Internet helps cut cost of medicine Patients get deals through Canada
September 17, 2001; Hal Dardick Special to the Tribune

State Sen. Chris Lauzen (R-Aurora) told the Heislers about the Internet site. In a trial of the site from June through August, Lauzen said 49 of 50 Illinois participants reported saving between 22 percent and 89 percent on the cost of their prescription drugs. One paid 5 percent more.

"Constituents tell me that they are forced to choose between paying for groceries, utility bills and their prescription medications," Lauzen said. "Through the help of many people, we have found at least one way to cut some of those costs in half."

In the United States, Lauzen said, the drugs would have cost $21,517, but participants paid $9,649, a 55 percent saving.

Thousands of dollars saved...

Between July and December 2000, 145 people from Vermont, New York and Massachusetts used the service, Wennar said. She estimated the savings at $59,000.

The U.S. Food and Drug Administration estimates that 2 million mail parcels containing FDA-regulated products for personal use enter the country each year.

Prescription drugs are cheaper in Canada for several reasons, including Canadian price controls, a government prohibition on direct-to-consumer advertising and the stronger value of the U.S. dollar.

The FDA allows individuals to go to Canada and buy up to three months' worth of FDA-approved drugs prescribed by Canadian doctors for personal use.

In July the U.S. House of Representatives passed a bill that would allow individuals to buy drugs from abroad by mail order and the Internet, but it soundly rejected a measure sponsored by U.S. Rep. Bernard Sanders (I-Vt.) that would have allowed wholesale reimportation of American-made pharmaceuticals by companies or individuals.

Abstract:
" U.S.-made drugs that are reimported may not have been stored under proper conditions or may not be the real product, because the United States does not regulate foreign distributors or pharmacies," FDA official William K. Hubbard told a U.S. Senate Commerce subcommittee recently. "Therefore, unapproved drugs and reimported approved medications may be contaminated, subpotent, superpotent or counterfeit."

July 29, 2002

Look Who's Running Drugs

Americans are going to Canada — and Canadian websites — for cut-rate prescriptions. Bad idea?

BY CHRISTINE GORMAN

For years, U.S. citizens living in northern border states from Maine to Washington have been slipping into Canada to pick up prescription drugs at cut-rate prices. The Senate passed a proposal last week that would make it easier to ship Canadian drugs directly to the U.S. But opposition from the drug industry is fierce, and Washington handicappers give the measure little chance of becoming law.

So where does that leave price-conscious consumers — especially those senior citizens whose drug costs are not covered by Medicare?

On the Internet, of course. In the past two years, online...

The complete article is 493 words long.

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Internet medicine trips up Doctor Opsahl www.sacbee.com/content/ne...3018c.html


Internet medicine trips up doctor
He's accused of writing prescriptions without seeing patients.
By Steve Wiegand -- Bee Staff Writer
Published 2:15 a.m. PDT Monday, July 22, 2002

In the first case of its kind in California, a doctor faces the loss of his medical license for allegedly prescribing drugs illegally through the Internet.

Jon Steven Opsahl is accused of writing more than 8,000 prescriptions for antidepressants and painkillers to patients he never examined.

The Medical Board of California alleges Opsahl prescribed the drugs, over the course of a year, after talking on the telephone to patients from around the country who were referred to him by operators of a Texas-based Web site. According to the complaint, he received $60 for each consultation sent his way by the Web site, called Office In A Snap.

The Medical Board contends Opsahl violated an 18-month-old state law that bans physicians from dispensing potentially dangerous drugs via the Internet without first conducting a "good faith examination." The board has interpreted that phrase, in almost all situations, to mean an exam done in person.

Law enforcement and health officials say Opsahl's case, which goes before an administrative law judge Thursday in San Diego, is just the beginning of what they expect will be a steady stream of confrontations between traditional medical protocol and cyber-pharmacies.

"It's going to be a lot more common in the future," said Sanford Feldman, the deputy attorney general representing the Medical Board.

Opsahl maintains that while patients were referred to him through the Web site, the telephone consultations provided him with enough information to responsibly prescribe the drugs, and in fact represent a more efficient way of practicing medicine.

"People's lives were turned around and improved," the 42-year-old doctor said in a telephone interview from the pain relief and addiction recovery program he runs in Colton, near San Bernardino.

"And I'm getting punished just because I didn't follow in goose-step marching order an outdated medical model that insists on a physical exam that isn't always necessary."

There is no federal law regulating Web site pharmacies, leaving it to individual states to determine what is legal or not in dispensing drugs over the Internet.

Some sites, most of them approved by the National Association of Boards of Pharmacy, require written authorization from a customer's physician before filling prescriptions online.

But for a fee that can range from $40 to $120, many other sites offer to fill a prescription, often through another Web site, following an online or telephone consultation with a physician. Thus a patient in California could sign on to a Minnesota-based Web site, have his questionnaire reviewed by a doctor in Alabama and receive a prescription from a pharmacy in Maine.

Others, especially sites based in other countries, require only that customers check a box affirming they are at least 18 years old and don't plan to abuse the drugs.

One such site, which claims to be affiliated with a pharmacy in Lima, Peru, contends it is legal to import medications as long as they are for personal use.

"Not so," said Will Glaspy, a spokesman for the federal Drug Enforcement Administration. "It's against the law for someone inside the United States to purchase or order controlled substances from a pharmacy that is outside the United States."

The use of Web sites that employ aggressive e-mail advertising to sell drugs is a relatively recent phenomenon. Health officials say the approach really took off four years ago with the introduction of the drug Viagra, designed to treat male sexual dysfunction.

The sites soon expanded their inventories to include drugs such as Propecia, for male baldness, and potentially addictive drugs such as Vicodin for pain relief and Valium for anxiety.

Internet pharmacies, known as "pill mills," send out thousands of unsolicited e-mails promising few-questions-asked delivery of drugs. Those who respond are directed to Web sites where they fill out questionnaires, use credit cards to pay often-exorbitant prices, then wait for the pills to be mailed.

The work can be lucrative. One doctor in Texas admitted writing 450 prescriptions a day. Another, in Oklahoma, reportedly made $175,000 in six weeks.

To combat the pill mill problem, the California Legislature approved a bill that went into effect last year. The law specifically bans filling prescriptions via the Internet unless there was first a "good faith examination" by a qualified physician. It sets a fine of $25,000 for each prescription illegally approved by a California physician or filled by a California-based Web site.

Two months ago, the pharmacy board used the law for the first time, to fine a Los Angeles drugstore and two pharmacists for filling Internet prescriptions without a medical examination. But the doctors involved were from out of state and were not cited. The case is being appealed.

In addition to the legal problems they pose, non-accredited sites often charge prices far above those charged at approved sites. One offshore pharmacy, for example, recently was charging $129 for 50 tablets of Valium. The same drug purchased from the Walgreens Web site -- which requires a written prescription -- costs $69 for 60 tablets.

There is also the question of what you're getting.

"Drugs from those kinds of sites could be adulterated, they could be expired, they could be anything," said Patricia Harris, executive officer of the California Board of Pharmacy. "There's no guarantee they are anything close to what they purport to be."

While the Food and Drug Administration sets standards for drug purity, neither it nor any other federal agency does much to patrol Internet pharmacies. California health and law enforcement officials say it's a decidedly uphill battle to deal with sites that can be based anywhere in the world.

In the Opsahl case, for example, the Web site that connected patients with doctors for phone consultations was based in San Antonio. The site since has closed, and a San Antonio phone number for the company has been disconnected.

"There are a lot of (law enforcement) agencies that have pieces of the pie," said Paul Nasca, a state Medical Board investigator who was assigned last year to patrol the Internet full time, "and we only have a narrow portion."

Absent an overriding federal law, state officials rely on each other to chase down rogue Internet physicians and pharmacies.

The Federation of State Medical Boards has run a clearinghouse for medical boards and law enforcement for the last two years, where state officials can trade information.

"We've investigated 350 sites in a little less than two years," said Dale L. Austin, deputy executive vice president of the federation, "and we've probably only scratched the surface."

Although Opsahl is the first California physician to face disciplinary action for prescribing via the Web, Medical Board spokeswoman Candis Cohen said formal charges have been filed against two other doctors in California and 25 other investigations are under way.

Opsahl came to public attention two years ago when he used Web sites and other devices to help persuade law enforcement officials to reopen the investigation of his mother's murder during a 1975 Carmichael bank robbery, allegedly by members of the Symbionese Liberation Army.

He contends that in his case, all the talk about Internet prescribing is moot.

"I wasn't even doing Internet 'scripting,' " he said. "I was not issuing prescriptions based on a questionnaire off the Internet. ... They were based on one-on-one interviews over the telephone."

Opsahl acknowledged that he did prescribe the antibiotic Cipro over an Internet site without a telephone consultation after the anthrax-in-the-mail scare of last October, but he said he stopped after being ordered to by the Medical Board.

"This is almost insane," he said. "Instead of backing off and seeing what merit there was to what I was doing, they are trying to make sure I crash and burn, when nobody, absolutely nobody, was hurt."

Administrative Law Judge Stephen Hjelt, in an April order that suspended Opsahl's license until his case is heard, took a different view.

"Respondent's belief that talking over the phone with patients satisfied the requirement of a good faith examination is profoundly disturbing and demonstrates a combination of incredible arrogance and a woeful lack of judgment," Hjelt wrote.

If Opsahl is found guilty, the Medical Board can take a wide range of actions, from placing him on probation to stripping him of his license.

Whatever happens, Deputy Attorney General Feldman said, "this won't be the last case of its kind in California."


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About the Writer
---------------------------

The Bee's Steve Wiegand can be reached at (916) 321-1076 or swiegand@sacbee.com.

Internet Pharmacy Offers Discounts
Fledgling Internet Pharmacy Offers Seniors Big Medication Discounts

October 16, 2002 ;The Associated Press

Worried about her elderly parents' struggles to pay for a dozen prescription medications each month, Karen Azarchi started researching how to get them cheaper from Canada.

She heard about other senior citizens skipping medication doses because they had little or no prescription coverage and couldn't afford the expense.

"It struck a nerve," Azarchi said, so the Trenton native decided to try to help, suspending her business as a computer software consultant.

In July, Azarchi opened Medications4Less, which transmits orders from customers to mail-order pharmacies in Canada, where government price controls limit costs to patients. The two mail-order pharmacies with which Azarchi is affiliated ship medicines directly to her customers at savings of 30 percent to 85 percent off those of major U.S. drugstore chains, she said.

"Seniors are scared, but they have to do it because they can't afford their medicines," Azarchi said. "The calls that I get, the people crying on the other end. One woman said she had to sell her house" to pay for her prescriptions.

Some people calling Azarchi's toll-free number to inquire about the business have told her they pay as much as $1,500 a month for prescriptions.

"I'm cutting them in half," said Azarchi, who runs the business out of her Plainsboro townhouse. She claims several hundred customers, who can order through her Web site or call to have an order form sent to them.

American pharmaceutical companies say their prices are justified by their huge research costs. Their trade group, Pharmaceutical Research and Manufacturers of America, vigorously lobbies against any legislation to allow mass reimportation of drugs or speed availability of generic equivalents. It has been running newspaper ads on the dangers of ordering drugs via the Internet and now lobbies for Congress to enact prescription coverage under Medicare, a dwindling prospect this year.

AARP spokesman Stephen Hahn said getting lower-cost drugs from Canada now is valuable for some people, but "the Medicare drug benefit will do the most to lower drug costs" for seniors.

The Food and Drug Administration has long allowed people to import a 90-day personal supply of drugs not available in this country, but warns of possible dangers.

"It's kind of buyer beware when you're ordering from an Internet site," said Thomas McGinnis, FDA's director of pharmacy affairs. "You don't really know what you're getting."

FDA has been working with the U.S. Customs Service and Canada's national health service to try to limit the flow of medications from there to here. The U.S. government has prosecuted operators of dozens of Internet drugstore sites, primarily ones offshore that don't require prescriptions or sell phony drugs.

Under FDA rules, U.S.-based Internet pharmacies must have licenses in states that require them.

In New Jersey, such a license is required only for those who actually dispense prescriptions, so Medications4Less is exempt, said Genene Morris, a spokeswoman for the State Board of Pharmacy.

Azarchi said she interprets the U.S. law as allowing patients to import drugs for terminal illnesses, which technically covers her mostly elderly clientele. But she concedes that FDA would probably view her operation as illegal.

"I consider what I do to be a service," she said. "I'm not in this to make big money."

Azarchi said she is still losing money and living off her savings, but hopes to be turning a small profit within six months.

Many Internet pharmacies sell potentially dangerous drugs without prescriptions and send unsolicited ads to thousands of e-mail accounts, but Azarchi said she does not. Medications4Less does not handle narcotics, drugs for acute conditions such as infections, or orders sent without an American doctor's prescription.

The order form asks customers to list their medical conditions, other drugs they take, medication allergies, and height and weight to ensure correct dosage for some drugs. A physician in Canada reviews the information, checks it with the American doctor if needed, then writes a new prescription; Canadian pharmacies can only fill prescriptions written by doctors licensed there.

Medications are shipped in sealed, original bottles from U.S. and Canadian manufacturers. Azarchi said that reassures her customers that the drugs are not tampered with, counterfeit or expired concerns U.S. health and safety officials have repeatedly stressed in opposing legislation to allow mass reimportation of drugs from other countries.

Hu Warden, an 81-year-old retired architect in Dallas, just reordered a 90-day supply of six medications he takes for heart trouble, high cholesterol, an ulcer and other ills. He searched the Internet for medicine from Canada on his internist's advice after the stock market plunge cut his nest egg in half, forcing him and his wife to tighten their belts. Warden said last week that Medications4Less is saving him about half the $600 per month he had been spending.

"It's a good company to do business with, as far as I can see," Warden said. "Everything is just like I get here, except two of them have a different label" because they are generic rather than brand-name drugs.

Warden said Azarchi provides excellent service and he always gets to speak with a person immediately when he calls.

Michael Vetri, a 46-year-old father of four from Boothwyn, Pa., turned to Medications4Less because his health plan has no prescription coverage. The real estate investor was paying $500 a month for a drug for a nerve condition that gives him constant, intense facial pain, despite two surgeries.

"Medications4Less had probably the cheapest prices I found" after searching the Internet for alternatives, Vetri said. "I just think it's preposterous that the drug is manufactured here and you have to go to Canada to get a fair price."

By Bill Redeker

DENVER, Colo., March 8

Colorado businessman Don Bozarth got the idea while trying to take care of his mother-in-law.

Due to the rising cost of prescription drugs, many Americans are ordering their medications online from Canadian suppliers. (ABCNEWS.com) Across-the-Border Bargains
Ordering Prescription Drugs Online From Canada Is Cheaper

"I discovered pharmaceutical prices had doubled in the past 10 years," he said. "And as you know, most seniors who are on Medicare have no prescription coverage."
So he looked around for less expensive prescription drugs. He found them in Canada. "Everyone's seen the articles about seniors getting on buses and going to Canada but I believed there must be an easier way," said Bozarth.

After carefully studying the law, he discovered it was possible to place orders over the Internet — as long as there was a prescription and a doctor in Canada willing to review it and write the same prescription. Thus "www.canadianmedsusa.com" was born.

Carollee Hatch, 74, who is battling breast cancer, was one of the first customers. "In Canada, my tamoxifen would be $13.95, plus the $20 co-pay. Here in the United States I was paying $187! It's a tremendous savings," she said.

Hatch also buys her husband Claude's medicines through the company and says she is saving enough money to take a vacation this summer.

Sister Mary Kay Kottenstette, a 64-year-old nun and part-time Spanish teacher, is also sold on the plan. She is taking three medications to treat high cholesterol, gout and thyroid problems. "I have no health insurance, I only make $15,000 a year and I can't spend it all on medicines," she said. "Last year, I spent $1,068 on these three drugs; Lipitor, allopurinol and Synthroid. This year I'll be spending about $640. The savings are absolutely amazing!"

FDA Won't Punish Seniors

The Food and Drug Administration says that technically the practice violates federal laws. But a spokesman says the FDA looks the other way and does not enforce them. "We don't want to punish seniors," he said.

The FDA also says it cannot guarantee the purity of the drugs from Canada. But the truth is, in most cases, the drugs are identical.

When pressed on how she felt about the legality of all of this, Kottenstette was blunt. "You know what? When the laws are unjust, I really don't care," she said. "There are so many people without health insurance, without the means to take care of themselves, and it just isn't just."

Bozarth says demand is picking up and he plans to expand his service. He is careful to point out that all his company is allowed to do is assist those who have questions and need help placing their orders.

"The prescription drugs are mailed directly to the patients from a pharmacy in Winnipeg, Manitoba," he says. "I make a small percentage from the price of the prescription."

What's to keep the rest of us from ordering our prescriptions from Canada?

"Absolutely nothing," he says. "In fact if the trend continues, perhaps it will force the drug companies to do something about their high prices."