Washington Editor

WASHINGTON - Americans who buy prescription drugs more cheaply from Canada soon might face their most difficult obstacle - the Canadian government.

Late last year, that country's top health official said he wants to put the brakes on U.S. purchases through Canadian pharmacies. Ujjal Dosanjh, Canada's Minister of Health, fears a depletion of his country's drug supplies. In November, he told a Harvard Medical School audience "that Canada cannot be the drug store of the United States."

Next month, Dosanjh plans to ask his government to approve measures to restrict Canadian doctors from prescribing drugs for patients they haven't seen. Canadian doctors are paid between "$5 and $10 per each prescription" they rewrite or co-sign, said Marv Shepherd, director of the Center for Pharmacoeconomic Study at the University of Texas in Austin. He thinks the Canadian drug importation process soon could be halted as a result of Dosanjh's efforts.

"I think there is a high probability of it," he said, "due mainly to two factors in Canada. No. 1 is the supply of the drugs, and No. 2 is that many health care organizations in Canada don't like the ethical principles of prescribing medication without seeing the patient."

But some in the U.S. don't want to see the Canadian drug importation option disappear. Minnesota is one of a number of states that help its residents find Canadian pharmacies on the Internet, via an official government website.

"The Canadian government should not slam the door on American consumers seeking more affordable prescription medicines from safe Canadian pharmacies," Minnesota Gov. Tim Pawlenty said on the state's website. "The proposed change in Canada's prescription drug policy would have serious effects on the pocketbooks and well-being of the more than 2 million Americans who buy their prescription medicines from Canada."

In his speech at Harvard, Dosanjh said Internet pharmacy sales from Canada to the U.S. have plateaued at about $600 million per year. Last month, a U.S. government report from the Department of Health and Human Services concluded that about 12 million prescription drugs, worth about $700 million, entered the U.S. from Canada in 2003 via Internet sales and travel by American consumers. The report, which was created by a task force chaired by U.S. Surgeon General Richard Carmona, also found that an equivalent amount of drugs are coming in from the rest of the world.

"I don't think the Internet buying of foreign pharmaceuticals is going to stop," Shepherd said. "You can get around a lot of laws by doing that."

Pawlenty said the Minnesota government would continue to steer its residents to overseas markets.

"In the unfortunate event that Canada changes its policy," he said, "we will seek a way to keep our MinnesotaRxConnect.com website operating by facilitating purchases from European countries with safe pharmacy systems."

The federal report is clearly critical of the practice, however, noting that Americans who purchase drugs from overseas generally are doing so at a "significant risk." That sentiment was echoed by Shepherd, who said imported drugs might have no active ingredient, or levels that are too high or low. He added that some drugs are imported without prescriptions, meaning that they are used absent of physician supervision and therefore increasing interaction risks.

"There's no doubt that there is a risk," Shepherd said, "and the FDA has published that many times - that it's a buyer-beware market."

Should Canada no longer be an option for drug importation, he said pharmacies selling drugs from there might move to offshore islands where they can operate with less government interference. In that case, U.S. consumers could end up trying websites based in western European countries, as Pawlenty said on Minnesota's website, or buy from sites in less-regulated territories.

But Shepherd said that as Medicare coverage of prescription drugs climbs in the U.S., the consumer drive to seek overseas drugs could decrease. And for uninsured Americans, he said a number of U.S. sources exist to obtain drugs cheaply.

"If U.S. governors really want to help people in this situation, why don't they put on their state websites links identifying those places in the U.S. that are offering good, quality drugs?" he asked. "There is the helpingpatients.org website and the togetherrx.com website."

The Together Rx program was unveiled just last week. Created in concert by almost a dozen large pharmaceutical companies, it amounts to a prescription drug discount card designed to help uninsured Americans save money when buying their products.

Up to 36 million Americans, about 80 percent of the estimated 45 million people in the U.S. without medical coverage, could be eligible for the discount card and could begin getting markdowns at participating pharmacies by the middle of next month.

The program allows certain people to save between 25 percent and 40 percent on more than 275 brand-name drugs and a host of generic products. To qualify, applicants must be legal U.S. residents younger than 65 and not eligible for Medicare and have no other private or public drug coverage. Their incomes cannot be higher than $30,000 for a single person or $60,000 for a family of four.

The pharmaceutical companies already offer a card to Medicare recipients, designed largely as a bridge until Medicare's drug benefit is added.

The U.S. government report also found that total savings from legalized importation under a commercial system would be a small percentage relative to total drug spending in the U.S., about 1 percent to 2 percent, and said generic drugs often are cheaper in the U.S. compared to international prices for similar drugs.

In suburban Washington, government officials in Maryland's Montgomery County are rethinking plans to make Canadian drugs available to employees after a school system analysis concluded that the practice wouldn't save as much money as hoped. Economic conditions such as a weakening U.S. dollar and shipping costs surfaced as reasons that drug importation might prove more expensive than originally thought.

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