Elders - The New Drug Traffickers

Affordable Drugs Across Borders

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Newsweek (May 8, 2000) called it "The Real Drug War." Meanwhile, former Acting Assistant Secretary for Aging William Benson says on page 4 of this issue of Aging Today that in Washington, "Republicans and Democrats are scrambling to show they are doing something about prescription drugs for elders." And the New York Times (May 7, 2000) reported that in the U.S. pharmaceutical market, drug prices are "outstripping the rise in overall medical costs and general inflation."

From April 1999 to March 2000, prescription costs climbed 5.2%, while medical expenditures went up by 3.9% and overall prices increased by 3.7%. That may sound manageable, unless you are among the one in four Medicare beneficiaries shelling out at least $500 per month from your own pocket for medicine. And half of these older Americans are paying $1,000 or more--according to a study released last fall by the aarp Public Policy Institute, Washington, D.C. ("How Much Are Medicare Beneficiaries Paying Out-of-Pocket for Prescription Drugs?").

Pharmaceutical companies argue that if the U.S. government imposed price controls such as those enacted by most other nations, the industry could not generate enough revenue to research and develop new drugs. But faced with the current prices, growing numbers of older Americans--especially middle-income elders--are taking risks, such as reducing their drug compliance to make a bottle of costly pills last longer--or are making a run for the border.

For example, Maureen West, age-beat reporter for The Arizona Republic, recently traveled on a Casino Fun tour bus packed with older adults traveling to Mexico. The tour operator reported that business has boomed in the past year--not with elders making gambling forays but with older adults purchasing prescription medications at the 28 farmacias in downtown Los Algodones, a tiny Baja California town 10 miles south of Yuma, Ariz. Why the surge of new drug traffickers? West explains in "Loss of HMOs Makes Seniors 'Drug Runners'" (May 1, 2000; available online at www.azcen tral.com) that since managed care organizations in the past year dropped Medicare HMO programs covering 30,000 older Arizonans, many of them find that "medications that used to cost them $100 a month now cost $400."

In the following article Boston-based science and health journalist John F. Lauerman reports on elders who travel north to Canada. Lauerman, coauthor of Living to 100: Lessons in Living to Your Maximum Potential at Any Age (New York City: Basic Books, 1999) also contributed to Newsweek's coverage.

Who would have thought that Annette Gagnon would end up being so lucky? Her home on Main Street in Madawaska, Maine, is less than a half-mile from the International Bridge to Edmundston, New Brunswick, in Canada. When her supply of atorvastatin, a cholesterol-lowering drug, runs low, she simply points her car to the border and goes to the Atlantic Super Value pharmacy.

There she can buy a month's supply of the medication for $43 Canadian, rather than the $100 U.S. she would pay at home.

Gagnon is far from alone. Mario Levesque, a pharmacist at Jean Coutu Pharmacy in Edmundston, a half-mile from the International Bridge, said that about 5% of his business comes from people fleeing high drug prices in the United States. Many of them, like Gagnon, are looking for expensive heart drugs, such as Cardura--also known by its generic name, doxazosin--or an antihypertensive ACE inhibitor like Zestril. There would be more U.S. customers, but about half of the prescriptions that patients bring in are written by doctors without the cross-registration needed before Canadian pharmacists can fill them.

Maine state Senate majority leader Chellie Pingree, a Democrat, recently introduced legislation that would limit drug prices in the state so they would be on a par with those in Canada. The bill passed in the Maine Legislature, but before Gov. Angus King, an independent, signed it, Pingree decided to withdraw it so he could collaborate with King on redrafting the price controls aspect of the bill to stand up better to legal scrutiny. Most political observers agree, though, that any such state legislation would end up in protracted court battles and that federal action is needed. In the meantime, the drug traffic over the International Bridge is increasing.

"A couple of years ago, we only got one or two American customers a month, usually people who worked in Canada," said Levesque. "Now it's about three or four a day. Usually they want a three-month supply."

Canadian pharmacist George Michaud remembers about 20 years ago when Canadians were driving the other way to avoid paying higher tariffs on American drugs. He does fill-in work, such as when a local druggist is on vacation, at many pharmacies along the U.S. border, and he thinks the international trade is going to intensify. "The way the word is spreading, it's going to be three or four American customers an hour. Most people are saying, 'You're going to see me again.' If someone can save $60 to $70 a shot, what do you think they're going to do?"

For Gagnon, who has undergone quadruple-bypass surgery, proximity to the border is a lifesaver. Her husband, who worked in the nearby Frazier paper mills for 45 years, died this April, leaving her with a Social Security income of $522 per month.

Gagnon is one of the many elders in Maine who frequently must choose between going without food or other necessities or skipping medications. Not everyone is fortunate enough to live close to Canada, though. Viola Quirion lives in Waterville, Maine, about four hours from Montreal. "I had to skip my drugs, and I had a lot of pain," she said. "I couldn't do anything. I tried to skip some meals, and I bought the cheapest food I could."

Quirion, a septuagenarian who lives in a senior housing complex on $1,000 a month, takes Prilosec to control acid reflux from her stomach and Relafen to relieve arthritis. "When I skip the Relafen, my inflammation comes back," she said. "And if I skip the Prilosec, I can't digest my food." A month's supply of these two drugs costs her more than $200.

A member of the Maine Council of Senior Citizens, Quirion decided to join the group when they organized a bus expedition to Montreal. "It's pretty rough," she said. "We're a bunch of senior citizens with canes and crutches and oxygen tanks, so it's not an easy trip. But those who can, make it."After travel expenses, she saved $197.28 on a three-month supply of drugs--the most Canadian law allows a customer to buy at one time.

Lucille Soper, 65, and her husband Charles, 66, have never gone to Canada to buy medications. Soon, however, they may have to start thinking about making the trip from their home in Orland, Maine, just outside Bangor.

Charles Soper, a welder, will retire on June 1. The recipient of a kidney transplant from his son, he takes a number of immunosuppresants to prevent his body from rejecting the organ. The most expensive of these is Sandimmune, a brand of cyclosporin, and when Soper's benefits run out 18 months from now, he will begin shouldering the $19,500 annual expense of the drug. Soper and his wife take eight other prescription drugs that will devour much of the $30,000 annual retirement income they had hoped would make their later years comfortable. Luckily, Lucille has a plan: "Pray a lot."

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