Cancel the Discount?
FAIRMONT — Mary Ellen Nottingham was running an errand earlier
this month when she spotted a photographer taking pictures of Fairmont's
Discount Prescription Center. "I thought: Oh no, it's happening." She told her
"I told myself, if he's trying to put them out of business,
maybe I can do something," she
She'd seen on television that the West Virginia Board of
Pharmacy is trying to shut the place down. She feared the photographer was a
The 5-foot-1 woman didn't calm down until the newspaper
photographer explained that he was just taking pictures for a story. "I was
ready to make a stand," she
"I guess he thought I was going to attack
Nottingham believes her health is at stake. She orders seven
prescriptions from Canada through Discount Pharmacy Center, including Lipitor,
Plavix, Glucophage and Tricor. "I'm on 18 different pills a day now," she
"Medicine keeps me alive," she
"Medicine, the Lord and
these people who run this business."
She buys a three-month supply, the maximum anyone can import at
one time. "I'm saving around $400 a month," she
"A lot of people might
right. When you don't have money, you eat a lot of macaroni and potatoes."
Catching her breath inside the store, Nottingham said that,
after 33 years of making a decent living — 28 at Fairmont's Electronic Control
Systems — she developed near-fatal heart disease and couldn't work anymore.
"Boom, the paycheck was gone," she
"It's been rough, to
put it mildly."
Now she lives on her pension and Social Security, minus her
Medicare B payment. She gets about $1,200 a month total. "It's gone practically
before I get it," she
Medicare does not cover her prescription
drugs. "I'm so thankful this place opened up."
Not everybody is as thankful
In May, the state Board of Pharmacy ordered Discount
Prescription Center to shut its doors or face legal action. The pharmacy board
contends that the center is a pharmacy without a pharmacist.
Pharmacy boards in at least 19 other states are defending their
turf, trying to shut down buy-from-Canada storefronts. Hundreds of these little
businesses have sprung up in at least 30 states in the past year. The U.S. Food
and Drug Administration is urging state boards to put on the lid on them before
they spread further.
In March, the Arkansas pharmacy board sent the nation's first
Moore told USA Today that he would appeal to the U.S. Supreme Court if
going to fight like a wild animal."
To the dismay of pharmaceutical companies and local pharmacies,
Canadian Internet firms have developed a new marketing tool. Each week,
busloads of prescription-filling Americans cross the Canadian border. At least
a million Americans order by computer. Now Canadians are partnering with
American entrepreneurs to attract customers like Nottingham who feel most
comfortable in a U.S. store, where someone can help them.
West Virginia University law professor Bob Bastress represents
owner Carole Becker and her husband, Steve, who manages the store. He has filed
a motion asking the Kanawha Circuit Court to block the state effort to shut the
The case is local, Bastress said, but it involves international
issues: American access to more affordable drugs and access to foreign markets,
pharmaceutical company profits, and senior citizens who can't afford drugs. It
may be the nation's first such hearing. Other states, the FDA and
pharmaceutical companies will be following it.
"The pharmaceutical companies have wanted to shut down the
Canadian outlets for years," said Kevin Outterson, who teaches health law at
WVU. "When people started buying Canadian drugs over the Internet, the
companies didn't know how to stop that buying, because it would mean arresting
Grandma and Grandpa here in the States. That's not going to happen.
"But older people aren't as adept with computers as younger
people are. So these storefront facilitators have developed. Storefronts are a
much easier target, politically."
Meanwhile, the Fairmont store — located in a rehabbed gas
Like storefronts in other states, it isn't fancy and doesn't require much
overhead. American and Canadian flags fly from the building. Signs are modest.
One small, tidy room holds some bookshelves, a few chairs and a table with a
laptop computer, phone and fax machine.
When Mary Ellen Nottingham first came in, Steve Becker showed
her what her prescriptions would cost in Canada. "I couldn't believe I can sit
in Fairmont, W.Va., and get prices like that," she
She found she could get a month of Lipitor for $55.50, a month
of Plavix for $69.30 and a month of the generic of Glucophage for $9.72. It
would cost her about twice as much in Fairmont.
Nottingham showed Becker her prescriptions, and he faxed the
forms, her medical information and her credit card number to his Manitoba-based
.com. A Canadian doctor reviewed Nottingham's form and
prescriptions for accuracy and validity, as required by Canadian law, Becker
Critics say this is exactly the problem. There is no pharmacist
at the Fairmont store to make sure Nottingham isn't ordering two conflicting
medicines, for instance. Nottingham says her doctors — and the Canadian doctor —
She got her medications in the mail at her Fairmont home within
two weeks after she ordered them, she
She didn't pay Becker anything.
Discount Prescription Center gets a 10 percent fee from his Canadian partner
for every prescription they process. "That's how I make money," he
There's a processing fee no matter how you order, he
The store prices are in the ballpark for Canadian Internet
pharmacies: 30 percent to 80 percent lower.
Prices, not patient safety, are the driving force behind all
this, said Outterson. "A huge proportion of the industry's global profits
depend on maintaining the U.S. prices. If U.S. prices went down to the level of
Canadian prices, the pharmaceutical industry would lose tens of millions of
But health care costs — and therefore health insurance rates —
would go down. "Health insurance rates would decrease and stabilize somewhat,
which means more small business owners would be able to offer health insurance
to their employees," said Sally Richardson, who directs WVU's Institute for
Health Care Policy.
Not just a West Virginia story
Steve Becker says he and his wife are fighting the shutdown
order on principle. "This is something that changes people's lives," he
people get packages ready for the post office."
He is not for a drug-ordering free-for-all. He believes the
Canadian market is safe, for instance, but the Mexican market is not. "Anybody
who trusts the Mexican drug market obviously hasn't been to Mexico," he
William Douglass, director of the West Virginia Board of
Pharmacy, says he stands on principle, too. He is protecting the public well-
being. "We don't want to stop people from finding cheaper sources for their
prescription drugs," he
"We know a lot of people need that. We just don't
believe this source is either safe or legal."
"Those kinds of statements really tick off Canadian officials,"
Bastress contends that the FDA is responding to pressure from
the pharmaceutical industry on the Bush administration. The FDA denies
it. "Because the medications are not subject to FDA's safety oversight, they
could be outdated, contaminated, counterfeit or contain too much or too little
of the active ingredient."
"Canada has their own equivalent of the FDA and, if anything,
they've got a better record than we do." Becker said, recalling that fake
Lipitor recently turned up in the U.S. drug stream, and a Missouri pharmacist
was convicted of diluting people's cancer prescriptions.
"I can't speak for how their regulatory bodies are up there.
I'm not really familiar with them," Douglass
"But to have something
coming from as far away as across the border of a foreign country allows the
criminal element to have more of a success."
"There are no drugs on my clients' premises," Bastress
"They do not handle drugs, dispense drugs or accept money from people
ordering the drugs. They process orders. How can anyone call that a
Shift in how drugs
are bought and sold
Buy-from-Canada storefronts are multiplying fast. Tulsa, Okla.-
based RxDepot opened its doors in 2002. By early August, there were 74 RXDepots
in 24 states, according to RXDepot President Carl Moore. Florida has about 150
such storefronts, he
The Florida pharmacy board has taken no action. Others are
ready to pounce. In May, the Kentucky Board of Pharmacy director told the
Louisville Courier-Journal that if a storefront opens in Kentucky, "We will
proceed fairly quickly with an injunction."
The U.S. Congress appears to be going in the other direction.
Both houses have passed bills that would legalize prescription drug-buying from
Canada. Those bills are stuck in committee. And politicians are stuck between
increasingly angry seniors and a pharmaceutical industry that contributed more
than $20 million to congressional campaigns in 2002.
The FDA warns that Canadian Internet pharmacies don't have
enough drugs to supply the United States, so counterfeits are inevitable. If we
get the orders, we'll get the drugs, Canadian pharmacies say.
No, you won't, the pharmaceutical companies say. Three of the
world's largest pharmaceutical companies — Pfizer, AstraZeneca, and
GlaxoSmithKline — are trying to cut the Canadian pharmacies off at the pass.
They have announced they will cut off supplies to Canadian Internet pharmacies
that buy drugs at wholesale prices, then resell them to Americans at Canadian
prices. Canadian wholesalers are planning end runs.
"There are antitrust issues here," said WVU's Outterman. "You
can't tell people who they can sell to."
Canadians have a lot of money at stake, too. Like West
Virginia, the province of Manitoba is economically stressed. The Canadian
Internet pharmacy business is centered there. "Suddenly, they have access to
millions of customers," Outterman observed.
Earle Turow, chairman of Discount Drugs of Canada, told Newsday
he expects his organization to clear $100 million next year. He thinks the
Internet industry should be internationally regulated, not shut down, he
"We're doing good work for the seniors," Turow
running a straight business. If they try to shut us down, they're going to be
confronted with a major uprising from the seniors."
"If you look at this logically," said Carl Moore of
RXDepot, "do you think, with that World Wide Web, that these people are going
to be able to hold 400 million people hostage with prices that are two and
three times as high as anywhere else in the world?
"You've got the big pharmacy companies scared to death," he
enterprise in this country."
"a genuine consumer revolt"
In Fairmont, Howard Postlethwaite plopped down for the first
time on one of Discount Prescription's folding chairs. "How're your legal
troubles coming?" he asked Steve Becker, as if the two were old
At age 70, Postlewaite is diligently investigating drug prices.
The retired life insurance agent has decided he and his wife can no longer
afford their Medigap insurance. He is trying to find ways they can afford their
"I'm a radical when it comes to pharmaceutical companies," he
"Every time I go to pick up some medicine for me and my wife, the price's
gone up." He has figured out that it will cost him more to keep the insurance
than to shop around and buy from other countries.
Postlethwaite has systematically researched the subject on the
Internet. "The pharmaceutical companies have over 600 lobbyists registered in
D.C., and they give millions a year to politicians," he said, so he doesn't
believe Congress will actually pass anything that gives Medicare prescription
"It's all for the campaign," he
"After that's over,
they'll forget about it."
He is determined to get those low prices. "I have to," he
"If they manage to shut the whole thing down, my wife and I will be
driving up to Canada every three months."
Earlier this month, a Washington Post editorial called the
American consumer's increasingly defiant determination to buy from Canada "a
genuine consumer revolt."
An Internet search turned up at least 26 stories about the FDA
effort to shut down the storefronts. The stories come from many states:
Delaware, Indiana, Florida, Arkansas and Montana, among others.
Washington Times that "I have to work an extra job so that I could pay for my
pills. I have no idea why our government wants to force us to buy these drugs
from Canada. But that's what we will do."
don't know how they [FDA] think poor people — you know, on Social Security and
fixed incomes — can do it," she
"As long as I can get it that much
cheaper, I'm going to."
mother has flat refused to buy her heart medicine [at American prices] because
it costs more than she gets in a month."
Earlier this summer, the city of Springfield, Mass., announced
that it will buy prescription drugs through Canada for its employees and
retirees, saving the city $4 million to $9 million a year.
The FDA commissioner asked Springfield's mayor to reconsider,
for the safety of his city's citizens. The mayor said he has bought his son's
diabetes medication from Canada for years and has heard of no safety problems
with the Canadian supply.
drugs a utility?
Given consumers' determination to get low prices, all this
legal action could paradoxically make the market less safe for consumers, said
law professor Outterson.
"If they shut down Canadian outlets that can be regulated, they
will be sending American customers to highly unregulated outlets that truly
might be dangerous." Thailand, Brazil and India all ship large quantities of
much-less-regulated drugs worldwide, for instance.
Outterson suggests that, if West Virginia wants to find a
creative solution, it might make more sense to explore ways to let state
pharmacists buy prescription drugs through Canada, then perhaps tack on a
"The political atmosphere is right for something like this," he
"That would probably set up a furious battle between the state
of West Virginia and the pharmaceutical companies and the federal government.
But wouldn't that be a glorious fight? The state and the citizens could save
tens of millions of dollars a year in drug costs. I think at the end of the
day, West Virginia would win."
The pharmaceutical companies sued when Maine announced it was
going to use its Medicaid clout to demand lower prices, and the Supreme Court
ruled in Maine's favor earlier this year, he noted.
In Fairmont, Steve Becker is philosophical. The U.S. Senate has
passed a bill that would let U.S. pharmacies import Canadian drugs.
If Congress were to pass it, he'd probably be out of business.
If that happens, he said, he would be happy for his customers and go back to
Whatever happens, he predicts, U.S. pharmaceutical drugs will
eventually be regulated as a utility. "Americans won't tolerate these prices
much longer, he
"The pharmaceutical companies have worked very hard over the
past 40 years to convince the American people that we can't do without their
products and services. And the American people have bought it. The vast
majority now believe that they can't make it without these pharmaceuticals." he
"Any kind of moral judgment aside, we have to begin to consider that
pharmaceutical companies are utilities."
West Virginians average 15 prescriptions a year, 4 more than
the national average, according to Blue Cross Blue Shield of America.
"We have traditionally regarded utilities as those goods and
services that society cannot do without," Becker
"That goes right to the heart of the pharmaceutical company's
argument that this is a free market. The necessity of those goods to our
"We are totally dependent on pharmaceuticals," he
to me, that makes them a utility."
A lot must happen to get from here to reasonable regulation, he
He and his wife will play their small parts in this international drama
by going to court in October.
To contact staff writer Kate Long, use e-mail or call 348-