The Illinois Drug Trade
Over the course of nearly four years in the late 1990s, prescription medications ate at Pearline Atkins' savings like the ulcers they were treating ate away at her stomach.
Over the course of nearly four years in the late 1990s, prescription medications ate at Pearline Atkins' savings like the ulcers they were treating ate away at her stomach. Atkins-too young for Medicare, but not for some of the health problems that had crept up later in life-watched thousands of dollars disappear. Now on Medicare, the 68-year-old retired cook says she's grateful she no longer has to shell out more than $200 a month for prescriptions, but wonders how she can survive on $688 a month with no savings.
"I'm at the poverty level now because I had to pay for my drugs in order to live," Atkins says from her one-bedroom apartment in Uptown. "That just took all my little savings. Now I'm taking even more medicine because I'm older and things have developed. I'm just thankful I'm on the [Medicare] program."
In August, Gov. Rod Blagojevich announced a plan that would give Illinois residents access to cheaper prescription drugs through pharmacies in Canada, Ireland and the United Kingdom. Aimed initially at an estimated 23 percent of the state's population, including 500,000 seniors, the program involves setting up a network of pharmacies in other countries through which Illinois consumers could save between 25 and 50 percent on prescriptions.
"Almost 3 million residents don't have prescription drug coverage," says Abby Ottenhoff, a spokeswoman from Blagojevich's office. "They are paying the highest price in the world for medicines they need. We've heard from people who are choosing between food and medicine. It's a serious health concern."
The state plans to hire a pharmacy benefits manager to administer the program, which was slated for implementation by the end of last month, Ottenhoff says. The pharmacy benefits manager will act as a clearinghouse for the program, and residents will be able to access the network by either calling a toll-free number or going online. To use the network, each patient will have to fill out a complete health profile form and provide his or her medical background, along with a signed prescription from a physician. A U.S. doctor could also fax the prescription to the clearinghouse. A program physician will then review the prescription before re-writing it and giving it to one of the foreign pharmacies in the network. All network pharmacies would be inspected to ensure they meet state standards, Ottenhoff says.
Four other states, Minnesota, Wisconsin, New Hampshire and North Dakota, have created Web sites linking consumers to Canadian pharmacies. "What we're doing is similar, but it has more safeguards built in," Ottenhoff says. But as far as officials from the Food and Drug Administration are concerned, no matter what the safeguards, the program has risks.
"We have no authority to protect the citizens of Illinois from problems that may come from these drugs," says William Hubbard, the FDA's associate commissioner for policy and planning. "It is important that pharmacies operate correctly, but it still doesn't go to the issue of the quality of the drug."
Hubbard says he has written Blagojevich and met with his staff on two occasions to express the FDA's opposition to the program. He not only is concerned about the safety of importing drugs from foreign countries, but with the legality of the practice.
"The drugs would certainly be illegal," Hubbard says. "There's no question the drugs would be illegal. The Irish and British government have made it very clear they don't approve."
Ottenhoff points out that the FDA has done nothing to stop the millions of people who already have gone to Canada and Europe to buy their prescription drugs. "They're also not making sure the drugs that are brought in are from legitimate sources and meet our standards," she says.
Even before Blagojevich announced his program, the idea of purchasing medicine from Canadian pharmacies crossed 67-year-old Barbro Soper's mind. The Chicago resident describes herself and her husband, Jess, as "thrifty" and says they do not like to touch their savings unless it's absolutely necessary. That's why last year, after being fed up with the more than $150 a month she was spending on asthmatic bronchitis and anti-seizure medicine, Soper asked her doctor to write her prescriptions she could mail to Canada. She never sent them.
"There's something about it that just bothers me," she says. "We're one of the richest countries in the world, and we can't provide health care."
In July, Soper enrolled in the state's Circuit Breaker Pharmaceutical Assistance Program, which allows her to purchase prescriptions for $1 to $4. However, if the vacant apartment she and her husband own in Wrigleyville is rented in 2005, she might not qualify for the program. (To be in the program, couples must be at least 65 and make no more than $28,480, she says.) "It makes me very angry," Soper says, referring to the drug companies. "Don't tell me they're not raking in billions of dollars."
If she doesn't qualify for the Circuit Breaker program next year, Soper says she will consider ordering medicine from foreign countries. State officials are expecting Illinois residents to save an estimated $1.9 billion within the first year of having access to pharmacies in Canada and Europe. According to the state's Web site, a drug such as Lipitor, used to treat cholesterol, costs $214 at a Chicago pharmacy, $144 in Ireland, $158 in the United Kingdom and $162 in Canada. Celebrex, used to treat arthritis, costs $271 at the same local pharmacy, $178 in Ireland, $188 in the United Kingdom and $149 in Canada, according to the same Web site. The diabetes medicine Actos can cost as much as $542 here, $286 in the United Kingdom and $377 in Canada.
Only drugs that are used for long periods of time and would not perish during shipping would be available for Illinois residents to purchase. About 60 foreign pharmacies have joined the network, Ottenhoff says.
"We've tried to work with Washington and with the FDA, but we haven't gotten a response," she says. "We've done the research and looked at what the options are by giving [residents] the opportunity to buy [drugs] from safe countries like Canada and the United Kingdom."
Norma Wilson, 73, of northwest suburban Elk Grove Village says she spends about $230 a month on asthma medication.
"I would rather be doing something else with my money," Wilson says. "When I worked hard I thought my government would take care of basic things in life such as clean water, health care and important prescriptions. I was being foolish." Although Wilson has heard of other seniors buying their drugs from Canada and Europe, she is skeptical about the concept. To Wilson, who calls herself a liberal and volunteered to stuff envelopes during the civil rights movement, if something sounds too good to be true, it probably is.
"I've lived a fairly long time, and I know when somebody's giving me the wrong information and telling me how they really care about me, whether it be the government or the drug companies," Wilson says. "They tell us things they want us to hear, things they want us to believe, but the fact is that there are many people who are not taking their medication because they can't afford it. I think the drug companies are going to be one step ahead of us and pretty soon buying drugs in Canada will probably save the average senior like myself some small penance."
Drug companies actually may already be one step ahead of Blagojevich's plan. According to an August 26, 2004, press release from the governor's office, Blagojevich has asked drug-manufacturer Pfizer to stop its efforts to modify its contracts to prevent British wholesalers from sending drugs outside the United Kingdom.
And it isn't just seniors who are suffering from the rising cost of prescription drugs. About 1.3 million Chicago-area residents are uninsured, says Lindsay Calcatera, spokeswoman for Access Community Health Network in Chicago. In 2003, the agency implemented a federal program called the 340B Drug Discount Program, available at 21 Access health centers. The program provides drugs to consumers at a reduced cost, subsidized by the manufacturers. Patients who qualify for the program must be part of Access and either without insurance or on Medicare.
So far, Calcatera says the program has been a success and a quicker answer to the issue than debating over whether drugs should be imported from other countries. "We support any effort to get people more affordable drugs. We don't have two years for the [state] government to figure it out," she says. "Our patients really need savings the most."
While the large chains haven't been responsive about participating in the 340B program, independent pharmacies such as Ambrose Pharmacy in Little Village are willing to offer the discount. Dennis Ambrose, owner of the Ambrose Pharmacy-which serves a mostly Hispanic clientele-says he has seen patients come in and ask for a price breakdown of the drugs they're prescribed.
"They'll take what they think they need,"Ambrose says. "They're not going to take what they're supposed to take. Eating comes first."
Although Ambrose agrees even more needs to be done to bring the cost of prescription drugs down to a reasonable level, he isn't sure purchasing them from Canada and other countries is the answer. "As a retailer, I'm not happy about it," he says. "I think it opens more doors for people to do illegal things with [the drugs] such as counterfeiting. I don't know of any controls they can put on them. I'm concerned for the citizens here." Ambrose says it's a shame that Americans think they must seek their prescription drugs from other countries. "It raises the cost to everyone here," he says. "I think everyone has the misconception that it's the pharmacies making all the money. It's not."
Ottenhoff says an announcement will be made before the foreign pharmacy network is launched, providing citizens with a Web address for the program as well as the toll-free number. In the meantime, Atkins, who was cooking lunch for more than 600 people a day when her health forced her to leave her job with the Chicago Board of Education in 1994, is lobbying to improve life for seniors through her involvement with the Jane Addams Senior Caucus. One of her fights-to lower the cost of prescription drugs-is a never-ending battle.
"I don't care what age you are, it doesn't pay to get sick," Atkins says. "It's going to cost you. You wonder if it's all right to go to Canada. I don't know. The United States is the richest country on earth. Why is it we've come to the new millennium and we have to go through this process [for] staying alive? Why is it we can't get what we need? This is why I fight for seniors."
Published: October 01, 2004
Issue: November 2004
