Phillips

in Washington

You can understand if Suzanne Woodard gets a little melodramatic. Fifty-two years ago, she emigrated from Quebec to New Hampshire, became an American citizen and recited the famous pledge of allegiance. “I said the words, ‘justice for all,’ and I believed it,” she recalls. Now, at 67, she finds herself crossing the border the other way—in search of drugs that she and her husband, Russell, need to stay healthy in their senior years. In New Hampshire, the Woodards pay more than $400 (U.S.) every month—a quarter of their income—on prescription drugs. But in Quebec, they can find the same products, most of them made in the U.S.A., at halfprice. “It’s disgusting that we have to go to another country for things we need to live,” says Woodard. “Those words about justice—it’s an empty phrase.”

The flood of Americans, many of them seniors like the Woodards, seeking cheaper drugs in Canada and Mexico has become a potent political issue in an election year. The cost of drugs is rising far faster than other U.S. health costs— about 15 per cent a year—and politicians are feeling the heat. And now several New England states, led by Vermont, are pushing a bold new plan. They want to reach a deal with Canadian provinces, starting with Quebec, that would give Americans access to prescription drugs at the lower Canadian prices. The idea is to get their citizens a break on products many desperately need—and to pressure U.S. drugmakers to lower their prices. “We call it,” says Peter Shumlin, president of Vermont’s state senate, “the Canadian connection.”

Other U.S. politicians are getting on the bandwagon. At a recent stop in Rochester, N.Y., in her campaign for a Senate seat, Hillary Rodham Clinton bashed the drug industry and decried the price gap. “People in our country are paying the highest prices in the world for the exact same drugs that others are finding at much lower prices across the border in Canada,” she said. (Unlike the United States, prescription prices in Canada are controlled by a federal agency, the Patented Medicine Prices Review Board.) Clinton promised to work for a law that would allow U.S. pharmacies, hospitals and wholesalers to import drugs approved for use in the United States back from Canada—at Canadian prices.

At the moment such a move—called reimportation— would violate U.S. law. But it is exactly what Vermont and a growing number of U.S. legislators are proposing. Shumlin’s Canadian connection is one of several measures to lower drug prices that lawmakers from the six New England states and New York discussed at a meeting in Boston on Feb. 11. Last week, Vermont Gov. Howard Dean met with the governors of New Hampshire and Maine, and the three agreed to ask Premier Lucien Bouchard to open talks aimed at making it easier for U.S. consumers to buy from pharmacists in Quebec. In return, they propose giving Quebecers wider access to health facilities in their states—such as cancer clinics. “Our system is disadvantaged in some ways, and so is yours,” Dean, who is himself a doctor, told Macleans. “The idea would be to improve the situation on both sides.”

Preliminary talks are already under way between Vermont and Quebec, but Quebec officials are cautious about suggestions of a cross-border exchange of services. Quebec began sending cancer patients to several New England hospitals last summer because of bloated waiting lists for radiation treatment, but health ministry spokesman Alain Vézina dismissed the idea of tying that to cheaper drugs for Americans. “The two things don’t have a common link,” he said.

What the New Englanders want is to make it easier for people like Suzanne and Russell Woodard to get Canada’s cheaper drugs. About two-thirds of American seniors have some kind of private insurance for drugs, but the Woodards are among those with no coverage. They have made two bus trips to Montreal, organized by seniors’ groups, to save money on their prescriptions. On the first visit, last September, they paid $1,882 (Cdn.) for a supply of the drugs that Russell Woodward, 70, needs to treat his diabetes and Suzanne needs for high blood pressure. The same drugs back in Piermont, N.H., they reckon, would cost $2,100 (U.S.)— almost 65-per-cent more. “It’s a huge difference,” she said.

But it wasn’t easy. Under current law, they had to find a doctor licensed in Quebec who was willing to reissue their prescriptions under his own name so that a Quebec pharmacist could fill it. Vermont’s legislators want Quebec to change its rules so a pharmacist there could fill a prescription issued by a Vermont doctor. Ideally, said Shumlin, the pharmacist could ship the dmgs directly to Vermont so patients would not even have to leave the state. This week, he hopes the state senate will adopt a law saying Vermonters should have access to drugs at Canadian prices by Oct. 1,2001. “Right now,” he said, “we’re the laughingstock of the world when it comes to what we pay for products people need to stay alive.”

savings across me Doraer When shopping for prescriptions with U.S. dollars, Americans find Canadian drugs to be significantly cheaper (cost per pill)

Such a move would be a boon to Canadian pharmacists, as well. U.S. consumers in search of cheaper drugs are crossing into Canada not only from New England and New York, but from Minnesota, North Dakota, Montana, Washington state and elsewhere—and into Mexico from southwestern states. Véronique Vaillancourt, the only pharmacist in Stanstead, Que., on the Vermont border, says business from Americans is up 30 per cent since October, when the CBS show 60 Minutes aired a report about the cross-border trade. In nearby Bedford, Que., pharmacist Jacques Bouchard gets lots of inquiries from Americans, but many are discouraged because they must first see a Quebec physician. Business would boom, he says, if the rules were eased: “It would be paradise.” The Canadian connection is just one measure that New England and New York are examining. In Boston, they discussed forming a co-operative to negotiate cheaper bulk prices from drug companies for their 29 million residents. The idea would be to obtain the products for people who do not have insurance covering prescription drugs at the same price that the U.S. government gets them under its Medicaid program—a 28-per-cent discount. Other politicians are tackling the problem. President Bill Clinton, for example, wants to expand the Medicare program that covers senior citizens to pay for half the cost of prescription drugs, up to $2,500 per person each year.

U.S. drug companies, not surprisingly, are fighting back. The industry’s trade association, the Pharmaceutical Research and Manufacturers of America, opposes drug price controls around the world—but is particularly concerned about the possibility of a law allowing the reimportation of U.S.-made drugs from Canada. It says that would bleed away money its members use for the costly research needed to develop cutting-edge drugs. And the Canadian system, it says, is no solution. Many of the most advanced (and most expensive) new drugs are simply not available to Canadians because cost-conscious provincial health plans refuse to approve them for use. “The price that Canadians pay for cheaper drugs,” argues the PhRMA, “is longer waits for and less access to health-improving and life-saving therapies. Do we really want this kind of system for us?”

While the political battles rages, though, seniors like Suzanne Woodard wait—and seethe. “I know they want to do something,” she says. “I just hope it’s in my lifetime.”

With Brenda Branswell in Montreal

Brenda Branswell