Lower Drug Prices Send Many South : Pharmaceuticals: Americans are lured to Mexico by prescription medicines costing as little as one-tenth as much as in the United States.

Every day, large quantities of prescription drugs are brought across the border from Tijuana into the United States in the purses and suitcases of ordinary Americans--most often senior citizens.

Unable to afford skyrocketing U.S. drug prices, they make regular pilgrimages to Mexico to buy medications for high blood pressure, asthma, arthritis and a host of common ailments at a tenth or less the cost at home for identical or virtually identical drugs.

For years, desperation for a cure has driven sick Americans south of the border for drugs they couldn’t get at home: questionable treatments such as Laetrile for cancer and a variety of AIDS drugs not yet approved for use in the United States.

But now, economic desperation is sending south increasing numbers of Americans who wouldn’t dream of taking anything experimental or “alternative.”

In the northern United States, people head for Canada, where medications also are much cheaper. The wholesale prices of four of the 10 top-selling U.S. prescription drugs are 60% to 280% more in this country than in Canada, according to a federal study. Recent studies have also shown that U.S. prescription drug prices have outpaced inflation threefold in the last decade, creating a particular strain on the elderly whose prescription costs are not covered by Medicare.

Burt Sunkin was one of the early pilgrims. He has been driving south for medication for more than 20 years and figures he has saved thousands of dollars in the process. His son depends on an asthma drug called Ventolin, made by British-based pharmaceutical giant Glaxo. It costs $18 to $22 for several days’ supply in Los Angeles drugstores. In Tijuana, the same amount of medication costs $2.20. Sunkin brings back 100 boxes at a time.

Before he started going to Mexico, Sunkin had a cousin in England send over the drug because it was so much cheaper there, he said.

Sunkin also goes to Tijuana to buy Mevacor, an anti-cholesterol drug he needs for himself. It costs $200 per hundred in Los Angeles but $8 to $10 in Tijuana.

“As a citizen of this country, it aggravates me that a drug made by the same company is so much more expensive here. It is mind-boggling that they allow this to continue and not help the poor working guy struggling on a budget,” said Sunkin, who owns a synthetic-fiber manufacturing business in Los Angeles.

Sunkin said he wouldn’t think of taking drugs that weren’t approved in the United States or that his doctor hadn’t prescribed. But he said he believes that the Tijuana pharmacies are “very, very well run.” His uncle, Ted Buchalter, is a pharmacist and doesn’t discourage him from buying in Mexico.

Like many retail pharmacists, Buchalter, who runs Mickey Fine Pharmacy in Beverly Hills, said he loses a good deal of business to Tijuana. “(Some) people tell us they buy here only when they don’t have time to go to Mexico,” he said. For example, Retin-A, an acne and anti-wrinkle medication, can be bought in Tijuana retail stores for less than U.S. druggists pay wholesale, Buchalter said.

Don Baker, a pharmacist in Escondido, about an hour from Tijuana, said that so many of his customers buy in Mexico that it “significantly” cuts into his business. Older people on expensive daily drugs for hypertension, arthritis and ulcers are the ones who go south most often, he said.

“They tell me Naprosyn (an arthritis drug) is $20 there versus $100 here,” Baker said. “Tagamet for ulcers is $15 there, compared to $85 here. My customers say, ‘This is why I’m not buying from you anymore.’ ”

Though doctors and pharmacists say large numbers of patients go to Tijuana for medication, nobody knows how much prescription medication crosses the border from Mexico into the United States. Bringing in medicine for personal use--defined as up to a six-month supply--is legal, as long as it is declared, said Jerry Martin, director of the San Ysidro port for the U.S. Customs Service. The exception is if the Food and Drug Administration has named a drug as dangerous and asked Customs to stop its entry.

No U.S. agency keeps track of the entry of legal prescription drugs. “We get a lot of people bringing personal-use medications, but it’s not a problem,” Martin said.

Dr. Greg Thompson, director of the Los Angeles Regional Drug and Poison Center, said the center gets 60 calls a day from Los Angeles-area doctors asking about foreign versions of prescription drugs that their patients have brought back, mostly from Mexico.

Are patients putting themselves at risk by buying in Mexico?

“Our advice is if you’re going out of the country to purchase a product, you’re taking a risk,” said Jur Strobos, the FDA’s acting director of policy research. Earlier this year, the FDA issued an import alert against six overseas companies selling illegal mail-order drugs for depression, high blood pressure, fungal infections and other conditions.

Even when the active ingredient in a drug is identical to a substance approved in the United States, the inert materials used to make up the pill may be different in European or Mexican formulations, leading to different effects in the body, Strobos said. If people choose drugs without a doctor’s advice--many are available over the counter in Mexico--they may be exposing themselves to danger, he said.

Even if a drug is originally prescribed by a physician, if a patient persists in taking the drug without continuing medical supervision, he also may be endangering his health. In addition, dangerous interactions between drugs may occur if a patient buys some drugs in the United States and some in Mexico and both pharmacists are not fully aware of everything he is taking.

Also, some American pharmacists say they are concerned about the risk of counterfeit drugs being sold to consumers.

But thousands of people do use drugs purchased in Mexico, most apparently without ill effect. Many drugs sold there are made there by subsidiaries of U.S. or European makers, which say that their quality standards are the same around the world.

Other drugs sold in Tijuana may be made in Europe or the United States. Glaxo spokesman Rick Sluder said Ventolin sold in Mexico is made by a Mexican subsidiary of Glaxo. “It’s the same molecule, the same medicine, the same concentration, the same quality standards,” he said.

A spokesman for Merck says Vasotec and Pepcid, two drugs often purchased in Tijuana, are manufactured by a Merck joint venture in Mexico. “They’re basically the same product as in the United States,” he said, noting that raw materials for drugs made in Mexico are often imported from the United States.

If the drugs are the same, why the enormous price differences?

“There are many products that are less expensive in Mexico. It’s difficult to compare international prices. It’s apples and oranges,” Sluder said. He said currency fluctuations, differences in intellectual property laws, different packaging requirements and labor costs contribute to the price differences.

But a Government Accounting Office report released last week said the main reason prices are so much cheaper in Canada than the United States is Canada’s stricter price regulations. “The costs of production and distribution . . . make up only a small share of the total cost of any drug . . . . Consequently, production and distribution costs cannot be a major source of price differentials,” the report concluded.

Research and development, not manufacturing, make up the bulk of drug costs, which pharmaceutical makers argue are justified by the enormous cost and high risk involved in drug research.

“That may be true,” said Rep. Henry Waxman (D-Los Angeles), who ordered the GAO study. “But . . . it appears that our citizens are bearing a disproportionate portion of the burden of drug research, while other countries get both the benefits of the research and significantly lower prices.”