Suddenly Senior: Snubbing Medicare, some look to Canada

Frank Kaiser, Suddenly Senior

Monday, February 27, 2006

Subject: [RxNews] Snubbing Medicare, some look to Canada - from Suddenly Senior

Tens of thousands of Florida's seniors skip the government's new prescription-drug benefit.

Robyn Shelton Sentinel Medical Writer

February 27, 2006

Florida's elderly are snubbing Medicare's new prescription-drug benefit by the tens of thousands, saying they still get better deals buying their medicine through Canadian pharmacies.

Even though the practice is illegal, seniors say it allows them to stretch their drug budget further. Prescriptions often cost 30 percent to 50 percent less there than in the United States because the Canadian government limits what drug-makers can charge.

Among those making the choice is M.C. "Smoky" Taylor, 79, who does not have insurance to help pay for the five medications he uses regularly.

Taylor said he saves about $800 annually on blood-pressure, diabetes, cholesterol and other medications. He has no plan to join the Medicare prescription program.

"I tell everyone to look into Canada," said Taylor, who lives in Leesburg. "My doctors even recommend it, so what does that tell you?

"I wouldn't sign up for one of these [Medicare] plans. They're all messed up, they don't cover all the drugs you need, and you have to pay a fee every month. It's ridiculous."

It's hard to say how many seniors are using Canadian pharmacies in lieu of Medicare's program, which went into effect Jan. 1.

Anecdotally, pharmacists in Canada noted a drop-off in business last month but an uptick in February.

Even so, they say, it's too early to predict how Medicare's drug benefit, called Part D, will affect demand for Canadian drugs among U.S. seniors.

In the United States, Medicare wants seniors to know they are taking two risks if they purchase drugs from Canada.

First, the U.S. government cannot vouch for the safety of the foreign drugs. Second, those without Part D do not have true protection against high drug expenses.

"By enrolling in a Medicare drug plan, beneficiaries not only get good prices, but insurance against catastrophic drug costs," said Peter Ashkenaz, a spokesman at the Centers for Medicare and Medicaid Services in Washington. "You cannot get the peace of mind of insurance by ordering your drugs from Canada."

Buying medicine from Canada remains a contentious topic in the United States, where some lawmakers have been pushing without success to legalize Canadian drugs. The practice is illegal under a federal law that prohibits the importation of medicines from other countries.

Even so, an estimated 2 million Americans buy their prescriptions from Canada, and the U.S. government never has prosecuted anyone for doing so -- though U.S. customs and drug officials occasionally seize drug packages coming into the country.

The pharmacies don't share details about their customers for privacy reasons, but it's a safe bet to say that most of them are seniors, said Andrew Strempler, president of RxNorth.com, a Canadian Internet pharmacy.

He also said Florida residents make up a sizable portion, estimating that
25 percent of his company's 200,000 American clients live in the Sunshine State.

Strempler said he has not seen a drop-off in business, noting a rise from December to January of 3 percent.

He thinks some seniors are investigating the Medicare options and finding a cheaper alternative across the border. His company did an analysis of Part D, running nearly 500 different scenarios through the government's Internet-based system that helps people compare the costs of various plans in their areas.

Using commonly prescribed drugs, Strempler said his pharmacy is cheaper than the least-expensive Medicare plan in most situations.

"There are cases when people can do better [with Medicare]," Strempler said. "For example, people who are spending an enormous amount of money, with catastrophic costs, are going to save.

But what we've found is that these plans, while they had the best intentions in mind, were not designed for the typical, healthy senior" whose costs are not as high.

Better option for some

Charlotte Kuglin, 75, of Lake County considers herself lucky that she needs only a handful of medications regularly. She and her husband, Walter, have been filling their prescriptions through RxNorth for three years.

Still, when she heard about Part D, Kuglin was eager to examine the program. After crunching the numbers, she found she still saves about $1,300 more annually by going through Canada than by enrolling in the Medicare program.

Although she is a staunch supporter of President Bush, Kuglin said she will not be taking part in the program that he has touted heavily. She also finds no logic in the government's warnings about potential safety concerns with Canadian medicines.

A retired nurse, Kuglin said the drugs come in bottles that have not been opened since they left the manufacturers. She has no worries about getting authentic, safe drugs.

"I love President Bush; I think he's a wonderful man," she said. "But there are some things he's done that I don't agree with, and this [drug program] is one of them."

Medicare spokesman Ashkenaz said people don't have to go to Canada for the best prices. He said seniors can pay less through Part D, especially if they are buying generic drugs and taking advantage of the mail-order options available with many plans.

In those cases, "beneficiaries enrolled in [Part D plans] may pay less for their drugs than those ordering drugs from Canada," he said.

So far, Medicare has reported a strong interest in its new coverage, with about 15.8 million people enrolled in the coverage through private companies or managed-care organizations. An additional 9.5 million people on Medicare have drug coverage through other sources, such as retiree or veterans benefits.

That leaves about 15 million Medicare recipients who still could join Part D if they chose to do so. People can sign up through May 15 for the initial enrollment period.

As people continue to study their options, advocates say seniors should be aware that Canada is a possible source for cheaper medicines.

"We definitely tell them it's an option, and it can be a lower-cost option than Part D," said Diane Archer, founder and special counsel for the Medicare Rights Center in New York.

'Doughnut hole' help

That's the same message Canadian pharmacies are trying to reinforce as they risk losing business to the new program.

Andy Troszok, president of the Canadian International Pharmacy Association, said drugstores in his organization did see a decline in orders for January, but they already have been reporting a bump in February.

He thinks many seniors might use Canadian stores among a variety of sources to fill their drug needs. For example, people might continue to order Canadian drugs for those medicines not covered by their Part D plans. Or they might wait and order from Canada once they reach the so-called "doughnut hole" when drug coverage temporarily stops in the plans.

"Regardless of Part D, Canada is still an option that is very viable," he said.

Robyn Shelton can be reached at rshelton@orlandosentinel.com or 407-420-5487.