BENNINGTON, Vt. — A shy woman, seldom prone to displays of political exasperation, Jane Hanlon spread copies of her prescription bills out before her and let the figures do the talking. Until recently, the 71-year-old hairdresser paid $95 a month at her neighborhood pharmacy for the tamoxifen that has kept her breast cancer in check for eight years.
Now Hanlon gets her tamoxifen from Canada--for $125 a year.
"And that includes shipping," said Hanlon, of nearby Williamstown, Mass. She paused to collect her thoughts, then added: "The way drugs are marketed in this country, well, somebody's making a lot of money off us senior citizens. If Canada can do this, why can't we?"
Hanlon and thousands of elderly residents of New England border states aren't sitting around waiting for answers from politicians who made prescription drugs for seniors a centerpiece of the election season.
By bus, by car, by foot and by fax machine, seniors have set up an expanding underground pipeline to secure medication from Canada, where drugs often sell for a fraction of what U.S. consumers pay. Increasingly, U.S. doctors have become allies.
Crossing the Canadian border to buy up to a six-months' supply of prescription drugs is within the laws of both countries. A U.S. citizen must visit a Canadian doctor to obtain a valid prescription. Alternatively, some U.S. doctors have "border licenses" to prescribe in both countries. But the spinoff method of ordering medication from Canada by fax is in a nether world: not quite legal, but also not entirely illegal.
Senior citizens are such a vulnerable population that no legislature has moved to ban the Canadian prescription drug purchasing efforts. But some organizers of bus trips say they fear lawmakers may bow to the clout of the prescription drug industry by attempting to halt the trend.
On an informal basis, foreign drug-buying is hardly new. For years, people from California and other border states have slipped into Mexico to buy medication. But organized prescription shopping excursions--"drug runs," as some senior citizens here playfully call the trips--have turned the phenomenon into a mass experience.
Chartered bus trips that began about a year ago in Vermont have inspired imitation in Western border states, even turning into campaign events in two U.S. Senate races this fall. Minnesota Democrat Mark Dayton took a busload of elderly drug buyers to Canada and won. Brian Schweitzer of Montana, also a Democrat, did the same but lost. After Rep. Bernie Sanders (I-Vt.) became the first member of Congress to host a bus trip last year, several of his colleagues followed suit.
As if they were three nations negotiating a trade treaty, Maine, New Hampshire and Vermont are forming a buying co-op to bring cheaper pharmaceuticals to their elderly residents. Some doctors in U.S. border communities have obtained licenses allowing them to prescribe directly to Canadian pharmacies. In towns such as Calais, Maine, patients simply stroll across a bridge to New Brunswick to buy medication.
Recently, a health care group here found a way around the ordeal of long bus rides to visit first a doctor, then a pharmacy in Canada. Using a prescription-like template, a handful of Vermont doctors faxes drug orders for patients to a Canadian pharmacy. The drugs are then shipped to the ordering doctor's office, where patients pick up their supply. Even with FedEx charges, the drugs usually cost U.S. patients a sliver of what they used to pay.
The drugs are cheaper in Canada because that country's system of socialized medicine tightly controls pharmaceutical costs. U.S. drug prices also are higher because of costly advertising campaigns, government lobbying and research and development expenses. Another factor is the favorable exchange rate for U.S. dollars in Canada that makes items less expensive there.
Same Drugs, Same Packaging
Drugs purchased by U.S. citizens in Canada generally are manufactured in the same plants in Puerto Rico as drugs sold in this country. Often the packaging is identical. Doctors and other medical experts say the Canadian prescription drug market is more closely supervised than its counterpart in Mexico, where pharmaceuticals can be purchased without visiting a local doctor--and sometimes without a genuine prescription.
Seniors, many on fixed incomes, celebrate the savings of shopping in Canada but lament a U.S. prescription marketplace that sends them--and their dollars--out of the country. They are well aware of the political message inherent in this elderly exodus.
"I'd have to say it's pretty shameful," said 71-year-old Barbara Gordon of Grand Isle, Vt. Gordon and her husband, who are retired dairy farmers, ride the bus every few months to Quebec for medication.