FRIDAY, July 1, 2005 (HealthDay News) -- If Canada makes good on its pledge this week to restrict exports of prescription drugs, it will mean short-term headaches for U.S. consumers needing cheaper, potentially lifesaving pharmaceuticals.
In the long-term, however, such a move could force some dramatic changes in the prescription drug network, and might even prompt a political showdown in Washington, D.C., experts say.
"For millions of Americans who currently import drugs from Canada because they can't afford to pay the prices in the U.S., this would make it difficult, if not impossible, to do so unless they could go to Canada," said Kirsten Sloan, AARP's national coordinator for health issues.
"What it doesn't mean, which is just as important, is that it's not going to diminish the growing public sentiment that there has to be something done to control costs," she added.
The proposed Canadian legislation "potentially takes away one of the last opportunities for somewhat more affordable drugs," added Isaac BenEzra, president of the Massachusetts Senior Action Council in Amherst, who gets his drugs from Canada and helps others do so as well. "That spells not taking your pills, cutting your pills in half, not filling your prescriptions, and that leads to more serious problems and, in the end, it can be deadly. It's bad news."
Soaring U.S. prescription drug costs and the growth of the Internet have fueled cross-border drug sales in recent years, with one U.S. Department of Heath and Human Services study estimating that more than 12 million prescriptions destined for American patients were filled by Canadian pharmacies in 2003 alone, for a total $700 million in sales.
While the Bush administration has firmly opposed legalizing drug imports, government leaders in Illinois, Minnesota, New Hampshire, North Dakota and Wisconsin and cities like Springfield, Mass. have set up programs to help cash-strapped residents buy their pharmaceuticals from Canada. And one poll, conducted in January by the Kaiser Family Foundation, found that 73 percent of Americans support legal changes that would allow them unfettered access to Canadian drugs.
Drugmakers contend that price controls in countries such as Canada depress the cost of prescription drugs to consumers to artificially low levels. Such price controls, which don't exist in the United States, would discourage the research and development needed to bring new and better drugs to market, according to the manufacturers.
Reacting to the upsurge in cross-border activity, drug companies such as Pfizer Inc. and GlaxoSmithKline have cut supplies to Canadian pharmacies and wholesalers that serve American customers.
Abby Ottenhoff, a spokeswoman for Illinois' pro-import Democratic governor, Rod Blagojevich, told HealthDay last fall, "It's a well-known fact that the pharmaceutical industry is trying to shut down supply to Canadian pharmacies that are serving American citizens."
The potential reduction in cross-border sales has many Americans on edge. The new Medicare prescription drug benefit, which takes effect in January, will provide some relief to older patients, but not all of the 42 million or so Americans without insurance. "This impacts them in a huge way," Sloan said.
The loss of Canadian pharmaceuticals may not be quite as traumatic as once anticipated, however.
The Ottawa government announced this week that it is drafting legislation to restrict bulk exports of Canadian drugs, but this legislation is not going to be as severe as originally feared by many Americans. And any changes would probably not happen till later this year at the earliest, according to news reports.
The Canadian initiative stems from a concern that pharmacy sales to the United States could cause domestic shortages, although none currently exists.
Experts estimate that close to 2 million Americans rely on Canadian supplies for needed prescription drugs. Prices in Canada are up to 70 percent lower than those in the United States, which has the highest drug prices in the world, according to Bloomberg News Service.
The Canadian proposals include prohibiting the bulk exportation of prescription drugs, strengthening current Canadian regulations that would require a patient-doctor relationship before drugs could be dispensed, and curbing Internet opportunities to buy drugs, explained Sloan.
"The patient would have to go over the border and not just go into a drug store but to a doctor," she said.
Currently, U.S. doctors can fax prescriptions to Canadian doctors who then sign the prescription and pass it on to an Internet pharmacy.
The issue has taken on added urgency in Canada because the U.S. Congress is expected to pass legislation that would facilitate imports of Internet prescription drugs into the United States.
One effect of the pending Canadian move is that people are already looking elsewhere for low-cost alternatives. The Associated Press reported that Minnesota Gov. Tim Pawlenty is exploring British mail-order pharmacies as an alternative. Minnesota led other states when it established the first Web site aimed at helping residents buy cheaper drugs from Canada.
"If Canada closes its doors, the U.S. will look to other places," Sloan said. "In the short-term, it might close one avenue but I think it opens another."
In fact, according to The New York Times, many of the largest online pharmacies have started storing their inventories overseas.
"These are all short-term solutions," Sloan cautioned. "The fact that Americans have been buying their drugs from Canada has acted like a safety valve for many people. When you block these safety valves, the pressure continues to build, and it is building every day. People can't afford the medications that they need, and Americans are pretty good at forcing an issue once it gets to the point where all of the safety valves are closed."
AARP has an article on assessing Canadian pharmacies.