Mike Jordan has just left a Rite Aid pharmacy with a $111.78 prescription bill. "As far as I can tell, I will be getting about 40 percent of this back," the retiree says, referring to Medicare's new program to cover a portion of drug costs for those who enroll. But he thinks he can do even better.
"I can get the same drugs for 80 percent less if I make a trip to Mexico," he says. "That's still a better option for me."
The push to allow people like Mr. Jordan to buy prescription drugs from abroad, lowering their medical bills, is gaining a huge new ally: California Gov. Arnold Schwarzenegger (R).
In a letter to congressional leaders this month, Governor Schwarzenegger urged lawmakers to ease federal restrictions on purchasing prescription drugs outside the United States. The letter noted that 45 million Americans, including 7 million in California without health insurance, have limited access to affordable medication.
While prescription-drug costs in the US continue to grow at a faster rate than any other category of healthcare expenditure, he said, "residents of Canada, the European Union, and millions of others around the world pay less ... because their governments impose price controls that effectively shift the financial burden of research and development to the US."
Brand-name prescription drugs cost an average of 35 to 55 percent more in the US than in other industrialized nations, according to the Congressional Budget Office.
Because of California's size and influence, Schwarzenegger's plea for Congress to "take action in 2006 to allow the importation of safe, more affordable medicines" may spur prescription-drug legislation in Washington, say some national observers.
"Schwarzenegger's letter to Congress is a really important development because it is an acknowledgment from the largest state [by population] in the Union that this is a federal issue and one that needs to be dealt with by Congress rather than on the state level," says Peter Pitts, a former associate commissioner at the US Food and Drug Administration (FDA), now vice president for health affairs at the public relations agency Manning, Salvage, & Lee.
In recent years, several congressional bills have floundered, though polls show that Americans overwhelmingly support legalizing prescription-drug imports. A Kaiser Family Foundation poll last April found that 77 percent of the public would support action by Congress to allow Americans to buy prescription drugs from pharmacies in Canada.
Meanwhile, at least seven states (including Texas, Nevada, Illinois, Rhode Island, Wisconsin, Minnesota, and Vermont) have taken steps on their own to allow the importation of drugs from foreign companies. Many have run into legal roadblocks. In Texas and Nevada, the state attorneys general found such measures to be against federal law. Schwarzenegger himself has vetoed four bills, saying, "I am concerned that quick legislative fixes at the state level would be contrary to federal law and over-simplify the complex safety, trade, supply, and pricing issues involved."
Other states, such as Maine and Wisconsin, have instituted discount programs, and several cities have created their own importation programs (though a Washington, D.C., law was later blocked by federal law). The US Conference of Mayors last year adopted a resolution calling on Congress to allow access to medications from Canada.
In Washington, a bill sponsored by Sens. Byron Dorgan (D) and Olympia Snowe of Maine (R), to allow purchase of FDA-approved drugs at lower prices, has been stalled in committee since February 2005.
Some who support easing the import ban blame the Republican leadership for bowing to pharmaceutical companies.
"Congress has tackled this issue on multiple occasions..., and it always gets derailed by Republican leadership, either in committee, or refusing to hold a vote, or in conference committee," says Barry Piatt, communications director for Senator Dorgan. "They have been doing everything in their power to kill these bills."
Many Republican lawmakers, including Senate majority leader Bill Frist of Tennessee, a medical doctor, argue that importing foreign medication - and re-importing drugs that were originally manufactured in the US before being sold more cheaply in other countries - does not ensure consumer safety.
"[Senator Frist] will not compromise the safety of the American people and, while he is working ... on drug reimportation, until it can be done safely, he will not support it," says Amy Call, a spokeswoman for Frist.
Others agree. "The consumer can't be sure of what he is getting or from where, and there is no relationship with a pharmacist who can review the entire profile of drugs someone is taking," says Brian Meyer, director of government affairs for the American Society of Health-System Pharmacists.
Those who oppose lifting the ban also suggest that importation of drugs into the US would cause private investment in drug research to dry up. Research and development costs are high for each new medication - $800 million on average, according to the Cato Institute, a Washington think tank.
Legalizing prescription-drug imports would cause drugmakers to raise prices abroad, not to lower them in the US, others note. John Graham, director of healthcare studies at the Pacific Research Institute in San Francisco, says such was the case with programs in Minnesota and Illinois.
Still others say inaction results from contradictory economic and social motivations.
"[The bills in Congress] try to allow American firms and citizens to import deeply discounted drugs, while at the same time assuring the American public that the drugs are safe - ends that often conflict," says Roger Pilon, director of the Center for Constitutional Studies at the Cato Institute.