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Bus to Cheaper Meds Makes Last Stop 


By Warren Wolfe,Star Tribune

June 30, 2007

Angry over rising drug costs, a group of older Minnesotans pioneered the nation's first free bus trips to Canada for low-cost drugs in 1995, then in 2002 started the first nonprofit website to buy drugs from Canada. 

But on Friday, the Minnesota Senior Federation bus with 26 paying customers stopped at CanTrust Pharmacy in Winnipeg for its last scheduled drug run to Canada, where government controls keep prices far lower than in the United States. 

A new Medicare drug benefit for older and disabled Americans, plus a stronger Canadian dollar, have slashed in half what had been $1 billion in annual cross-border drug sales. Half of Canada's 140 or so mail-order pharmacies have gone out of business. 

With the drop in demand, sales have plummeted on the federation's website -- and a similar one started by the state of Minnesota in 2004. Sales through the state's Minnesota RxConnect program were about $23,300 in May, down from a peak of $159,500 in January 2005. 

But the benefits of buying from Canada were clear Friday to federation members who boarded the bus after picking up their orders at the storefront pharmacy: Three months worth of 42 prescriptions bought for $6,605 -- a savings, they figure, of about 40 percent from Twin Cities retail prices. 

"The issue hasn't gone away. People are still getting gouged on drug prices. And the Medicare drug benefit, while helpful, hasn't solved the problem," said Lee Graczyk. He is executive director of the federation, which unsuccessfully sued the big drug companies a few years ago and continues to lobby Congress. "We're still fighting the battle." 

The anger that propelled the Senior Federation into national leadership on drug-price issues was never far from the surface during the three-day bus trip, and conversations about politics, war, the Twins and even the weather had a way of turning to drug prices. 

"I believe in capitalism," said Chuck Bissel, 66, of Apple Valley. "But when health care and medicine are publicly traded on the stock exchange, the bottom line is not my health. It's their profit, pure and simple." 

Financed by a senator 

The bus trips began in 1995. But they picked up sharply in 2001, after newly elected Sen. Mark Dayton, D-Minn., pledged his Senate salary to fund them. There have been about 30 in the past six years. 

But the money ended when Dayton did not seek reelection last year. This trip cost about $10,000 -- free to the travelers, all expenses covered by Dayton. Some money remains in a federation account, and there could be another trip or two, but none is scheduled, Graczyk said. 

"You know, these trips are not cost-effective," Graczyk said. "It's far cheaper to use the federation website to order drugs. But we've done them to make a point: Given the vast wealth of the United States, you shouldn't have to drive eight hours to buy affordable drugs." 

The bus riders spent nearly six hours Thursday seeing Dr. Craig Hildahl, 56, a Canadian who practiced in the Twin Cities for nearly 10 years until 2006. Hildahl examined each patient, took medical histories, questioned them closely, examined their U.S. prescriptions, then wrote Canadian prescriptions. 

Impact of Medicare benefit 

On this trip, the Medicare drug benefit showed up in two ways: Its coverage has made going to Canada unnecessary for some drugs, but its "doughnut hole" in coverage, the portion of plans where the user is required to pick up the whole cost of prescriptions, is sending some Americans scurrying back to Canadian suppliers. 

On this trip, Adrienne Ratliff, 74, of Minneapolis -- recently named AARP's 2007 state volunteer of the year -- filled only her four most expensive prescriptions, leaving the rest to be covered by her UCare Minnesota insurer. 
"I've got to try to keep those costs down," she said. "Last year I financed the last of my doughnut hole costs on my credit card, and I really don't want to do that this year." 

Michael Eggerth, 53, came for a drug not available in U.S. pharmacies. The Spring Lake Park man has tried other drugs to combat Tourette's syndrome, a neurological disease, but he couldn't endure the side effects. 

Tetrabenzine has been used in Canada and Europe for 20 years, but is not available in the United States, where it is just now being tested.

"It cost me about $700 for three months, and that's not covered by insurance. But if it works, it's worth it," he said.

Several, including Delores Marsh, 82, of Maplewood, came to get pioglitazone, the cheaper generic equivalent of the diabetes drug Actos. The generic is not available in the United States.

New Internet pharmacies began sprouting in Canada in 1999 and spread like prairie fire, fueled by millions of American retirees with soaring prescription costs but no drug insurance.

Drug manufacturers have tried mightily to shut down the Canadian pharmacies serving Americans, agreeing with the U.S. Food and Drug Administration that those Internet pharmacies might be delivering tainted or fake drugs. 

So far there have been no reports of either problem, but after drugmakers threatened to cut off supplies to any wholesaler that sold drugs to the Internet pharmacies, the pharmacies began looking abroad for drugs.

Now they take orders for drugs from the United Kingdom, Germany, Israel, Australia, New Zealand and Spain, as well as some Canadian-owned operations in Fiji. 

"The efforts of the big drug companies to shut us down hurt for a time, but they've failed," said Jeffrey Uhl, who heads Universal Drugstore of Winnipeg. "Three years ago, there was a crisis every day. Now we can actually plan for next year and the year after."

Hitting the doughnut hole

Still, his sales have dropped by about 40 percent in the past two years. Part of his strategy has become helping U.S. customers get into Medicare plans.

"We know that will help them," Uhl said. "But we remind them that we're also here to help if they hit that gap and they know they won't get through it."

Connie Rance, 67, of Minneapolis, will hit the doughnut hole in a few months, and saving about $200 on two drugs she bought in Canada this trip will help, she said.

"What I worry about is all the other people, especially people of color like me, who don't even know about buying from Canada," she said. "I don't know if this is the last federation bus trip or not.

"I hope not. But I'm glad I came. And when I go home, I know some friends who should hear about this drug business with Canada."

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