November 20, 2003
Members will hear testimony regarding the cost of prescription drugs in the United States, the effect of such prices on consumers, and the potential benefit of allowing consumers to purchase and import such drugs from other countries. Chairman McCain will preside. Following is a tentative witness list (not necessarily in order of appearance):
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The Honorable Rick Santorum
The Honorable Debbie StabenowUnited States SenatorMichigan
The Honorable John McCain
Good morning. Today’s hearing focuses on the debate over prescription drug importation. This Committee held its last hearing on this issue just over two years ago. As I think back to that hearing, I must say that I am disappointed that, to this day, our laws still do not give American consumers the right to import prescription drugs. To be clear, we’re not talking today about just any drugs. Rather, we’re talking about prescription drugs that have had their safety and effectiveness certified by the U.S. Food and Drug Administration. Nevertheless, FDA-approved prescription drugs remain an exception to the free flow of trade between the United States and the rest of the industrialized world. This trade problem is stoking the fire of America’s prescription drug price crisis. The prescription drug prices paid by our sick, elderly, and uninsured are significantly higher than those of other industrialized countries like Australia, France, and Switzerland. As a result, millions of our citizens travel across the border to Canada each year to purchase prescription drugs. Others purchase imported pharmaceuticals over the Internet. In all, Americans spend hundreds of millions of dollars on imported pharmaceuticals – not because they don’t want to buy prescription drugs in the U.S., but because they simply can’t afford to. I fully agree that demand for lower prices should not lead us to sacrifice the health and safety of our citizens. That is why any legislation that permits the freer importation of pharmaceuticals must contain safeguards that protect American consumers from tainted or counterfeit prescription drugs. But those who oppose importation must begin to engage in a dialogue to tell us what additional or alternative safety measures they believe will work. They must stop repeatedly telling us only that there is nothing we can do to implement an effective importation system that protects both the health and the pocketbooks of American consumers. Indeed, it seems to me that most Americans – and especially those in need of prescription drugs to treat serious illnesses – want us to stop listening to the naysayers and start working on a reasonable solution to the ever-growing problem of excessive prescription drug prices in this country. To that end, I have co-sponsored S. 1781, the Pharmaceutical Market Access Act of 2003, with several of my colleagues including Senators Dorgan and Snowe. Though the act is likely not the cure-all for the problem of skyrocketing prescription drug prices in this country, it is this type of legislation that would allow our citizens greater access to the pharmaceutical markets of other industrialized countries while still maintaining the safety of our prescription drug supply. The act would do so by permitting American consumers to import FDA-approved prescription drugs from Canada, European countries, and other industrialized nations, while requiring safety measures such as anti-counterfeiting technology for prescription drug packaging that is virtually identical to the technology used to secure U.S. currency. I hope that our witnesses today will engage in a constructive discussion about how best to strike a balance between affordable prescription drug prices and a safe prescription drug supply. Before we proceed any further, however, I want to note my disappointment that the Pharmaceutical Research and Manufacturers of America, which has repeatedly spoken out against the liberalization of our prescription drug importation laws, has declined our invitation to appear today. I find it extraordinary that an organization tasked with speaking for several major pharmaceutical manufacturers on this issue, and that has spent roughly $8.5 million in lobbying expenses this year, could not make the time to share with us the views of the companies it represents. I thank the witnesses who did accept our invitation and I look forward to hearing their testimony.
The Honorable Gil Gutknecht
The Honorable Bernie SandersUnited States SenatorVermont
Mr. John M. Taylor
Click here for a Microsoft Word version of Mr. Taylor remarks.
The Honorable Tim Pawlenty
Chairman McCain, Senator Hollings, and members of the Senate Commerce Committee, it is an honor to be with you today. Not far from here, along the banks of the Potomac, is our national memorial to President Franklin D. Roosevelt. During an earlier time of crisis, President Roosevelt pushed for innovation. He said, “It is common sense to take a method and try it; if it fails, admit it frankly and try another. But above all, try something.” It’s time to try something different in America’s prescription drug crisis. This isn’t about politics or ideology. It isn’t about the New Deal. It’s about getting a “Better Deal” for our people. Individuals, families, job providers, and units of government across the nation are facing a health care crisis. Simply put, the cost of health care is rising faster than our ability to keep up. The current rate of cost increase is unsustainable. If we do not find effective ways to address this crisis, it will seriously undermine our economy, our ability to provide health care, and our ability to enhance our quality of life. It is one of the fundamental challenges of our time. Health care costs are escalating rapidly for a variety of reasons – not just because of the costs of prescription medicines. However, prescription medicine prices are an increasingly significant contributor to the cost crisis. The tentative agreement regarding a Medicare prescription drug benefit is good progress, and I applaud the Congress for it. However, giving more people coverage addresses only part of the challenge. With or without coverage, costs simply cannot keep increasing at the current rate. We’ve all heard the arguments about why Americans pay more for prescription drugs than other countries. But the bottom line is Americans pay more than the rest of the world and the price differential puts prescription medicines out of reach for too many Americans. The current situation is unfair and untenable. That’s why we’re doing what we are in Minnesota. We’re taking a method and trying it. Minnesota’s Plan The Minnesota Plan for Prescription Drugs has a very simple goal – to get a better deal for Minnesotans. We are establishing a program to facilitate the purchase of prescription drugs from Canada by individuals. Through a website, all Minnesotans will be able to determine if their prescription is available at a lower cost from a Canadian pharmacy, and if so, how to order it. The site will focus on only maintenance drugs that can be shipped and are known to be cheaper in Canada. Only reputable Canadian pharmacies licensed by a Canadian province, willing to negotiate a discounted price and have their safety protocols reviewed by the Minnesota Department of Human Services will be used. The site will also let consumers know if there is a lower cost generic alternative about which they should see their doctor. Those individuals wishing to take advantage of the program will need to obtain a prescription from their own physician and send a copy of the prescription, an order form and a medical history questionnaire to the Canadian pharmacy. To comply with Canadian law, the prescription will be reviewed and countersigned by a Canadian physician. Assuming that all is in order, the pharmacy will ship the medication to the patient by mail and in the manufacturer’s original, sealed container. The next step is to provide incentives, such as waiving co-payments or sharing savings, to our state employees so they also take advantage of this lower cost alternative. We recognize that these measures are not the ideal or long-term solution. They are, however, designed to provide short-term relief and to build pressure for long-term reform. Ensuring Safety I’m pleased to be here today with Deputy Commissioner Taylor from the Food and Drug Administration, which is charged with ensuring the safety of the prescription drugs Americans use. Those who oppose reimportation often talk of great problems with safety. On this point, it is important to keep straight what we are proposing and what we are not proposing. We are proposing to reference services available from established, reputable, credible, accredited Canadian pharmacies. There is no evidence to suggest such pharmacies are unsafe. Canadians are not dying or at risk because of their system. Assertions that a plan like Minnesota’s is unsafe suggests either the pharmacies we would choose are unsafe or they are too inept to properly mail or deliver medicines safely. Neither is true. Moreover many reputable, established pharmacies in the U.S. already use a mail order, Internet or phone order system. The FDA apparently thinks it works well for them. For example, the Veterans Hospital in Minneapolis mails out a large number of prescriptions to patients each week. Our proposal should not be confused with the questionable Internet pharmacy or “storefront” marketing entities that are currently offering their services to U.S. citizens with little or no oversight. We agree that such operations present an unreasonable safety risk to consumers. Our Department of Human Services conducted a review of Canadian practices, similar but independent of that done by the State of Illinois. We came to the same conclusion that they did: the Canadian system is comparable to ours in safety standards. There is a misperception that reimportation from Canada is some risky endeavor in which we give up safety to use a Third World apothecary just to save a dime. Canada’s pharmaceutical regulatory system is strong and effective. At the state level, we’re prepared to monitor and ensure that those pharmacies serving our citizens are held to the highest standards of safety. Let me briefly explain to you some of the safety and security protocols we will be using as part of our reimportation plan: 1. Any pharmacy associated with our website must be accredited by an organization such as the Internet Mail-order Pharmacy Accreditation Commission, which uses 92 standards in their process; 2. The pharmacy must agree to allow inspection of their facilities and wholesalers that supply these pharmacies will also be inspected; 3. Medications will only be dispensed in the manufacturer’s unopened, safety-sealed containers in dose-appropriate amounts; 4. Those medications shipped must be produced in an FDA-approved manufacturing facility; 5. Medicines will be for maintenance drugs only and the patient will likely be required to have been taking the medicine for at least thirty days before the prescription is filled. The Industry’s Threats In recent weeks, as the prospects of reimportation facilitated by units of government gets closer to a reality, executives of the pharmaceutical industry have publicly threatened to withhold supplies of prescription drugs to those Canadian pharmacies who supply Americans. Their threats are reprehensible. I also believe these threats may be a violation of federal and state anti-trust laws and urge this committee to review the comments and actions of the companies involved. Minnesota is Ready to Lead the Way The states are often called the “laboratories of democracy.” The State of Minnesota is proving that again by moving ahead in implementing this reimportation plan. As President Roosevelt advised, we have to try something. Let us be the experiment. Let us try it. Let us put the arguments to the test. If it doesn’t work, we’ll admit it. The current system is not “safe” because too many people can’t afford their medicine. Thank you very much.
Witness Panel 2
Mr. Donald MacArthur
Click here for a Microsoft Word version of Mr. MacArthur's remarks.
Mr. Carmen A. Catizone
Mr. Chairman and Members of the Committee: I am honored to be here today and discuss with you how the purchase and import of drugs from other countries affects the health and safety of US patients. The purchase and import of drugs from other countries places access to affordable medications squarely in opposition to preserving the safeguards of our medication approval and state regulatory processes. NABP respectfully requests your support for a careful and thoughtful approach to resolving this complex issue and a rebuff of reactionary proposals fueled by populist rhetoric that irresponsibly cast aside valid concerns about patient safety. The National Association of Boards of Pharmacy (NABP), which I represent, was founded in 1904. Our members are the pharmacy regulatory and licensing jurisdictions in the United States, District of Columbia, Guam, Puerto Rico, and the Virgin Islands, eight provinces of Canada, three Australian States, New Zealand, and South Africa. Our purpose is to serve as the independent, international, and impartial Association that assists states and provinces in developing, implementing, and enforcing uniform standards for the purpose of protecting the public health. We have no affiliation with the pharmaceutical industry nor do we receive any appreciable funding from the pharmaceutical industry. As a charitable and educational organization, we do accept unrestricted, educational grants of no larger than $4,000 for educational programs at our Annual Meeting and Fall Conference. Among the sponsors for our educational sessions are some pharmaceutical manufacturers. NABP’s primary revenue sources are examination fees from the development and administration of the national licensure examination (NAPLEX) and application fees for the licensure transfer and clearinghouse system (NABP Licensure Transfer and Clearinghouse Program), NABP maintains for the states. These fees are paid by the applicants for licensure and licensure transfer and not the states. The only fees paid to NABP by the states and provincial jurisdictions are annual membership fees of $250. Collapse of the US Drug Approval and Patient Dispensing Systems NABP’s involvement with the distribution and dispensing of medications from pharmacies utilizing the Internet began in 1997. At that time NABP introduced our Verified Internet Pharmacy Practice Sites (VIPPS) program, to inform consumers of legal and safe Internet pharmacies. From the first awarding of a VIPPS certificate in 1999 to the present time, NABP has monitored the activities of Internet sites distributing medications. We have observed firsthand the birth, evolution, and revolution of an industry that holds promise for select populations of patients but, if allowed to proceed along the present course, will remove the Food and Drug Administration’s (FDA) drug approval system and dispensing of maintenance medications for chronic diseases from the US to the country, territory, or back room with the lowest prescription drug prices, regardless of the standards or safeguards in place in those other countries or territories. The facts of the situation are indisputably clear; the importation of prescription medications is illegal. This fact has been explicitly stated by the FDA and state boards of pharmacy. On November 6, the United States District Court for the Northern District of Oklahoma affirmed this fact by noting in its decision in the United States of America versus RX Depot, Inc and RX of Canada that prescription medications imported into the US violate federal law. The Court noted further that individuals involved in this activity violated the law openly and notoriously. It is also a fact that the pricing of pharmaceuticals in the US differs from Canada and other parts of the world. The difference in price is a primary incentive for individuals abandoning the safe and legal US system to purchase and import drugs from other countries. NABP believes that the US pharmaceutical industry must address this situation and propose meaningful changes to the pricing policies in place in the US and the world. Patient Harm and Compromise of the US Regulatory System Critics of the regulatory actions of the state boards of pharmacy against entities distributing or assisting in the distribution of medications from other countries contend that there have been only a few reports of patient harm and injury. Although the number of reports may be low, the actual harm to patients is immeasurable and could be significant. NABP maintains that the number of reported patient injuries is low and immeasurable because patients may not be able to discern whether the drugs received from other countries are authentic or appropriate, injuries resulting from patients receiving wrong or counterfeit drugs may not manifest in the health care system until sometime later when the patient’s condition worsens and requires emergency treatment or hospitalization, and consumers purchasing drugs from other countries are reluctant to report any adverse consequences because of the fear of prosecution for violating federal and state laws. In recent correspondence to the State of Illinois, the FDA documented instances where patients suffered harm from the purchase and import of drugs from other countries. The letter also identified drugs purportedly shipped from Canada that were actually distributed from India and drugs being shipped that were unapproved generic versions or sub or super potent. NABP and its member boards are collecting data on incidences of patient harm caused by the purchase and import of drugs from other countries and will submit any information accumulated through this process to the Committee. NABP is alarmed by the data collected by the FDA and recent reports of additional incidents of patient harm: · A patient in Illinois ordered an inhaler to treat her child’s asthmatic condition from a Canadian pharmacy. After using the inhaler, the child told her mother that the medicine “seemed different.” Shortly after using the inhaler, the child suffered an asthmatic episode, the first in a considerable time. The mother only learned that the drug sent to her by the Canadian pharmacy was wrong when she asked the pharmacist at her local pharmacy to identify the medication. · An Oregon patient being treated for breast cancer received the wrong medication from a Canadian pharmacy. She continued to take the wrong drug for three months as her condition worsened. NABP has also learned that the purchase and import of drugs from other countries is gravely compromising state laws and regulations by granting the authority to practice medicine and prescribe medications to unqualified, unlicensed individuals. Public officials who openly endorse violating federal and state laws in order to obtain lower priced pharmaceuticals are supporting these transgressions and further damaging the regulatory system in the US. · A US entity affiliated with a Canadian pharmacy operation is paying paramedics in the US to conduct the physical examination and diagnosis of patients. The paramedics’ examinations and diagnosis are then forwarded to a Canadian pharmacy where prescriptions are issued by a Canadian doctor and drugs shipped to US patients. This activity contravenes US laws by allowing paramedics to practice medicine without appropriate education, training, and licensure. · A certification/purchasing program is providing the means for psychologists to illegally order psychotropic drugs (e.g. barbiturates, clozapine, haloperidol, etc.) for their patients through a Canadian pharmacy. Again, the opportunity to obtain prescription medications through foreign sources is directly abrogating the US regulatory system and allowing individuals to practice medicine without the appropriate education, training, and licensure. · Within the last four months, a staggering number of Web sites brazenly offering controlled substances without a valid prescription (as required by federal and state laws) and a never before witnessed preponderance of spam emails offering unrestricted and illegal access to controlled substances have flooded the computers of US citizens. Prior to the advocacy for the purchase and import of drugs from other countries by public officials in certain cities and states, such sites and offerings did not exist. Importation from Other Countries Places Patients Outside of Regulatory Safeguards NABP acknowledges that appropriate safeguards exist within Canada’s federal and provincial regulatory systems to ensure that the dispensing of medications in Canada to Canadian patients is safe. Similarly, NABP attests that the dispensing of medications to US patients within the US regulated system is safe. In fact, the safety and regulatory standards in place in the US are often regarded as the best in the world. Unfortunately, the same safeguards do not exist for patients purchasing and importing drugs from other countries. Although Health Canada prohibits the import of drugs for dispensing to Canadian patients, it does not prohibit or regulate the import of drugs for export to US patients. The regulatory void and breach of the safety net for US patients is significant and unknown to the overwhelming majority of patients ordering drugs from Canadian pharmacies. NABP learned first-hand from the president of an Internet pharmacy corporation based in Canada that drugs shipped to US patients may not be approved by the Canadian drug approval process and may originate in New Zealand, Vietnam, or any country in the world where prescription drug prices are lower than those in the US or Canada. In fact, there are no limitations as to where drugs will originate from for delivery to US patients. Shockingly, Internet operations in Canada are already providing US patients with drugs from other countries unapproved in Canada or the US! A recent advertisement brought to NABP’s attention offers to match the price of any medication from Canada by shipping drugs from Israel. Several newspapers have interviewed Canadian Internet pharmacies who admit to freely purchasing and exporting to the US medications from Pakistan, Bulgaria, and Latin America. Allowing for the purchase and import of drugs from other countries essentially abolishes the FDA’s drug approval process and circumvents state regulation. Advocating that it is acceptable to violate federal and state laws because the price of pharmaceuticals is high, creates the opportunity for unscrupulous and dangerous individuals to operate Web sites or distribution enterprises that will ship drugs to US patients that may be nothing more than placebos, wrong, inappropriate, or even counterfeit. If the safeguards in place for drug approval and the regulation of pharmacies and wholesale distributors are deliberately compromised, US patients will be placed in a “buyers beware” environment and left unprotected to gamble with their health and safety when purchasing and importing drugs from other countries. Inter-border Regulatory Proposal NABP requests the Committee’s support for the enforcement of current federal and state laws concerning the illegal importation of medication from other countries and prosecution of individuals involved in these activities, whether they are private citizens or mayors or governors. In the interim, NABP and its counterpart in Canada, the National Association of Pharmacy Regulatory Authorities (NAPRA), recognize that a solution resolving the conflict of access versus safety must be developed to address the needs of US patients and prevent irreparable damage to, if not the elimination of, the regulatory systems in the US and Canada. To this end, NABP and NAPRA are in discussions to develop a regulatory framework that regulates the inter-border practice of pharmacy and dispensing of medications to patients in the US and Canada and provides similar protections as those afforded US patients who utilize pharmacies engaged in the interstate practice of pharmacy and dispensing of medications. The framework will coordinate the regulatory efforts and resources of Canadian provinces and US state boards of pharmacy. NABP and NAPRA will also be launching the VIPPS program in Canada to identify for Canadian patients legal and safe Internet pharmacies. The combination of the VIPPS Canada program and inter-border regulatory framework between the US and Canada will ensure for US patients that the purchase and importation of medications from licensed Canadian pharmacies will be safe and legal. However, even if NABP and NAPRA successfully formulate the appropriate regulatory framework for the inter-border dispensing of prescription medications, neither NABP nor NAPRA can make any representations for safety when drugs are shipped to US patients and originate outside of the US and Canadian approval processes. NABP’s concern with patients purchasing and importing medications from countries other than Canada will not be resolved unless this problem is addressed. In fact, NABP and NAPRA cannot move forward with the implementation of an inter-border regulatory framework until Health Canada takes decisive action to prohibit the importing of medications from other countries, outside of Canada’s drug approval process, by Canadian pharmacies for dispensing or distribution to US patients. NABP also believes it essential before the implementation of an inter-border regulatory framework for the FDA and Health Canada to establish a means for mutual recognition of drug products. In closing, NABP respectfully requests that the Committee recognize that allowing and encouraging the purchase and importation of medications from other countries is a serious threat to our regulatory foundation and patient safety and may thrust the US back in time to the days when snake oil salesmen and quack tonics threatened the well being of unknowing and unsuspecting patients. NABP requests further the Committee’s assistance in preserving the sanctity of current regulations so as to prevent any patient from being seriously injured by the illegal importation of medications from other countries. NABP believes that no patient should suffer or be harmed as a consequence of disregarding federal and state laws that ensure the dispensing of safe and effective medications to US patients. Thank you for the opportunity to address this important issue.
Mr. Lewis Lubka
Chairman McCain and Members of the Commerce, Science, and Transportation Committee, thank you for holding this hearing today on the impact of prescription drug importation on consumers. My name is Lewis Lubka and I live in Fargo, North Dakota. I am here today representing the Alliance for Retired Americans. The Alliance is a national organization of over three million members that works to create an America that protects the health and economic security of seniors, rewards work, strengthens families and builds thriving communities. It was launched in January 2001 by a national coalition of labor unions and community-based organizations dedicated to improving the quality of life for retirees and older Americans. I am seventy-seven years old and take at least three prescriptions at any given time. Between Myocalcin and Fosamax for osteoporosis, and Synthroid for my thyroid, I spend well over $2,000 a year on my prescriptions. I have purchased my drugs in Canada to help defray these costs. I saw an American doctor, filled a prescription in the United States, and brought it to a doctor in the city of Emerson, right over the border in Canada. After I saw the Canadian doctor, I took the new prescription to a Canadian pharmacy that was located in the same building. I brought $300 in cash with me and purchased $800 worth of medications with the money. I feel completely safe in taking Canadian medications. The Alliance for Retired Americans has made more than twenty trips to Canada from states stretching from coast to coast, serving hundreds of riders. No one has ever reported getting sick or had any adverse effects from taking those medications. I am a veteran of World War II. I was a paratrooper in the 82nd Airborne Division. As a former welder and then a professor, I am an ex-shipyard worker, an ex-assembly-line worker, and an ex-steelworker, as well as a retired member of the National Education Association. I have lived all over this country, seen many people, and witnessed a lot in my lifetime. I worked in the Hoboken, New Jersey shipyards of Bethlehem Steel repairing the Stockholm after it collided with the Andrea Doria. I worked for General Electric in Kentucky before becoming a professor at North Dakota State University. I have always been a human rights activist and was a part of Martin Luther King’s civil rights movement. I am still working for human rights. Senators, I know right from wrong. The bill that is coming out of the Conference Committee is not good for retirees. It does nothing to contain the skyrocketing prices of prescription drugs. In fact, it forbids Medicare from using the purchasing power of 40 million beneficiaries to negotiate the best drug prices. The federal government currently bargains for the best prices in the Department of Veterans Affairs, the Department of Defense, and the Indian Health Service systems. There is no logic on why Congress would forbid Medicare from doing the same. Seniors and all taxpayers are the losers. This bill caters to the pharmaceutical industry by unnecessarily preventing American citizens from getting their drugs in Canada where they are safe and affordable. I have never seen anyone get sick from taking a drug imported from Canada, but I have seen many people suffering from high drug prices that they cannot afford. Drugs from Canada are just as safe as American drugs – in fact many of the drugs from Canada were made in the U.S.A.! Members of the Committee, I am here today to ask that you enact a drug benefit that allows drugs to be imported from Canada without loopholes that permit the Department of Health and Human Services to stop safe re-importation. To do anything else will make millions of seniors worse off. Thank you for inviting me here.
Dr. David Funderburk
Mr. Chairman, Members of the Commerce Committee, I want to thank you for the opportunity to testify today on behalf of S.1781, which would allow Americans to have increased access to prescription drugs at reasonable prices. I would ask permission that my entire statement be included in the record. My name is David Funderburk, and I serve as Legislative Counsel for the TREA Senior Citizens League, known as TSCL. TSCL is a nationwide non-profit education and lobbying organization with approximately 1.2 million members and supporters, which will be celebrating its Tenth Anniversary in a few months. TSCL’s Board of Trustees is an all-volunteer group of retired military headed up by its Chairman, George A. Smith. TSCL sends out an informative newsletter by mail and by e-mail to hundreds of thousands of seniors 10 times per year. It stays in touch with its members via e-mail alerts. TSCL publishes informational booklets such as those that help seniors better understand Social Security and Medicare, and other issues. And, TSCL has an information-packed web site, www.tscl.org, with information on the drug re-import bill, and many other policy issues affecting seniors. TSCL has nearly 23,700 members and supporters in your state of Arizona, Mr. Chairman. (I remember the Chairman coming to my hometown not too many years ago to campaign for me when I was in Congress. It’s always nice to be with you, Mr. Chairman.) On the House side, TSCL has been working diligently on behalf of H.R.2427, introduced by Congressmen Gil Gutknecht (R-MN) and Rahm Emanuel (D-IL), and is happy to today announce its support for S.1781, the companion measure here in the Senate. In TSCL’s annual survey in February 2003, fully 87 percent of the TSCL membership responding voiced their support for drug importation. The current high cost of prescriptions is crippling our seniors. One of our members, “Lillian F,” told us “I don’t get enough Social Security for my medication and had to quit taking a couple of them.… I have Parkinson’s and I take medication for that and it is expensive.… Now my husband had a heart attack, and he has to take a lot of medications too, so I might have to quit taking more of my medicine.” Unfortunately, since “Lillian F.” wrote that e-mail to us in April of this year, her husband has passed away and she has had to cut back further on her medicines. It is on behalf of individuals such as “Lillian F” that we support more affordable prescription drugs, and we believe that S.1781 is a good place to start. The disparity of drug costs in the United States, Canada and Europe is striking. In Canada, someone can purchase Zocor for $45.49; here in the U.S., the same prescription is $123.43. Pravachol purchased in Canada, 40.00; in the United States, $85.60. No wonder seniors like “Lillian F” aren’t able to afford the medicine they need! TSCL is absolutely committed to this drug re-import legislation. Prior to the vote in the House of Representatives on H.R.2427, TSCL ran a half-page ad in the Washington Times, urging Members of Congress to support passage of the bill. We also sent out e-alerts to thousands of our supporters urging them to contact their elected Representatives. We continue our efforts through similar grassroots activities. We may not have the visibility and presence of the pharmaceutical industry, but there are fully 1.2 million seniors represented by TSCL. TSCL is funded with small contributions from its supporters and members and today I want to share with you the views of those members and supporters. Some who oppose S.1781 use the argument that measures such as S.1781 or H.R.2427 will open the floodgates for unsafe drugs coming into the United States. But right now, some 1 million Americans buy medicines from Canada either through bus trips or via the Internet, according to the Manitoba International Pharmacists Association. There have been no reported deaths from those drugs, according to testimony provided from the U.S. Food and Drug Administration (“FDA”) at a House hearing. And as Katherine Greider wrote in her book, “The Big Fix: How the Pharmaceutical Industry is Ripping Off American Consumers,” some 29 percent of seniors don’t fill their prescriptions because they can’t afford to. We see that in our own membership, as mentioned above. A drug that a senior -- or any American -- can’t afford, and therefore can’t take -- is not a safe drug. Please don’t accept the nonsense that if this law is passed seniors might make the wrong choice in buying prescription drugs. Seniors do not need such protection from government. TSCL Chairman George Smith wanted me to tell you that seniors especially ask to be treated like the responsible men and women they are. And seniors should have the right to assume the miniscule risk of using a drug obtained from Canada, rather than suffer the risk of not having the prescription drug to take at all. Everything we do, including getting out of bed in the morning entails risk, and it is not the business of the federal government to take away our freedom to make decisions like these for ourselves. Of course, the proposed legislation allows the importation of only FDA-approved drugs from FDA-approved facilities. Many drugs that Americans buy from Canada are actually made in New Jersey or Puerto Rico. There is no guarantee of safety in any drug that you take. However, S.1781 provides for state of the art technology to protect imported medicines – the same anti-counterfeiting measures used to protect our new currency. Right now, an American has a greater risk of getting sick by eating imported food than he or she does getting sick from a drug purchased in Canada or Germany. Americans over the age of 65 will spend some $1.8 trillion on prescriptions during the next 10 years, according to the Congressional Budget Office. Importing prescriptions could save them 35 percent, again according to CBO. States and localities, too, want to save dollars in these tight economic times. Minnesota, Iowa, Illinois, all are looking at drug importation. Closer to home, Montgomery County, Maryland is beginning to study the issue. Governor Blagojevich released a study that concluded imports from Canada were safe and could save his state of Illinois tens of millions of dollars a year. A study by Families USA found that marketing, advertising and administrative costs are much higher than what is currently spent on research and development, often twice as much. The pharmaceutical industry will still make a profit if S.1781 or H.R.2427 were to pass, and pharmaceutical companies would still be able to devote sufficient funds to R&D if they chose to do so. According to a statement by Senator Chuck Grassley, as cited in the Washington Post, “Imports create competition and keep domestic industry more responsive to consumers.” (Washington Post, November 8, 2003) The FDA has, in the past, looked the other way on Americans taking the bus to buy small personal supplies of medicines from Canada. This is changing. We have also recently seen a district judge grant an FDA request to shut down RxDepots in Oklahoma. The time to act is now. William Hubbard, associate commissioner of the FDA, was quoted in a September 16, 2003 article from the New York Times as saying, “It’s not O.K. for the individual to bring in drugs” (referring to bus trips of individuals going to Canada), “but so much of the stuff is coming in and it’s so uncompassionate to go after patients.” Should we then have compassion for Minnesotans who are able to make the trip to Canada, but not Mississippians who are not? I want to thank the distinguished Chairman for holding a hearing on this critical legislation, and on behalf of TSCL and its members, I urge the Senate to join the House and approve this important legislation. And in closing, let me say that TSCL wants to work with you and the Committee on this issue, and on other matters of importance to seniors in the future, and I thank you for the opportunity to testify here today on behalf of TSCL and its members and supporters. #