EXINGTON, Ky., Oct. 21 — For years, just about the only Americans regularly buying drugs in Canada were thrifty gray-haired New Englanders. Now, with state budgets squeezed, it is the nation's governors who are demanding access to Canada's cheap drugs. Here in Kentucky, the issue has become central to a tight governor's race. Cheap Drugs From Canada:
By GARDINER HARRIS
Another Political Hot Potato
The state's Democratic attorney general, Ben Chandler, has spent much of his remaining funds on an ad campaign that reminds voters that his Republican opponent, Representative Ernie Fletcher, voted in Congress against legalizing drug imports from Canada.
In a televised debate Monday night, Mr. Chandler accused Dr. Fletcher of "being in the pocket of prescription drug manufacturers."
Dr. Fletcher, a nonpracticing family physician, denies the charge. But he has had to spend precious money and time explaining why he voted against legalizing drug imports.
"I knew when I voted against it that it would be an attack issue," Dr. Fletcher said in an interview after the debate. "But as a physician, I took a Hippocratic oath to do no harm, and some of these drugs are dangerous."
Drug makers long ignored the trickle of patients who trooped across the border to buy drugs cheaply, but that trickle is threatening to turn into a flood. The growing political support for drug imports has galvanized the industry against one of the most serious threats to its profits since the Clinton health care proposals of 1993.
The governors of Minnesota, Illinois, Iowa and Wisconsin have said in recent weeks that they want to import cheaper medicines from Canada, saving state budgets and their citizens millions in the process.
"The reason you have the beginnings of a prairie rebellion here is that there is a crisis and nobody has properly responded," said Minnesota's governor, Tim Pawlenty, a Republican.
Illinois's governor, Rod R. Blagojevich, a Democrat, is stumping for an online petition to persuade federal officials to allow drug imports. "There's nothing that can stop an idea whose time has come," he said.
State officials in Massachusetts say they are also considering imports, and the city of Springfield, Mass., is using a Canadian pharmacy for its employee health plan. John Taylor, the top enforcement official of the Food and Drug Administration — which opposes such efforts — calls the push for drug imports a "tsunami" that the agency is having trouble tracking.
A measure legalizing imports is part of the Medicare prescription drug legislation that House and Senate negotiators are trying to reconcile in a conference committee. The proposal passed the House in July, but 53 senators signed a letter circulated by the drug industry saying they oppose drug imports. Since the measure is also opposed by the House's Republican leadership, its prospects in the conference committee at first seemed dim.
But F.D.A. officials and industry lobbyists say that conference members are searching for a compromise that would allow drug imports for a trial period, perhaps a year. That such a deal is being considered at all is a measure of how far the politics of the issue have evolved, after years in which the drug industry's determined opposition seemed the final word.
Drug makers remain adamantly against any compromise. "A pilot program with American patients as guinea pigs is a proposition that no responsible lawmaker should support," said Jeff Trewhitt, a spokesman for the drug industry's trade association, PhRMA.
But support for the industry has eroded as the gap between drug prices in the United States and the rest of the industrialized world has grown. Surveys by a Canadian health agency have found that American prices are, on average, about twice those in Canada and nearly three times those in Italy. With price controls in most other countries, the industry last year made half its sales — $200 billion worth — in the United States for the first time.
In Kentucky, the drug price gap has many people grumbling. Mark Nickolas, Mr. Chandler's campaign manager, said that the campaign had focused on the issue of drug imports because polling found that it resonated with voters.
Last month, Mr. Chandler filed suit on the state's behalf against five of the nation's largest drug makers, claiming they had cheated Kentucky out of millions of dollars. With the suit, the state belatedly joined a longstanding effort, spearheaded by federal prosecutors, to crack down on certain drug-pricing practices.
Mr. Chandler castigates drug makers at almost every opportunity. He tells voters that he intends to cut $150 million from the $700 million that Kentucky spends on drugs for Medicaid beneficiaries by "taking it out of the hide of drug companies." He supports efforts to obtain drugs from Canada and wants to establish a drug buying pool with other states.
On the stump, he also points out that Dr. Fletcher, in his 2000 Congressional campaign, benefited from more than $500,000 in ads paid for by the drug industry.
In an interview Monday, Dr. Fletcher said he did not believe that the drug-import issue would sway many Kentucky voters. He said that he was concerned that American consumers were the only ones being asked to pay for drug research, and said the state's drug bill could be cut by reducing the number of prescriptions that some Medicaid recipients receive.
Drug prices are by no means the only issue in the campaign. Taxes, gambling and a fierce fight over negative campaigning are in the foreground, too. A recent poll by The Courier-Journal of Louisville found the candidates virtually tied.
Dr. Fletcher's worries about the safety of drug imports are echoed by the F.D.A., which has begun a very public effort to illustrate the dangers. Last month, the agency announced that spot inspections of 1,153 mailed packages containing drugs from abroad found that most were counterfeit and many were dangerous. The F.D.A. is seeking to shut the largest chain of stores that helps Americans buy drugs from Canada.
But many import proponents say that the F.D.A. is exaggerating, and they point to the growing popularity of imports as proof of their benefits.
Governor Blagojevich of Illinois said in a telephone interview Tuesday that the state spent $340 million last year on prescription drugs for 230,000 state employees and retirees — a tab he said could be cut by tens of millions with drugs from Canada. Mr. Blagojevich said that Washington gave the drug industry steep tax breaks to support research and asserted that drugs sold in Canada were as safe as those sold in the United States.
Governor Pawlenty of Minnesota said that the states could resolve any safety worries by identifying Canadian pharmacies that can be trusted to provide safe products. "We could bring some due diligence to the process and help bring about consumer protection," he said.
Bob Leitman, a pollster with Harris Interactive, said that a recent survey found that 7 percent of Americans said they had purchased drugs from Canada, up from 5 percent last year. With more Americans aware of the sharp cross-border price differences, he said, the issue will only grow in political importance.
Should a bill legalizing drug imports pass Congress and be signed by President Bush, the drug industry still could defend its profits. Already, some drug makers are limiting sales to Canadian pharmacies so they can only get enough drugs to fill prescriptions written in Canada.
"I think there'd be a longtime game of cat and mouse in which the industry limits the damage," said Richard Evans, an analyst with Sanford C. Bernstein. Even if its tactics lead to drug shortages in Canada and Europe, he added, "the industry is clearly going to defend its most profitable market at the expense of less profitable markets."
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