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There are more ways than ever to buy prescriptions from Canada

Tuesday, July 22, 2003

By Christopher Snowbeck, Post-Gazette Staff Writer

It used to be that patients seeking low-priced prescriptions from Canada would actually travel for their medicine.

Lucille Dallas, 80, of Baldwin Borough buys medicines from Canada through the Physician Medicine Assist Program in Pleasant Hills. The medicines help Dallas maintain her busy lifestyle, including yard work. (Steve Mellon, Post-Gazette)
Those were the days when Jeanette Matzzie, 67, of McCandless read about seniors busing to Canada and decided to make her own medicinal journey. She discussed her prescription needs with her doctor, contacted a Canadian pharmacy and physician who agreed to the deal and then made the trip during the fall of 2000, stopping in Toronto for a performance of "The Lion King."

But now, scores of Canadian pharmacies use the Internet to sell medicines to Americans in the comfort of their own homes. And just last month, a Squirrel Hill storefront called Rx Depot became the second Allegheny County operation to provide walk-in assistance with placing medicine orders in Canada. A Pleasant Hills doctor started helping consumers this way last year.

With all this activity, the conventional wisdom about buying prescriptions anywhere remains relevant: It pays to shop around. But there's also reason to be cautious about buying from Canada.

"I'm not telling people not to go to Canada -- you do what you've got to do," said Charles Inlander, president of the People's Medical Society, a national consumer group based in Allentown. "But you don't know who you're dealing with often times and you really have no grounds if something goes wrong."

Just paperwork

George Risov, 23, of Squirrel Hill opened his Rx Depot franchise on Murray Avenue in June. The store consists of a fax machine, two phones, a desk and photocopier. Risov also can show customers on a computer the significant difference between U.S. prices and those available from Canada through Rx Depot.

Risov helps customers fill out a form that details their medical and family histories and their current prescriptions. The form also lists credit card information and the medicines being sought.

He faxes this information and copies of the presciptions to a Canadian pharmacy, which checks the order to make sure the drugs won't interact adversely. In two weeks, he said, customers receive the medicines, usually a 90-day supply, in the mail. The medicine price includes Risov's 10 percent commission and a flat $15 shipping fee.

An entrepreneur with experience in the import and export business, Risov is candid about his lack of a health-care background. Rx Depot is not a pharmacy but simply a way to help American consumers tap in to Canadian medicine prices, he said.

Rx Depot has opened 56 stores in eight months and Risov has the exclusive rights to open franchises in Pittsburgh and Philadelphia. He plans a Philly store by September and hopes to open in both Wheeling, W.Va. and Mt. Lebanon even sooner.

In its first three weeks of operation, the Squirrel Hill business generated $15,000 in revenue by placing orders for between 60 and 70 prescriptions, Risov said. He's happy to help people struggling to afford medicines, but is also clear about why he's in business: "Recurring revenues," he said.

"I've got no medical information here. All we do is paperwork," Risov said. "Our advantage is the fact that you can come in, sit down and do this."

But if consumers like the idea, regulators are ambivalent at best.

More info

For Web addresses and phone numbers for other prescription drug buying programs, click here.


State pharmacy boards have taken different approaches to Rx Depot.

Some, including Pennsylvania's, say the stores aren't filling prescriptions and therefore aren't subject to pharmacy regulations. Brian McDonald, spokesman for the Department of State, said the Pennsylvania board has sent a letter to the state Attorney General's consumer affairs bureau, just to make them aware of the trend. Oklahoma's board, however, sought a court injunction to shut down an Rx Depot.

The Food and Drug Administration also has questions. In a March 21 letter, the FDA told an Rx Depot operator in Lowell, Ark., that he was breaking several laws.

The government prohibits the re-importation of medicines made in the United States and sold abroad by anyone other than the manufacturer, wrote David J. Horowitz, director of the agency's office of compliance. Foreign versions of U.S.-approved drugs are generally considered not approved for use here by the FDA, he added.

But many Americans can attest to the safety of Canadian drugs. In fact, the U.S. Senate voted just last month to let pharmacists import prescription drugs from Canada and resell them.

But the FDA has opposed this idea for the same reason it criticizes Rx Depot: The practice increases the chance of counterfeit drugs entering the country.

"There is a possibility that drugs which come to U.S. consumers through Canada or purport to be from Canada may not actually be Canadian drugs," Horowitz wrote to Rx Depot. "In short, drugs delivered to the American public from foreign countries may be very different from products approved by the FDA and may not be safe and effective."

Rx Depot maintains that the medicines it helps people order are safe. The company also believes it is operating in a "safe harbor" created by the FDA's practice of turning a blind eye toward other consumer efforts to bring medicines from Canada, said Joseph P. Murphy, a Squirrel Hill attorney who advises the local outlet.


Harvey Organ, a pharmacist in Hamilton, Ontario, is blunt in his assessment of the FDA's arguments: They're ludicrous. Some drugs sold in the United States are actually manufactured in Canada, he said, and he questioned why counterfeiting would be a bigger problem in Canada than the United States.

Kohler Pharmacy, where Organ works, has sold medicines to U.S. citizens since 1997, originally to those coming on buses and, more recently, through a Web site called CanadaRx.net. It was to Kohler that Jeanette Matzzie drove to in 2000 and from which she continues to get refills by mail.

The pharmacy also is the source of many medicines for the Physician Medicine Assist Program of Dr. Joseph Rudolph of Pleasant Hills, who started ordering Canadian medicines for patients last year. As an offshoot of his allergy and asthma practice, Rudolph has helped 1,300 people buy medicine from Canada. Rudolph says FDA's concerns about Rx Depot don't apply to his program because it is structured differently.

Concern about getting safe and effective medicines from foreign sources is understandable. But consumers can put aside their worries by buying from a reputable Canadian pharmacy, Organ said. A pharmacy should be willing to provide a caller with its pharmacy license number, which can then be verified with provincial authorities.

"The moment they know we're a real pharmacy, they know we're buying from reputable manufacturers," he said.

Barbara Dickman, a Delmont volunteer who works on AARP's prescription drug task force, said consumers with questions also can get information from the National Association of Boards of Pharmacy. The association runs a program called VIPPS, which stands for the Verified Internet Pharmacy Practice Sites.

Comparing sources

Consumers might also want to do comparison shopping. In addition to Organ's CanadaRx.net, there are numerous Internet sources, including Rx-Canada.com, CanadaRx.com, CanadaDrugs.com and CrossBorderPharmacy.com.

The last three pharmacies and a fourth Canadian supplier can be accessed through a single U.S. Web site called UnitedHealthAlliance.com. Run by a nonprofit group in Vermont, United Health Alliance promotes comparison shopping and says Canadian sources promise their best price in exchange for being listed on the Web site.

The Rx Depot in Squirrel Hill lists prices on the Web site RxDepot.com. A list of sample prices from Rudolph's program is available at fpcmeds.com, although consumers must call to get a current price.

Rudolph said he has changed his program during the past year to route consumers seeking generic medicines to an American distributor, which is often cheaper. He also informs consumers about pharmaceutical company programs through which patients can get free medicines, so long as they meet income guidelines.

Commercial sources of Canadian medicines won't offer those services because they don't generate a profit, Rudolph said. Risov doesn't advise customers of them, either.

The best deal will vary, considering the variety of medicines on the market and the daily fluctuations in prices. Drug price alone isn't the only factor. Shipping costs can range from $10 to $20, and some Canadian sources apply a handling fee.

"Internet sites all have different prices, and it does pay to shop around, just as it pays to shop around to the different pharmacies in our own town," said Dickman of AARP.

Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412-263-2625.

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