Posted At Gazette.net

By: Douglas Tallman

Only four months ago, Montgomery County officials confidently believed county employees would be pocketing savings by now by importing their prescriptions from Canada.

Now, the county is crossing its fingers that it can sign a border-crossing contract before the summer recess, which begins Aug. 1.

"It's a 'when' question, not an 'if' question," said council President Thomas E. Perez, one of the chief proponents of the plan.

Even so, "what" questions loom on the horizon: What deal can Montgomery expect? What will happen with the U.S. dollar? What will Congress do?

Naysayers, like Councilman Michael J. Knapp, say the savings issue could be oversold.

"It's difficult to understand how much you think you can save," said Knapp (D-Dist. 2) of Germantown. Knapp, one of two council votes against the Montgomery-Canada plan in September, is a founder of the Rockville biotech company Celera Genomics.

"County employees already have good health insurance and a good co-pay system," he said.

The savings will be based on participation rates and the exchange rate between the United States and Canada. And the county can encourage participation by eliminating co-payments, said Perez (D-Dist. 5) of Takoma Park.

But as G. Wesley Girling put it: "Cheap is in the eye of the beholder."

Girling is the benefits director for Montgomery County Public Schools, which is handling the bid proposals for county agencies. Some employees might prefer to pay extra to see a local pharmacist, he said.

Montgomery County spends about $70 million a year on prescriptions for its 85,000 employees and retirees. During the protracted drug importation debate last year, a council study estimated importation could save the county treasury between $6 million and $15 million a year.

"It could be $2 million or $4 million or $10 million, but if it's $4 million or $2 million, that's $4 million or $2 million we didn't otherwise have," Perez said. "The thing to do is put a program in place, see how it works, and make mid-course corrections where warranted."

A number of states and communities have tried to save their taxpayers by importing drugs from Canada, where controls keep prices low.

Girling said the county is at a different starting point than other governments.

"We've already got a pretty competitive deal with our domestic drug vendor," Girling said. "From a retail standpoint, there are lots of savings. But the county is getting wholesale discounts that are pretty significant already from our domestic supplier."

The county received five responses to its request for proposals and has been discussing the plan with one vendor. A meeting with a second vendor is scheduled for today, Perez said.

Girling declined to name the vendors but said both are based in Canada with U.S. offices. Only name-brand maintenance drugs will be covered -- no generics and no acute care drugs, such as antibiotics. He said he thought a program might be in place by October.

As the mayor of Springfield, Mass., Michael Albano helped to launch his city's Canada drug re-importation program. Its second anniversary will be July 7 and the city has saved about $8.5 million, he said.

Albano said Wednesday that governments should find ample savings from Canadian drugs, even with the value of the U.S. dollar falling.

"In the worst-case scenario, it's a hedge against inflation and increased prices from pharmaceutical companies down the road," he said. "There is no reason not to move ahead."

Sharon Treat, executive director of the National Legislative Association on Prescription Drug Prices, agreed. Government programs were averaging 50 percent savings, but with the weakening of the dollar, the savings have slipped to 30 percent to 40 percent, said Treat, whose organization is based in Hallowell, Maine.

Last week, AARP said Canadian drug importation is safe and affordable, spokesman Steve Hahn said.

That prompted a response from the Pharmaceutical Research and Manufacturers of America (PhRMA) to warn that importation schemes discussed in Congress could allow drug importation from more than 24 countries.

"This puts the U.S. drug supply at risk for exposure to counterfeit, fake and substandard medicines, and is a classic bait and switch being pulled on America's seniors," said Ken Johnson, PhRMA's senior vice president, in a statement.

Supporters discount the safety question.

In Minnesota, where a state-run Web site provides access to Canadian and British pharmacies for all residents, 13,000 prescriptions have been filled since January 2004. Not one problem has been reported, said Brian McClung, press secretary for Gov. Timothy J. Pawlenty (R).

The safety debate is beginning to irk our neighbor to the north. Canadian Ambassador Frank McKenna, in an Associated Press interview earlier this month, said his country's pharmaceutical regulatory regime was tougher than the United States'.

"We don't want the reputation of our pharmaceutical sector sullied by attacks from the United States of America saying that re-imported drugs aren't safe," he said.

For Treat, getting drugs from Canada misses the larger point that prescriptions cost too much.

"It may not be the most elegant public policy solution. ... But as legislators and county commissioners you do what you can to make sure people have the medications they need at a price they can afford," she said.

What opponents fear, Treat said, was that the United States would stop importing Canadian drugs and instead start importing Canadian price controls.