FAIRMONT — Mary Ellen Nottingham was running an errand earlierthis month when she spotted a photographer taking pictures of Fairmont'sDiscount Prescription Center. "I thought: Oh no, it's happening." She told her
ister-in-law to wait in the car. "I told myself, if he's trying to put them out of business,maybe I can do something," she aid. She'd seen on television that the West Virginia Board ofPharmacy is trying to shut the place down. She feared the photographer was a
tate worker, gathering evidence of some sort. The 5-foot-1 woman didn't calm down until the newspaperphotographer explained that he was just taking pictures for a story. "I was
ready to make a stand," she aid."I guess he thought I was going to attackhim." Nottingham believes her health is at stake. She orders sevenprescriptions from Canada through Discount Pharmacy Center, including Lipitor,Plavix, Glucophage and Tricor. "I'm on 18 different pills a day now," she aid. "I'm diabetic, and I've had aorto-bifemoral bypass surgery. "Medicine keeps me alive," she aid."Medicine, the Lord andthese people who run this business." She buys a three-month supply, the maximum anyone can import atone time. "I'm saving around $400 a month," she aid."A lot of people might ot know what a difference that makes. I can put gas in the car. And I can eatright. 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 ControlSystems — she developed near-fatal heart disease and couldn't work anymore. "Boom, the paycheck was gone," she aid."It's been rough, toput it mildly." Now she lives on her pension and Social Security, minus herMedicare B payment. She gets about $1,200 a month total. "It's gone practicallybefore I get it," she aid.Medicare does not cover her prescriptiondrugs. "I'm so thankful this place opened up." Not everybody is as thankful In May, the state Board of Pharmacy ordered DiscountPrescription Center to shut its doors or face legal action. The pharmacy boardcontends that the center is a pharmacy without a pharmacist. Pharmacy boards in at least 19 other states are defending theirturf, trying to shut down buy-from-Canada storefronts. Hundreds of these littlebusinesses have sprung up in at least 30 states in the past year. The U.S. Foodand Drug Administration is urging state boards to put on the lid on them beforethey spread further. In March, the Arkansas pharmacy board sent the nation's first hut-down-or-be-prosecuted letter to one of these new storefronts. Owner CarlMoore told USA Today that he would appeal to the U.S. Supreme Court if ecessary. "We believe that we're morally and ethically right," he aid."We'regoing 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 leasta million Americans order by computer. Now Canadians are partnering withAmerican entrepreneurs to attract customers like Nottingham who feel mostcomfortable in a U.S. store, where someone can help them. West Virginia University law professor Bob Bastress representsowner Carole Becker and her husband, Steve, who manages the store. He has fileda motion asking the Kanawha Circuit Court to block the state effort to shut the tore down. The hearing is scheduled for Oct. 2. The case is local, Bastress said, but it involves internationalissues: American access to more affordable drugs and access to foreign markets,pharmaceutical company profits, and senior citizens who can't afford drugs. Itmay be the nation's first such hearing. Other states, the FDA andpharmaceutical companies will be following it. "The pharmaceutical companies have wanted to shut down theCanadian outlets for years," said Kevin Outterson, who teaches health law atWVU. "When people started buying Canadian drugs over the Internet, thecompanies didn't know how to stop that buying, because it would mean arrestingGrandma and Grandpa here in the States. That's not going to happen. "But older people aren't as adept with computers as youngerpeople are. So these storefront facilitators have developed. Storefronts are amuch easier target, politically." Meanwhile, the Fairmont store — located in a rehabbed gas tation — is open for business, right across from Fairmont General Hospital.Like storefronts in other states, it isn't fancy and doesn't require muchoverhead. 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 alaptop computer, phone and fax machine. When Mary Ellen Nottingham first came in, Steve Becker showedher what her prescriptions would cost in Canada. "I couldn't believe I can sitin Fairmont, W.Va., and get prices like that," she aid. She found she could get a month of Lipitor for $55.50, a monthof Plavix for $69.30 and a month of the generic of Glucophage for $9.72. Itwould cost her about twice as much in Fairmont. Nottingham showed Becker her prescriptions, and he faxed theforms, her medical information and her credit card number to his Manitoba-basedpartner, discountprescriptionsofcanada .com. A Canadian doctor reviewed Nottingham's form andprescriptions for accuracy and validity, as required by Canadian law, Becker aid. The company managers verified her credit card and shipped the drugs toher address. Critics say this is exactly the problem. There is no pharmacistat the Fairmont store to make sure Nottingham isn't ordering two conflictingmedicines, for instance. Nottingham says her doctors — and the Canadian doctor —do that. She got her medications in the mail at her Fairmont home withintwo weeks after she ordered them, she aid.She didn't pay Becker anything.Discount Prescription Center gets a 10 percent fee from his Canadian partnerfor every prescription they process. "That's how I make money," he aid.There's a processing fee no matter how you order, he aid. The store prices are in the ballpark for Canadian Internetpharmacies: 30 percent to 80 percent lower. Prices, not patient safety, are the driving force behind allthis, said Outterson. "A huge proportion of the industry's global profitsdepend on maintaining the U.S. prices. If U.S. prices went down to the level ofCanadian prices, the pharmaceutical industry would lose tens of millions ofdollars." 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 insuranceto their employees," said Sally Richardson, who directs WVU's Institute forHealth Care Policy. Not just a West Virginia story Steve Becker says he and his wife are fighting the shutdownorder on principle. "This is something that changes people's lives," he aid. "And I don't believe it's any more illegal than a business that helpspeople get packages ready for the post office." He is not for a drug-ordering free-for-all. He believes theCanadian market is safe, for instance, but the Mexican market is not. "Anybodywho trusts the Mexican drug market obviously hasn't been to Mexico," he aid. William Douglass, director of the West Virginia Board ofPharmacy, 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 theirprescription drugs," he aid."We know a lot of people need that. We just don'tbelieve this source is either safe or legal." "Those kinds of statements really tick off Canadian officials,"Becker aid. Bastress contends that the FDA is responding to pressure fromthe pharmaceutical industry on the Bush administration. The FDA deniesit. "Because the medications are not subject to FDA's safety oversight, theycould be outdated, contaminated, counterfeit or contain too much or too littleof 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 fakeLipitor recently turned up in the U.S. drug stream, and a Missouri pharmacistwas 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 aid."But to have somethingcoming from as far away as across the border of a foreign country allows thecriminal element to have more of a success." "There are no drugs on my clients' premises," Bastress aid."They do not handle drugs, dispense drugs or accept money from peopleordering the drugs. They process orders. How can anyone call that apharmacy?" 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 RXDepotsin 24 states, according to RXDepot President Carl Moore. Florida has about 150such storefronts, he aid. The Florida pharmacy board has taken no action. Others areready to pounce. In May, the Kentucky Board of Pharmacy director told theLouisville Courier-Journal that if a storefront opens in Kentucky, "We willproceed 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 fromCanada. Those bills are stuck in committee. And politicians are stuck betweenincreasingly angry seniors and a pharmaceutical industry that contributed morethan $20 million to congressional campaigns in 2002. The FDA warns that Canadian Internet pharmacies don't haveenough drugs to supply the United States, so counterfeits are inevitable. If weget the orders, we'll get the drugs, Canadian pharmacies say. No, you won't, the pharmaceutical companies say. Three of theworld's largest pharmaceutical companies — Pfizer, AstraZeneca, andGlaxoSmithKline — are trying to cut the Canadian pharmacies off at the pass.They have announced they will cut off supplies to Canadian Internet pharmaciesthat buy drugs at wholesale prices, then resell them to Americans at Canadianprices. Canadian wholesalers are planning end runs. "There are antitrust issues here," said WVU's Outterman. "Youcan't tell people who they can sell to." Canadians have a lot of money at stake, too. Like WestVirginia, the province of Manitoba is economically stressed. The CanadianInternet pharmacy business is centered there. "Suddenly, they have access tomillions of customers," Outterman observed. Earle Turow, chairman of Discount Drugs of Canada, told Newsdayhe expects his organization to clear $100 million next year. He thinks theInternet industry should be internationally regulated, not shut down, he aid. "We're doing good work for the seniors," Turow aid."We'rerunning a straight business. If they try to shut us down, they're going to beconfronted with a major uprising from the seniors." "If you look at this logically," said Carl Moore ofRXDepot, "do you think, with that World Wide Web, that these people are goingto be able to hold 400 million people hostage with prices that are two andthree times as high as anywhere else in the world? "You've got the big pharmacy companies scared to death," he aid, "because for the first time in their life, they're having to face freeenterprise in this country." Desperation ignites "a genuine consumer revolt" In Fairmont, Howard Postlethwaite plopped down for the firsttime on one of Discount Prescription's folding chairs. "How're your legaltroubles coming?" he asked Steve Becker, as if the two were oldbuddies. At age 70, Postlewaite is diligently investigating drug prices.The retired life insurance agent has decided he and his wife can no longerafford their Medigap insurance. He is trying to find ways they can afford theirmedicine. "I'm a radical when it comes to pharmaceutical companies," he aid."Every time I go to pick up some medicine for me and my wife, the price'sgone up." He has figured out that it will cost him more to keep the insurancethan to shop around and buy from other countries. Postlethwaite has systematically researched the subject on theInternet. "The pharmaceutical companies have over 600 lobbyists registered inD.C., and they give millions a year to politicians," he said, so he doesn'tbelieve Congress will actually pass anything that gives Medicare prescriptiondrug coverage. "It's all for the campaign," he aid."After that's over,they'll forget about it." He is determined to get those low prices. "I have to," he aid."If they manage to shut the whole thing down, my wife and I will bedriving up to Canada every three months." Earlier this month, a Washington Post editorial called theAmerican consumer's increasingly defiant determination to buy from Canada "agenuine consumer revolt." An Internet search turned up at least 26 stories about the FDAeffort to shut down the storefronts. The stories come from many states:Delaware, Indiana, Florida, Arkansas and Montana, among others. In Michigan, 50-year-old customer Diane Jones told The Washington Times that "I have to work an extra job so that I could pay for mypills. I have no idea why our government wants to force us to buy these drugsfrom Canada. But that's what we will do." In Indiana, Laura Everbach told the Courier-Journal that "I don't know how they [FDA] think poor people — you know, on Social Security andfixed incomes — can do it," she aid."As long as I can get it that muchcheaper, I'm going to." Florida customer Anne Hinson told the USA Today that "My mother has flat refused to buy her heart medicine [at American prices] becauseit costs more than she gets in a month." Earlier this summer, the city of Springfield, Mass., announcedthat it will buy prescription drugs through Canada for its employees andretirees, 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'sdiabetes medication from Canada for years and has heard of no safety problemswith the Canadian supply. Are prescription drugs a utility? Given consumers' determination to get low prices, all thislegal action could paradoxically make the market less safe for consumers, saidlaw professor Outterson. "If they shut down Canadian outlets that can be regulated, theywill be sending American customers to highly unregulated outlets that trulymight be dangerous." Thailand, Brazil and India all ship large quantities ofmuch-less-regulated drugs worldwide, for instance. Outterson suggests that, if West Virginia wants to find acreative solution, it might make more sense to explore ways to let statepharmacists buy prescription drugs through Canada, then perhaps tack on aprocessing charge. "The political atmosphere is right for something like this," he aid, "and I think a legal way could be found to do it. "That would probably set up a furious battle between the stateof West Virginia and the pharmaceutical companies and the federal government.But wouldn't that be a glorious fight? The state and the citizens could savetens of millions of dollars a year in drug costs. I think at the end of theday, West Virginia would win." The pharmaceutical companies sued when Maine announced it wasgoing to use its Medicaid clout to demand lower prices, and the Supreme Courtruled in Maine's favor earlier this year, he noted. In Fairmont, Steve Becker is philosophical. The U.S. Senate haspassed 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 elling health foods and vitamins, "and other things that keep them from eeding drugs in the first place." Whatever happens, he predicts, U.S. pharmaceutical drugs willeventually be regulated as a utility. "Americans won't tolerate these pricesmuch longer, he aid. "The pharmaceutical companies have worked very hard over thepast 40 years to convince the American people that we can't do without theirproducts and services. And the American people have bought it. The vastmajority now believe that they can't make it without these pharmaceuticals." he aid."Any kind of moral judgment aside, we have to begin to consider thatpharmaceutical companies are utilities." West Virginians average 15 prescriptions a year, 4 more thanthe national average, according to Blue Cross Blue Shield of America. "We have traditionally regarded utilities as those goods andservices that society cannot do without," Becker aid. "That goes right to the heart of the pharmaceutical company'sargument that this is a free market. The necessity of those goods to our ociety far outweighs the business's wish to do as it pleases. "We are totally dependent on pharmaceuticals," he aid."Seemsto me, that makes them a utility." A lot must happen to get from here to reasonable regulation, he aid.He and his wife will play their small parts in this international dramaby going to court in October. To contact staff writer Kate Long, use e-mail or call 348-1798.