SPRINGFIELD, Mass. — Four times a day, when 13-year-old Mikey Albano injects himself with insulin from Canada to control his diabetes, his only concern is aiming the syringe.
Mikey -- the son of this city's mayor -- knows that some people question whether the medication that comes by mail to his home in a refrigerated package might be outdated or otherwise unsafe. Mikey also has heard critics suggest his father is endangering his life to save a few pennies.
"That is just wrong," the eighth-grader says. "And I'm living proof."
Three months ago, Mayor Michael J. Albano launched the country's first insurance plan that allows city workers to buy lower-cost medication from Canada. Albano and leaders of 23 unions spent nine months crafting a program to curb health-care expenses, which had more than doubled since the mayor took office in 1996.
In this medium-sized city in western Massachusetts, some of the 20,000 workers and their families are saving 30% to 90% on prescriptions because Canada's provincial health-care systems and government regulations keep prices lower.
Though the program defies federal restrictions on pharmaceutical purchases from Canada, Springfield Meds, as the plan is known, has emerged as a model for cities and states across America.
Officials from Boston and New York City were on hand Tuesday when Albano met with a congressional delegation looking into ways to lower prescription drug costs -- and those cities immediately began considering programs to re-import drugs that U.S. companies have sold to Canadian pharmacies.
Other cities including Sacramento and Los Angeles and states such as Minnesota, Michigan and Illinois are talking about similar plans. Earlier this week, Illinois Gov. Rod Blagojevich released a study showing that Canadian pharmacies were as safe as those in the U.S. -- and sometimes even safer.
In Washington, lawmakers working on legislation to overhaul Medicare are considering a proposal that would make it legal to import U.S.-made drugs from Canada. But many governors and mayors are not waiting for Congress to act.
Massachusetts Sen. Edward M. Kennedy came to Albano's defense when the Food and Drug Administration objected to Springfield's program even before it took effect. "We as a nation can't continue to tolerate double-digit inflation in the cost of prescription drugs," Kennedy said.
Albano's opponents -- drug companies and pharmacists, along with the FDA -- said imported drugs often failed to meet U.S. standards, and contended that mail and Internet-based delivery systems might be providing outdated drugs.
"There is a large risk for safety, and this is a very bad precedent," FDA Associate Commissioner William Hubbard said. "Some percentage of Americans are going to be harmed if this kind of practice becomes routine -- and some probably already are being harmed."
The mayor said he told the FDA: "Gentlemen, we are doing business with Canada. Not Iraq, not North Korea -- Canada. These are our friends."
Before approving the program, Albano inspected the nine Ontario pharmacies that provide drugs for the mail-order house that manages Springfield Meds. The mayor was reassured by what he found, and his son became the first person in town to receive medication from Canada.
Mikey's doctor said the boy was doing fine, the mayor said. "The Albano family is saving about $250 a year," he said, and other families may save up to $850 a year. The annual savings to the city, he added, "conservatively will be up to $9 million" -- enough to allow him to rehire some laid-off city workers.
"I had no intention of becoming a national spokesperson for or against anything," Albano said. "I just wanted to stabilize the city's finances for the next few years -- and to help city employees save some money."
Albano, a Democrat, said he was troubled last spring when cuts in state aid forced him to lay off 323 city workers, including 76 police officers and 52 firefighters. His shrinking budget was burdened by health-care costs that in six years had shot from $33 million to $67 million. Prescription costs alone soared from $9 million to $18 million in that period.
Health-care costs threatened to rise another 20% next year, Albano said. He knew he could neither change what physicians charged nor alter the prices of medical tests or hospitalization. So "we looked at the cost of prescriptions," he said.
The mayor and his task force quickly focused northward. Congress had approved prescription drug bills that allowed re-importation of drugs from foreign countries, including Canada. Several Democratic presidential candidates have vowed to make Canadian pharmaceuticals available to U.S. citizens.
For years, Americans have gone to Canada to save money on medicines. In border states, senior citizens groups organize bus trips to Canadian pharmacies. Internet sites also allow Americans to buy drugs from Canada -- the same medication sold in the United States.