Las Vegas Business Press :: News : Nevada's Canadian drug plan

Nevada's Canadian drug plan

may face challenges

VALERIE MILLER

BUSINESS PRESS

University Medical Center Director of Pharmacy Don Frisch thinks the poor will have a tough time using Nevada's Canadian drug importation system.

Oncologist Dr. Arnold Wax is passionate when he talks about skyrocketing drug prices in the United States. The Southern Nevada physician has seen his patients make difficult choices. Some have had to skimp on buying potentially lifesaving drugs while substituting cheaper, less-effective, alternatives in their place.

So far none have paid with their lives, said Wax, who is a doctor with the Comprehensive Cancer Centers of Nevada. "Some certainly had side effects because they did not fill them and got sicker, and sometimes we had to come up with some alternative that was maybe not as effective."

State lawmakers like Assemblywoman Barbara Buckley, D-Las Vegas, said they wanted to give people like that a better choice when they passed Senate Bill 5 at the end of the recently concluded Nevada legislative session. The bill paved the way for Nevadans to order their medications from state-regulated online pharmacies in Canada. Before the ink could dry on the new law, however, Canadian government officials began looking at restricting drug exports to the United States.

Canada's House of Commons could take up the proposal by Health Minister Ujjal Dosanjh to ban bulk exports when it reconvenes in the fall. The health minister has said the ban is needed to protect Canadian citizens from drug shortfalls in their own country.

Representatives from Nevada's Board of Pharmacy are going ahead with a trip this week to Winnipeg to meet with Canadian pharmacy representatives, and Buckley doesn't see the looming Canadian law as a roadblock.

"No, I am not concerned about that. The latest proposal from the Canadian (health) minister is to ban bulk exports," Buckley said, noting that the state's system would deal in individual, not bulk purchases. Typically, bulk purchases are made by pharmacies to stock their shelves.

Wax isn't so optimistic. He supports the state's efforts but thinks changes in Canadian law will make Nevada's program short-lived. "My question is, 'How long will it last?''' he asked.

Nevada's freshly minted law allowing the importation of prescription drugs from Canada is already having problems crossing the border into acceptance. The proposed legislation in Canada and questions about the implementation here at home are dogging the program before it starts.

While mostly hailed as a step in the right direction, critics say the Nevada's online import system may also be too cumbersome and costly for many people to navigate.

"There's a lot of people who want to use it, but the people who could really benefit from it won't have the money for the computers. That's where the bottleneck really is," predicted Don Frisch, the director of pharmacy and a clinical practitioner at University Medical Center. "In an online pharmacy, they require a credit card online and then a fax of a subscription, and a lot of people won't likely have a fax machine."

A Web site would be set up and run by the state Office of Consumer Health Assistance. Those Canadian pharmacies licensed by Nevada's Board of Pharmacy would be identified on or linked to the Web site. Patients would log on to the site, fill out forms and then fax in their prescriptions from Nevada doctors, explained Louis Ling, the general counsel for the state Board of Pharmacy. A Canadian doctor would then fill out a duplicate prescription for the Canadian pharmacy to fill and ship back directly to the patient.

Scott Phillips shares the concern of people like Frisch that the Internet will become a technological barrier.

"Seniors don't want to buy on the Internet," he said. "They won't want to use their credit cards on the Internet." The businessman once was involved in the Canadian pharmaceutical importation industry.

Now in the financial field, Phillips studied the market when attempting to set up a storefront business for ordering Canadian drugs last year. His plans were dashed when Clark County refused to give him a business license because the county considered it an illegal business. While not allowed in unincorporated Clark County, the cities of Las Vegas and Henderson do not forbid such businesses.

Nevada's new law does not address the issues of the storefront operations. Storefronts normally transact business by serving as a physical location from which customers can order medications and sometimes pick up the shipped packages.

"Seniors are attracted to the simplicity of the storefronts," Phillips contended. "They would rather speak one-on-one with a person."

People age 65 and over are the biggest users of prescriptions drugs. They use an average of four times more prescriptions than those who are younger, noted Iain Buxton, a University of Nevada, Reno professor of pharmacy and the dean of the University of Nevada School of Pharmacy.

Buxton believes that the larger problem for programs such as Nevada's will be the pressure from the pharmaceutical industry on Canada to limit cheap Canadian imports into the United States.

"I would say that on balance Canada can't afford to supply drugs to the United States without losing its discount privileges," he said. Canadian drug imports into the United States have reached $700 million, according to the U.S. Food and Drug Administration.

Nevada is far from alone in legalizing its entry into the Canadian pharmaceutical business. Rhode Island and Texas have both recently passed similar laws allowing the importation of Canadian drugs but are still working out their regulations, said U.S. Food and Drug Administration Director of Pharmacy Affairs Tom McGinnis.

Five other states participate in the I-SaveRX program started by the state of Illinois in October 2004 under an initiative by Illinois Gov. Rod Blagojevich, a Democrat. Under that program, residents of Illinois, Wisconsin, Kansas, Missouri and Vermont can log onto the I-SaveRX Web site and order drugs through approved pharmacies in Canada, Great Britain and Ireland.

The process has safeguards, explained Susan Hofer, the spokesperson for the Illinois Department of Financial and Professional Regulations. "Before you order the drugs, your doctor has to fax a health profile to a central clearing house (in the United States)," she said. "It's about your health and what drugs you are taking."

After a U.S. pharmacist looks at the profile, the prescription is sent to the country where the prescription will be filled. It is later mailed to the patient. Hofer labeled her state's program as a success, getting about 10,000 participants in Illinois alone.

The state of Wisconsin had three different agencies inspect Canadian pharmacies last year at the direction of that state's governor, Jim Doyle. Wisconsin now has an informational Web site (besides the I-SaveRX site) with those pharmacies listed, state communications officer Carla Vigue explained. "Just the fact that the Web site is there for information helps, but it does direct them to links where they can order."

Not all gubernatorial initiatives allowing for Canadian drug imports are well received. In early 2004, then-New Hampshire Gov. Craig Benson listed two Canadian pharmacies on his official Web site. That didn't go over too well, said Paul Boisseau, the New Hampshire Board of Pharmacy's executive secretary.

"The (New Hampshire) Board of Pharmacy did not endorse it ... anecdotally, we heard very, very few people used the site," he said, adding the importation practice is still illegal under federal law.

The Food and Drug Administration's McGinnis said his agency is withholding final judgment on what Nevada is doing until it sees the state's regulations. Still, he maintained it would most likely violate federal law. McGinnis defended his agency's stance on the Canadian imports, citing legitimate safety concerns as the reason.

"Since there are no more excess Canadian drugs, we are getting drugs shipped (in) from Canada from pharmacies in India and elsewhere," McGinnis said. "We worry about the strength, quality and purity of medicines made around the world."

vmiller@lvpress.com | 702-871-6780 x331

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