Posted At Detroit Free Press

BY : Hanh Kim Quach

It started in 1999 with a field trip: Seniors with osteoporosis, high blood pressure and other ailments boarded a bus in Biddeford, Maine, at dawn -- picking up others waiting at rest stops along I-95 on the way north to the border town of Calais.

There, a doctor with both American and Canadian licenses wrote prescriptions for the two dozen seniors who made the six-hour trek.

Then the seniors crossed the St. Croix River into St. Stephen, Canada, where they filled the prescriptions for a fraction of what they would have paid in the United States.

The organizer was John Marvin, a retired union activist using his expertise to dramatize the high cost of prescription drugs.

Marvin's bus trips set in motion a fight that would spread across the country as citizen activists rebelled against rapidly rising drug prices and fought for a reprieve for seniors such as 78-year-old Fern Pirkle.

Pirkle said prescription drugs eat up 17% of her monthly income. That's if her doctor is able to slip her some samples of Actonel for her osteoporosis.

"He saves me $80 a month right there. But that's iffy," Pirkle said.

She also said she scrimps on pain medication to save money.

It's these kinds of situations that have bred resentment among seniors.

"Money is no object" for drug companies "because that's how they make their mega-billions," she said. "We're the only Western country in the world that has the system we do."

There's a reason for that, industry officials say: research and innovation. The kind of discount programs people are demanding amount to price controls that would cut into the money that drug companies need to maintain research.

"Yeah, we do end up paying a higher price for innovation and discovery. But as a cancer survivor, I am grateful," said Billy Tauzin, executive director of Pharmaceutical Research and Manufacturers of America, the trade organization for more than 100 drug companies.

"We can't" control prices "because we're jealous of a European country's drug costs."

Price controls fought in Maine

The trade organization fought those kinds of price controls in Maine.

At the Capitol in Augusta, activists lobbied for drug companies to be asked to provide discounts. If the state decided the discounts weren't good enough, it could sue those companies for profiteering. If the law passed, it would set a precedent for other states.

The industry fought hard, but a cavalry of pharmaceutical lobbyists was no match for the seniors, advocates said.

The Legislature passed the bill in 2000, and the governor signed it. Drug companies spent the next five years fighting the law, all the way to the Supreme Court, only to lose.

Maine's concession was to drop the provision allowing lawsuits for profiteering. It changed the law to use the state's Medicaid program as leverage, potentially making it harder for Medicaid patients to buy drugs from companies that didn't offer sufficient discounts.

Fight for discounts spreads

In the meantime, the push for discounts spread to other states. And this time, drug companies were ready to fight it.

A coalition led by union leaders in Ohio wanted to put a discount program like Maine's on the ballot in 2003, so they started gathering signatures seeking permission to circulate petitions more broadly.

Drug companies challenged the validity of the signatures, calling each person who signed into court.

"Then we knew what we were in for," said Cathy Levine, executive director of Universal Health Care Action Network in Ohio.

Advocates rescinded their petition and resubmitted 100 signatures, this time from lawyers, judges and other people they believed the drug industry would not challenge. It worked.

But not for long.

As a coalition of nonprofits began collecting thousands of signatures statewide to put the measure on the ballot, the pharmaceutical industry responded by challenging signatures in separate legal actions in 41 of the state's 88 counties.

Legal expenses mounted as the industry subpoenaed volunteers and paid signature gatherers.

For drug companies, it was a fight for their livelihood.

"If people want to turn us into a European price-control structure, we're going to battle them," Tauzin said.

By the end, the nonprofits wound up at the bargaining table with the drug companies. What they ultimately got was a plan proposed by the industry, with voluntary discounts.

The pharmaceutical trade organization spent more than $15 million in that fight.

But Ohio wasn't the only battleground. Lawyers were also sent to West Virginia, Oregon and Washington.

The companies hired lobbyists and countered with smaller-scale plans. They succeeded.

Industry strikes first in California

But in California, they tried something different. They teamed up with Gov. Arnold Schwarzenegger in January to propose CalRx, a plan similar to what was implemented in Ohio when the activists relented.

Much was at risk with California, where 10% of the nation lives. Mandatory discounts there could drive discounts deeper elsewhere, affecting the industry's bottom line.

But the industry's proposal stalled in the Legislature.

In response to the drug company's alliance with Schwarzenegger, a coalition of consumer groups and union organizers put together what would become Proposition 79, a drug discount plan much like Maine's.

The pharmaceutical industry group sued to keep Proposition 79 off the ballot.

That didn't work.

So the drug companies proposed a smaller-scale competing plan -- Proposition 78 -- essentially, the Ohio program.

The industry launched TV ads that told potential voters the union-supported initiative would limit their access to prescription drugs.

Proponents of Proposition 79 couldn't match the pharmaceutical industry's advertising budget.

But on Election Day, both measures failed.

"Now, we're back to where we wanted to be a year ago," Tauzin said.

But more fights are looming. Activists in Oregon are now aiming for a ballot initiative in 2006.

"We'll go in and fight it," Tauzin said.

"We're not going to give up."