More Nevada residents cut costs by importing drugs

Michelle Swafford

Thursday, Sept. 9, 2004 | 11:04 a.m.

Las Vegas resident Estelle Coronel estimates that she has saved thousands of dollars on prescription drug costs by ordering her medications on the Internet from foreign pharmacies.

She relies on four different Web sites, three of which are based in Canada, to purchase the four medications she takes and the nine medications her husband takes.

"People are going to have to make a decision on, 'Do I take my medicine, or do I eat?' " Coronel said. "It just blows me away. Why can the Canadian people get the drugs cheaper than we can from the same company?"

She said without discounted drugs from other countries she "could not sustain paying those kind of prices without going back to work."

Coronel does not worry about the safety of her drugs and says to her knowledge she has never had any altered or ineffective drugs. She said she has also purchased prescriptions from Mexico and said she had no problems with those drugs.

The Food and Drug Administration, which regulates medications, says importing drugs from other countries violates the Food, Drug and Cosmetic Act.

The FDA also says prescription Web sites often appear to be for legitimate companies when they are actually illegitimate and are selling unapproved drugs.

Regardless of the legal status, an increasing number of individuals nationwide and local and state governments are turning to other countries to take advantage of mandated discounts that those countries' governments have imposed on pharmaceutical manufacturers. Some of the drugs are imported, meaning they are produced in another country and shipped to the United States, while other drugs are being re-imported, meaning they are produced in the United States and sent to another country before being sold to Americans.

In Nevada, there are several companies and nonprofit groups that are helping Americans order their prescriptions from foreign pharmacies. Some people say they are not worried about whether it is illegal, while others cite a federal statute that they say allows Americans to order a 90-day supply of medication from foreign pharmacies for personal use.

Nevada officials do not endorse importing discounted drugs, but they have not penalized individuals and companies who are engaging in the practice.

Dan Roberts, executive director of the Medicare Advisory Foundation in Las Vegas and publisher of Senior Life magazine, has been helping about 1,000 Nevadans order their medications from a Canadian pharmacy.

The Medicare Advisory Foundation was formed to help seniors with their health insurance, but it has expanded to include help with filling prescription drugs because seniors say that is their biggest concern, Roberts said.

He estimates that Nevadans save an average of 40 percent on their drug bills when they order from Canada. The downside to ordering drugs on the Internet is that patients wait longer to receive their drugs.

Roberts said he is not convinced that the drugs from Canada are unsafe, but he added that he would not help Nevadans purchase drugs from Mexico or any other countries. He said the debate over whether to allow prescription drug re-importation is a political one that is being decided by the deep-pocketed pharmaceutical companies, which oppose drug re-importation.

"The thing that's frightening is that you have politics playing with these people who need these drugs to live," he said.

Roberts said he is not worried about the government shutting down his nonprofit foundation, which does not charge its clients to help them fill their prescriptions through a Canadian pharmacy. The organization's funding comes from publishing Senior Life magazine.

"I don't want to confront the government, but these people need help and we're going to help them," Roberts said. "If we go down, we go down in flames."

A Carson City-based company has been helping consumers purchase their drugs from other countries for more than four years and hasn't encountered any legal problems.

Pharmacy International LLC has helped between 6,000 and 8,000 people across the nation purchase drugs from England, Israel, India, South Africa, New Zealand and Canada.

"We're one of the leaders in this," said Bill Schilz, general manager of Pharmacy International. "We were doing this before it was fashionable, before everyone starting opening online pharmacies."

Pharmacy International requires an original prescription to be mailed in and then helps consumers find foreign pharmacies with discounted prescriptions, which offer an average savings of between 30 percent and 40 percent.

Pharmacy International processes the prescription orders as a liaison for the pharmacies and consumers, but never handles the drugs. It earns a minimum profit margin of 15 percent on the orders, Schilz said.

He said his company works with only one pharmacy in each country and limits the amount of prescriptions it sends to a pharmacy until it can confirm that it is legitimate.

"The suppliers that we've been dealing with have all been found to be reputable pharmacies," he said, adding that there has only been one bad experience where a Canadian pharmacy failed to mail the drugs.

Pharmacy International has not had any complaints with the FDA or the Nevada State Board of Pharmacy for its operations, Schilz said.

"The only problem is we find that oftentimes when they find that meds are coming across the border, they will delay them significantly," he said of the FDA. "The FDA doesn't overtly do this. They covertly advance their agenda by delaying things."

"If we were doing something that the FDA deemed illegal, we would be issued a cease-and-desist letter," he said."They've known about us for several years and as long as we continue to business ethically, we're going to be OK."

The only people that Pharmacy International cannot help are those who require a controlled substance for pain relief, those who need their medication quickly and those who need antibiotics for an infection.

Companies such as Pharmacy International need a city or county business license to operate, but do not need a pharmacy license because they do not possess the drugs at any point in the process, said Louis Ling, lawyer for the Nevada State Board of Pharmacy.

The Nevada State Board of Pharmacy has not taken a formal position on whether to allow importing and re-importing drugs because the governor's administration does not want to endorse a practice that violates federal law, Ling said.

He added that although drug importation is illegal, government officials have taken little action against individuals who buy their drugs from other countries.

"Nobody's going to arrest your grandma," Ling said. "They're looking at the institutional level as far as enforcement."

Many advocates for drug importation say drugs are the same in Canada and the United States, but Ling said there are differences. For example, the acid reflux pill Nexium, also known as the purple pill, is pink in Canada, he said.

"If you don't know what it is, don't take it," Ling said. "Pharmacists probably can't identify the drug either."

As to whether imported drugs are safe, Ling said states and the federal government can regulate only to a certain extent because the Internet is "extremely difficult to regulate."

He said Nevadans should be concerned about providing their medical and financial information to foreign companies in addition to the possibility that the drugs they receive will be counterfeit or altered.

"Just because it has a maple leaf on the Web site doesn't mean it's coming from Canada," Ling said.

Instead of importing brand name drugs from Canada and other countries, patients should consider switching their prescriptions to generic drugs or alternative brand name drugs that might be cheaper and equally effective, Ling said.

About 90 percent of the brand name drugs available in the United States have a generic equivalent.

"Generics generally are very safe," Ling said. "Nobody messes with generics because there's no (profit) margin on them."