House Backs Drug Sales by Net, Mail

The House voted Wednesday to make it legal for Americans to purchase prescription drugs from foreign countries by mail order or through the Internet, a step that could lead to significant savings for older Americans who use the most prescriptions.

Thousands of Americans from California and Arizona now travel to Mexico for medicine, while residents of some northern border states, including Minnesota and Vermont, go to Canada.

If the proposal becomes law, they could forgo travel and instead legally use the Internet, the mail or a fax machine to order FDA-approved drugs from foreign pharmacies. Many drugs sold in the United States are far less expensive in foreign countries where governments often impose price restrictions.

The measure easily passed the House by a vote of 324 to 101. But it faces an uncertain fate in the Senate and tough opposition from the Bush administration, with the Food and Drug Administration citing possible safety concerns for drugs ordered through the mail from abroad. And the idea poses a threat to the profits of the pharmaceutical industry, which deploys one of the richest and most powerful lobbying organizations in American politics.

Passage of the House bill underscores the growing importance of prescription drug costs as a political issue.

President Bush will offer his proposals today for Medicare reform, highlighted by a call for the 35 million Medicare beneficiaries to participate in discount purchasing programs when they buy prescription drugs.

Insurers such as Blue Cross and Blue Shield offer discount cards to members who purchase Medi-Gap supplemental insurance policies. The state of California also has a major discount program allowing senior Medicare beneficiaries to get the same prices paid by the state when it purchases prescription drugs.

“The president is very troubled about the price of prescription drugs and the lack of access that senior citizens have to prescription drugs,” Ari Fleischer, the White House press secretary, said Wednesday.

The White House hopes to create a clearinghouse that will enable seniors who do not have access to discount cards to enroll with companies, called pharmacy benefit managers, that buy prescription drugs on behalf of insurance companies and health plans.

Fleischer, at his daily White House briefing, said the president’s discount-card proposal is “very important, even before Medicare reform can be enacted, to help senior citizens to get the best prices possible so that the cost of prescription drugs can be lowered.

“There’s no question this is, in the places where it’s carried out, a very popular program. Senior citizens like it. AARP likes it. . . . It’s a part of combining the power of group purchasing in a manner that lowers prices.” AARP now operates a popular mail-order drug program for its members.

In One Case, Nearly One-Third the Price

The potential for even deeper savings for consumers could come from the House-approved measure allowing imports by mail. Rep. Gil Gutknecht (R-Minn.), sponsor of the measure, cited an example in which a constituent using a special ointment for a skin problem paid $130 for a tube in the U.S. but on a trip to Ireland bought the same medication for $46.

“The bottom line is, if you are wealthy enough to travel to Europe twice a year, you can bring back all the drugs you need for the year,” Gutknecht said. “But if you are a senior living on a fixed income, you pay the full price.”

If the measure approved by the House becomes law, “Web sites can be up and running at senior centers, connected with pharmaceutical supply businesses in Geneva or Paris,” Gutknecht said. The legislation is an amendment to an appropriation bill providing funding for the FDA, which enforces drug safety laws.

Computer technology allows for verification that a doctor has written a prescription, that an order had been placed with a legitimate supplier and that a package is on its way to the U.S. “If we can transfer millions of dollars with the push of a button, we can do this,” Gutknecht said.

The amendment “would open up the possibility for individuals to bring into the country medicines that may not be as safe or effective as they appear,” said Alan F. Holmer, president of the Pharmaceutical Research and Manufacturers of America. “Because the danger still exists, we will continue to oppose the personal use exemption in the Senate.”

Earlier, the House rejected an amendment by Rep. Bernard Sanders (I-Vt.) that would have allowed companies--distributors and marketers--to import pharmaceuticals for sale to U.S. consumers. Sanders said he is pleased by the final approval of Gutknecht’s measure, calling it a “solid victory” in the quest for lower pharmaceutical prices.

The amendment passed Wednesday would give only individuals the freedom to order drugs, something that is not specified under current law. But individuals are now deterred because the FDA often sends letters to those who get drugs from abroad warning they might be in violation of federal law. “For most folks, this letter is a very intimidating thing,” Gutknecht said.

In the Senate, the timing for consideration of the bill is uncertain. Sen. Dianne Feinstein (D-Calif.), a member of the agriculture appropriations subcommittee that would consider the issue, is ambivalent. On the one hand, she said, the pharmaceutical industry is “killing the goose that laid the golden egg, with the prices that they charge for drugs. I’ve watched this for some years. People are exasperated they can’t afford the drugs they need.”

On the other hand, she worried about safety issues and about assuring the quality of any drugs that would be ordered from abroad. “We have to be very careful not to jeopardize health. I want to see how the FDA would look at this and what kinds of safeguards would be needed.”

Bush Presses for One Patients’ Rights Bill

Also Wednesday, Bush went to Capitol Hill to lobby for one of two competing patients’ rights bills in the House. Later in the day, Bush touted the bill a second time in a public meeting with representatives of 12 medical specialist groups with a combined membership of about 300,000.

The president said a bill offered by Rep. Ernie Fletcher (R-Ky.) would best improve quality of care “without unnecessarily running up the cost of medicine, without encouraging more lawsuits, which will eventually cause people not to be able to have health insurance.”

Bush specifically endorsed the measure’s provision to create an external review appeal process when care has been denied. “It’s so important that we have a tight external review process, one that addresses patients’ needs, not the needs of people who want to sue everybody,” Bush said.

Separately, Bush intends to make good on a campaign promise to propose full prescription drug coverage under Medicare, Fleischer said. He said there is “no question” that there will be sufficient funds left in the surplus to finance such a plan.

Fleischer said the separate “immediate helping hand” proposal to give the states money to help indigent people 65 and older buy prescription drugs remains in Bush’s budget and that “the president still is committed to it.”