The federal government's ban on buying prescription drugs from Canada has left some states frozen in their tracks. But Republican Gov. Tim Pawlenty of Minnesota is brazenly bucking federal law by using the World Wide Web to help Gopher State residents buy less expensive drugs from Canada.
Pawlenty has launched an informational Web site -- MinnesotaRxConnect -- that lists more than 800 drugs available from two Canadian pharmacies that sell for about 35 percent less than in the United States. The move sets up a conflict with the Food and Drug Administration, which says it's illegal and unsafe to re-import U.S.-manufactured medicines that have been sold to Canada or other countries.
"You shouldn't have to get on a bus to get a fair deal on prescription medicines. You should just have to get online," Pawlenty said Feb. 5 in his State of the State Address. More than 11,700 Minnesotans have visited the site since it opened Jan. 30, but state officials said they don't know yet whether anyone has bought medicine online.
While Minnesota's move may be the boldest so far, Pawlenty is just one of dozens of governors, state legislators and city leaders across the country who are putting increased pressure on the federal government to allow re-importation.
States are hoping to access cheaper prescription drugs from Canada, where price controls keep costs down, for residents, state employees and prison inmates. There hasn't been much talk about including Medicaid beneficiaries yet, partly because states already receive large discounts from drug companies for those poor and disabled patients enrolled in the state-federal health insurance program.
"There is definitely bi-partisan interest in re-importation, but the FDA is being very, very difficult and is threatening to make an example out of someone," said Cheryl Rivers, a former Vermont legislator who heads the National Legislative Association on Prescription Drug Prices, which is made up of state lawmakers concerned about the rising cost of pharmaceuticals.
Minnesota is sticking its neck out with its Web site, but the state also has asked politely for federal permission to move ahead with a more comprehensive plan.
"At this point we don't know what will happen," said Brian Osberg, Minnesota's assistant commissioner of health care. "We're hoping that (the FDA) will allow this to continue and to help demonstrate that this can be done safely and cost-effectively."
When asked about Minnesota's Web site, FDA Associate Commissioner William Hubbard told Stateline.org: "We think it's dangerous. We told these state and city officials that we understand the motivations ... but that we can't ensure the safety of those drugs, Canada won't ensure the safety of those drugs, so they're putting their citizens and/or employees in the position of buying unregulated drugs."
Whether the FDA will sue Minnesota or any other city or state is unknown, but it's not out of the question, Hubbard said. "We have told them all that they could be potentially liable both civilly and criminally," Hubbard said.
Pawlenty has a certain amount of political cover to defy the FDA, given that he's a Republican who was encouraged to run for office in 2002 by Vice President Dick Cheney and that reducing drug costs is politically popular within his state.
At least two other states are poised to mimic Minnesota.
New Hampshire Gov. Craig Benson (R) announced in December 2003 plans to create a Web site that would be an information clearinghouse on buying prescriptions from abroad. The state is "putting the finishing touches" on its site, which is expected to be launched in mid-February, spokesman Wendell Packard said.
Wisconsin Gov. Jim Doyle (D) recently launched a similar Web site, the Prescription Drug Resource Center, but it does not provide information about specific pharmacies. It currently reads: "This is where we would direct you to safe Web sites in Canada, but the federal government maintains that such importation is illegal."
If the federal government does not take action against Minnesota, Wisconsin "would take that as a sign of approval" and provide more information on the Web site, Doyle spokesman Dan Leistikow said.
Elsewhere, Illinois Gov. Rod Blagojevich (D) launched an Internet petition and has requested a waiver from the federal government to let him purchase Canadian pharmaceuticals for state workers for an estimated savings of $90 million a year. The FDA, however, has shown no interest in granting waivers to its ban. Iowa Gov. Tom Vilsack (D), who also commissioned a cost-saving study, also recently asked for permission to move ahead with a similar plan.
Likewise in Rhode Island, where Secretary of State Matt Brown proposed Jan. 30 to seek federal permission to re-import prescription drugs from Canada. Gov. Don Carcieri (R) has not reviewed the proposal, according to the Providence Journal. North Dakota Gov. John Hoeven (R) said he would support re-importation, but only if it were deemed legal by the FDA.
Re-importation isn't on the official agenda of the upcoming National Governors Association meeting in Washington, D.C., but policy analysts suspect the issue is on governors' minds. To set up a discussion, Blagojevich and Pawlenty plan to host an unofficial prescription drug summit Feb. 24, when the NGA meetings close. In addition, 30 to 50 legislators plan to meet on the issue March 12 in Burlington, Vt.
Trudi Matthews, chief health policy analyst at The Council of State Governments, told Stateline.org that states are considering other importation measures besides creating informational Web sites. "Almost everyone who has proposed something has said that this is an interim measure to help consumers, but that it's not a final solution," she said. "The general feeling is that this would put pressure on manufacturers and those here in the states who sell drugs to provide better prices to consumers."
More than 20 states, from Alabama to Vermont, are considering creating importation laws in 2004. In 2003, seven states weighed the issue. No bills have been signed into law.
Advocates in Arizona, Missouri and Virginia are hoping to pass non-binding resolutions urging the federal government to legalize importation this session. Maine and Vermont passed similar resolutions in 2003.
Other states will consider amending pharmacy licensing regulations. A bill in Rhode Island, for example, would allow pharmacies licensed in Canada to do business in the state.
The issue also has been addressed recently by Congress. The landmark Medicare legislation President Bush signed late last year said that imported drugs from Canada could enter the United States if Secretary of Health and Human Services Tommy Thompson certified that it could be done safely. The legislation directed HHS to study whether safety certification could be made. Results are expected in December 2004.
Erin Madigan is a staff writer at Stateline.org.