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Alternative Meds
One Pennsylvania doctor wants to save seniors the hassle of riding the bus.
-Deborah Bolling

June 13-19, 2002

cover story

Rx Express

illustration by: John Fellows

Looking to save money and have a little fun, local seniors make a drug run to Canada in search of cheaper medication.

Mary Dorsey is feeling optimistic standing outside the South 22nd Street offices of the Action Alliance of Senior Citizens of Greater Philadelphia. It’s almost 9 a.m., and within the hour, Dorsey, a 79-year-old retired pediatric nurse, and about 30 other Philadelphia-area senior citizens will board a Greyhound bus for a 10-hour trip to Canada. Their goal: to purchase name-brand prescription drugs at affordable prices.

Leaving May 29, the overnight trip, arranged and paid for in part by Action Alliance and the Alliance for Retired Americans (ARA), has been in the pipeline for months. The excursion, dubbed the Rx Express, is one of 16 "border" bus trips organized by the ARA, a national retiree and senior-advocacy organization made up of more than 2.5 million members nationwide. The trips, part of a new political movement to protest the high cost of prescription drugs in the U.S., offer seniors an opportunity to travel to Canada to buy drugs at costs far lower than in the United States. Organizers say that by the middle of June buses filled with hundreds of hopeful seniors will have departed from Connecticut, Oregon, Washington state, Ohio, Michigan, North Dakota, Minnesota, Massachusetts, New Hampshire, Vermont, Wisconsin and Indiana.

Ideally, the trips will help low-income retirees offset the hefty pharmaceutical bills that so often accompany aging, but they are also intended to dramatize the need for Congress to introduce a comprehensive, affordable medical-health plan nationwide.

"We are sending a busload of seniors to Canada, because there they can find savings of up to 70 percent on their medications," explains Pedro Rodriguez, executive director of Action Alliance and a national vice president of ARA. "We expect those kinds of savings to help amortize their monthly and yearly expenses."

For $40 a person, the travelers bought a round trip to Canada; an overnight stay at a Kingston, Ontario, Comfort Inn; three meals; and the chance to meet others like themselves.

Though a promising alternative to the high prices of medication in the U.S., this trip, thanks to a combination of red-tape hang-ups and the increased scrutiny by both Canada and the U.S., won't be the panacea most of the seniors had expected.

Drugs are significantly cheaper in Canada because its system of socialized medicine tightly controls pharmaceutical costs. The Canadian government has a policy that manufacturers cannot charge "excessive" amounts for patented medicines. Drug companies sell their products at lower prices and take less profit. Another factor is the favorable exchange rate for U.S. dollars in Canada, making them even less expensive.

After Florida, Pennsylvania has the second-oldest population in the United States. Those over 65 represent 15.6 percent of the state's population of more than 12 million. Nationally, older Americans account for only 12 percent of the population, but 34 percent of the drug expenditures. Nearly one-third of older Americans, about 11 million, lack drug coverage of any type.

While Medicare is the primary health insurance for almost all Americans 65 and older and for the disabled, it covers only half of beneficiaries' health-care costs. The other half is paid for out of beneficiaries' pockets either directly or indirectly through supplementary health-care insurance. Those who do buy their own prescription drugs pay twice as much, sometimes more, as the drug manufacturers' most favored customers -- health insurers, managed-care plans and the federal government.

Since mid-May, scores of seniors have already made the arduous all-day trek to Canada. Hoping to save anywhere from 40 percent to 70 percent on their medication, they are also sending a powerful signal to lawmakers and the White House that they will go to extreme lengths to protest what they consider the outlandish and opportunistic pricing of life-extending prescription medication.

On June 18, the last scheduled trip of the Rx Express will depart from a U.S. northern-border state, and organizers are already projecting a million-dollar savings for the whole campaign.

"It's a good day, but it's also a sad day because you have to travel all the way to Canada to buy your medication," Edward Coyle, executive director of ARA, tells the group of about 50 who have gathered for an impromptu pep rally/press conference, before boarding the luxury bus. "In the next two weeks, buses will be leaving from every state that borders Canada. I salute you for doing this ... and we're going to take this issue to the streets in November."

Marty Berger, 73, a longtime Delaware County Democrat and labor organizer, works the crowd, hugging old friends and making new ones. Short, wiry and slightly bent over, his bright-white hair sprouts through the back of his UNITE (Union of Needletrades, Industrial and Textile Employees) cap. "I've been working with unions all my life," he says proudly, then leads the group in a chant: "WE CAME HERE TO LET YOU KNOW, HIGH DRUG PRICES HAVE TO GO!"

Honor Lanyon, a 70-something pixielike woman with vivid blue eyes, is one of those waiting to board the bus. "I pay for all my medication myself," she says. "I saw Peter Jennings talking about this on TV. He's Canadian, you know."

Lanyon, who says she relies entirely on Social Security and Medicare to cover her expenses, pulls a typed sheet from her jean jacket. "It'll cost me $671.10 for a three-month prescription for my medicines in the United States," she says gesturing to a list that reads Plavix, Pravachol and Altace. "It's only $357.48 in Canada. That's why I'm going ... to try and save a little money."

"Governor Rendell is on his way," Berger announces the candidate with a wink and a smile. Berger, who also serves as the state coordinator for the Pennsylvania Action Committee, has arranged this rally and two others at planned stops in Allentown and Wilkes-Barre.

When Rendell's large campaign bus quietly pulls up to the curb, the chatter that "he's here" spreads quickly through the crowd.

"Prescription drugs lengthen our lives, and they also improve the quality of our lives," Rendell tells the group in a raspy voice, saliva clinging to the corners of his mouth. "If I become your governor in January 2003 and Congress has not [introduced a comprehensive, affordable health plan], we're going to take action in Pennsylvania. If Congress doesn't do what it needs to do, you come see me in the third week of January and we'll take care of it."

Some critics of high-priced prescription drugs have blamed the skyrocketing costs partially on the media blitz that pharmaceutical companies have engaged in during the past few years. The Pharmaceutical Research and Manufacturers of America, a Washington-based trade association that represents the drug industry, suggests that lower drug prices in this country would mean less research and development for new drugs. Drug manufacturers say that their extensive advertising helps to inform citizens.

Sitting on the bus, Dorsey has no doubt that her trip fee is going to be well-spent. For starters, she had learned about the trip through her North Philly church, Deliverance Evangelistic; but even more importantly, instead of paying $60 for her monthly Tamoxifen prescription, Dorsey, a breast cancer survivor, says she expects to save at least $40 in Ontario if she fills her 90-day prescription.

Dorsey has lived in the Philip Murray House, apartments for senior citizens, in West Oak Lane, for 11 years. Although she is covered by Medicare, she says that she has no prescription coverage and that she spends $453.75 a year for her medications.

"I was with PACE, but I got dropped," she explains, referring to the Program of All-Inclusive Care for the Elderly, a state-run comprehensive delivery service integrated with Medicare and Medicaid that addresses the needs of long-term care clients. For most participants, the comprehensive package delivers services beyond those limited to the reimbursables under Medicare and Medicaid.

"I had gotten one lump sum of money, but it was just a one-time thing," says the well-manicured great-grandmother. "And they dropped me. That money wasn't a steady thing at all. [PACE officials] told me I'd get [PACE] back if I paid them $500. Heck, if I had $500, I wouldn't need them."

Gloria L. Armstrong, 73, says she learned of the trip at her monthly Golden Age Club meeting. A retired Philadelphia city worker, Armstrong receives health benefits, including a co-pay prescription plan, from Blue Cross Blue Shield's Keystone 65 plan. She says that under the plan, 80 percent of her prescription costs are covered by Medicaid. But, recently, she says, the bills have gotten higher.

"Before, a three-month supply of my medication cost me $30," Armstrong says, looking out the window as the bus trudges through Center City. "Now, the city has changed [its health] plan, and it's costing me $75 for the same prescription.

"I take at least five brand-name medications every day," she adds. "That's what the doctor prescribes. And I'm not interested in trying any of those generic drugs. To me, it's the difference between a Ford and a Mercedes."

Janys Sanchez, a pharmacist at Temple University Hospital, says that, in most cases, brand-name drugs and generics are interchangeable.

"The brand name is the one the company gave it when they developed it," she says. "So, when the generic companies make the drug [after the original patent has expired], they cannot use the name that belongs to the company. However, according to FDA regulations, it is supposed to contain exactly the same active ingredients. The only difference might be in the excipients."

Excipients are the ingredients manufacturers add to facilitate the amount of time it takes for the pill to dissolve, or to create the shape of the medication, i.e., a tablet versus a capsule or liquid.

"Like the brand-name companies, the generic companies are also regulated by the FDA. This means the generic product has to have the same active ingredient, and be able to dissolve and enter the bloodstream at the same rate as the original product," says Sanchez.

Many seniors, like Armstrong and Dorsey, feel they have no choice but to take the higher-priced brand-name medications. Although many prescription-drug plans offer affordable co-pays for generic drugs, the brand-name drugs seem more desirable and are steadily going up in price. For them, life is precious and every day is a gift, so why take chances?

On May 1, Pennsylvania House Democrats introduced a new drug plan that they say "would expand prescription assistance to at least 203,000 residents, reduce out-of-pocket expenses for senior citizens and others, and save Pennsylvania $132 million by embracing cost-effective solutions that are available to help the state guarantee affordable medications." (One idea is to transfer funds from the state lottery to the Medicaid fund; another is to use funds from the state's hefty tobacco settlement.)

A bipartisan group of senators from the northern states is also pushing "re-importation" legislation that would allow U.S. pharmacies and wholesalers to buy and re-sell medications from Canada, but progress is slow.

State Rep. Don Walko, a Democrat from Allegheny County whose district includes parts of Pittsburgh, is sponsoring the new laws. Two years ago, he boarded the first bus headed to Canada from Pennsylvania with his wife and one of his children.

"The pharmaceutical industry talks until they're blue in the face," Walko says during a recent telephone interview. "But prices keep going up because they have enormous advertising budgets, hefty research-and-development costs, excessive executive compensation and a profit margin of 19 percent. It's outrageous. The Canadians really address the needs of the middle class and others who can't take advantage of programs like PACE. But the bottom line is that people can't go up to Canada just to realize savings. It's impractical."

An hour and a half after leaving Philadelphia, the bus stops in Allentown for the second rally. Ed O'Brien, who's running for Congress in a district that also includes Bethlehem and Easton, steps onto the podium.

"I support a prescription drug plan that is affordable and voluntary for all seniors," he says. "I'm glad the Rx Express stopped in Allentown, but I certainly hope it's the last time I see you."

Driving through miles of countryside, past endless farmhouses, grain silos, mountains, valleys and a few horses, the seniors chat happily among themselves. Frequent stops, for lunch and another small rally where political hopefuls promise to "prioritize" the need for affordable health care, especially for seniors, lessen the duress of the 500-mile road trip.

For years, people from California and other border states have slipped into Mexico to buy medication. But newly organized prescription-shopping excursions have turned the phenomenon into a mass experience. Now, "drug runs" to Canadian provinces are happening almost every day.

Frederick Cotton, 82, has endured back pain and arthritis for years. Taken daily, his Altham and Celebrex medications cost about $219 a month. Between him and his wife, their yearly fixed income is $30,000. When his wife retired from private industry, her brand-name medications were covered under her benefits. When Cotton retired from the Philadelphia Housing Authority after 25 years of service, his medications were not.

"My doctor gave me five 90-day prescriptions," Cotton says. "I understand that the same medication made in Pennsylvania is sold cheaper in Canada. I blame the government for subsidizing these pharmaceutical companies but not offering a discount to the customers. If it's feasible, I'd like to buy the whole thing at once, since I'm going to need it anyway. And for me to be able to save a buck here or a buck there, it means a lot."

At a stop at a union headquarters in Scranton, six more seniors climb aboard.

"Isn't this crazy?" asks Alex Boris, 70, from Archbald, Pa., who boards the bus with his wife, Anna, 71, five hours after it's left Philadelphia. "We work our whole lives paying taxes in the United States and have to come to Canada to buy our medicine -- how sad."

During the next four hours, many seniors doze off, while others read, do word games, munch on snacks packed in plastic bags and sightsee.

To legally purchase prescription drugs in Canada, the seniors are required to submit forms from their doctors, describing their ailments and listing their medications. They also have to provide original prescriptions. Based on rules set by the College of Physicians and Surgeons of Ontario, a professional nongovernmental agency that provides medical licenses, Canadian prescription medication cannot be dispensed until a patient has had an evaluation by a Canadian doctor. Canada forbids the sale of prescription drugs unless prescribed by a Canadian-licensed physician and filled by a registered pharmacist in an accredited pharmacy.

Although many of the 30 Pennsylvania seniors on the trip have submitted the required paperwork weeks in advance, due to last-minute changes and unexpected problems, organizers say many of the applications did not arrive in the Action Alliance offices until a day or two before departure.

All, though, are assured they will see a doctor at the hotel. But when they arrive at Kingston's Comfort Inn, 10 hours after leaving Philadelphia, road-weary and exhausted, something appears to have gone terribly wrong.

At around 8:30 p.m., the group gathers at a nearby Swiss Chalet restaurant to finally eat dinner. Two hours later, when the travelers are sated and tired, but still planning to see the Canadian doctor before the night is through, a stranger approaches the table.

"I'm sorry to have to tell you that all of the required paperwork was not completed," announces Samantha Foder, a marketing director for a Kingston pharmaceutical delivery service called Canadian Prescription Drugs Inc. "In order to import prescription drugs to the U.S., certain documents must be completed and FDA guidelines must be followed. As of today, we've only received 17 or 18 completed applications. I'm sorry, but only those orders can be filled. Whoever organized this trip did not tell us there would be so many of you."

The bad news spread from table to table. Rosemary Hawthorne, the group leader from Action Alliance, worked swiftly to remedy the situation. Arrangements were made to have the 18 approved applicants meet in her room to be evaluated by the Canadian physician. Hawthorne promises to do what she can to accommodate everyone -- after all, the trip has been grueling -- but the ball is in the Canadians' court.

One by one, the weary travelers meet with two doctors who, familiar with their cases, have brought the medications to the hotel. The doctors, a man and a woman, say they are willing to stay all night if they have to, but will not grant any interviews to this reporter nor allow themselves to be identified.

Lately, members of the Canadian medical community who support Americans in search of affordable medications have been subjected to unprecedented scrutiny, targeted primarily by U.S. pharmaceutical companies.

Pedro Rodriguez says the attacks have made Canadian doctors apprehensive.

"They were actually going to cancel the whole trip," Rodriguez says. One of the Canadian doctors "told me he had gotten a visit on Friday from two inspectors from the Ontario physicians organization that handles licensing. He said they threatened to suspend his license because he was seeing Americans who were coming over the border to buy drugs."

Rodriguez says that, during their two-and-a-half-hour phone conversation, the doctor seemed frightened, but eventually agreed to honor his commitment.

"The larger picture is that U.S. drug manufacturers have put pressure on physicians to stop seeing Americans who come to Canada to get their prescriptions filled," he says. "But, mind you, all of this is perfectly legal."

Rodriguez says he believes the doctor felt he had to cut back the number of patients he would see just to be safe. Foder's excuse about improper paperwork was "a lot of cockamamie," he says.

By the end of the very long night, 11 of the 30 travelers have purchased their much-needed name-brand pills. But 19 seniors are headed home empty-handed. Some, like Armstrong, say they were advised that they could get better savings with the co-pay plans they already have. Others, like Dorsey, are just not seen.

"This was our first time doing this, and we ran into a few glitches," says April Jackson, 40, an Action Alliance counselor. "But please be patient. It's going to work out."

Padded feet and muffled conversation can be heard in the long hotel hallway long after midnight. Foder has recommended that anyone not seen by the doctor visit a walk-in clinic at a nearby mall the next morning. Unfortunately, the doctor at the Cataraqui mall wants to charge $55 for the visit. There are no takers.

"I'm disappointed, but we tried," says Cassie Morrel, a 73-year-old retired NYC nurse and Action Alliance treasurer and board member for 10 years. "I guess the people here couldn't understand how come our big, great country with its big, great government can't take care of their own."

Stopped and questioned at the Canadian border by U.S. Customs and the FDA, the seniors are subjected to another hurdle.

A customs officer, who asked not to be identified, says that in the past three years the number of individuals crossing the border by car to purchase medication has increased. But now, with the chartered buses, things appear to be more organized, and the Canadian government feels the trips have to be monitored more diligently.

"I do understand, though," he says. "I see this as a silent protest by elder Americans against their government's awful prescription drug policy."

Heading back to Philadelphia, the mood is not quite so buoyant. No one says they're sorry they made the trip, but most agree it was an awfully long way to come for nothing.

Frederick Cotton is one of the lucky ones.

"I saw a big savings," he says with a grin. "I saved about $50. I wouldn't have missed it for the world."

A few rows back, Isabelle Appleroth, 80, has also done well. She says she saved $221.

"Part of the reason I saved so much is because Prilosec is not sold as a generic in the States, but what they sold me is a generic," she says. "Evidently they are able to sell the generic brand in Canada, but not in the States."

Mary Dorsey says that even though she didn't see the doctor, she had a good time.

"You don't need drugs to have fun," she says wryly. "It's the best $40 I ever spent."

Rodriguez calculates that the cumulative savings -- for approximately 35 90-day prescriptions, hopefully refillable by phone or the Internet -- amount to nearly $4,000.

As the darkened, quiet bus makes its final approach to Philadelphia, the sparkling city skyline is a welcome sight. The driver pops in a cassette. Gospel music wafts through.

"Jesus, the road's a little rocky trying to get home," says the singer.

Most folks on the bus agree.

"I guess at the end of this journey, there's a spiritual message," Armstrong says.

Can I get an Amen?

—Deborah Bolling

Alternative Meds:One Pennsylvania doctor wants to save seniors the hassle of riding the bus.