Posted on 06/08/2003 1:43:09 PM PDT by areafiftyone
NUEVO PROGRESO, Mexico -- The warnings don't stop them. The White House reform plan doesn't make them wait.
They are on a personal quest involving money and health. So they trek across the border, alone or with loved ones, in a hopeful tide of humanity. They violate the law on such a huge scale that the government basically has given up on catching them.
They are refugees-for-a-day from the U.S. prescription drug system.
Margie Cockrill, 76, is one of them. She crossed the Rio Grande on a luxury tour bus from Corpus Christi, wearing a purple pantsuit and a lapel pin in the colors of the American flag.
Then, holding a mesh shopping bag that advertises her favorite foreign pharmacy, she headed straight for that drug store, one of dozens in this compact tourist town. There she found the Mexican treasure that is so elusive in Texas for Medicare beneficiaries like her: a steep price break on her medications.
Linda Rivera, proprietor of Pharmacy Progreso, greeted Cockrill like a relative. It was Cockrill's 10th visit, the third since her husband died a year ago.
Cockrill is fighting osteoporosis, high blood pressure and other ailments. She and Rivera talked about the latest prices of the pharmacy's generic and brand-name pills, which have Spanish labeling and the names of U.S. manufacturers.
Soon Cockrill plunked down about $220 in cash for several months' worth of medicine. She said she would have had to pay twice as much in Corpus Christi. With Medicare, Cockrill has no insurance coverage for prescription drugs.
"It seems like they are getting more than they should get," Cockrill said of the U.S. prices set by drug manufacturers.
She didn't need U.S. prescriptions to buy the pills from Rivera. And although returning to the United States with such medications is technically illegal, as is having medicine shipped in from Canada, no one questioned Cockrill about the contents of her mesh bag when she walked through a U.S. Customs and Border Protection turnstile into Texas and got back onto the bus with about 30 other shoppers.
It's a regular route for Cockrill, for an untold number of Houstonians and for hundreds of thousands of U.S. residents. For decades, Americans have bought prescription drugs from friendly, English-speaking vendors in Mexico for the same reason they bought liquor, jewelry and ceramics there. Cheap and easy is cheap and easy.
And the U.S. government usually looks the other way when the importation rules are broken by people with just enough medicine from Mexico or Canada for their own use.
But some things are changing in places like Nuevo Progreso, which lies between Matamoros and Reynosa, about seven hours by car from Houston.
As the price of prescription drugs has spiked in the United States, the pressure to find less expensive versions in Mexico has increased, according to experts. Now, as many as 40 percent of all U.S. residents who travel to Mexico return with purchased pharmaceuticals, according to the U.S. Food and Drug Administration. They spend hundreds of millions of dollars.
Riding the wave, some pharmacies stand side by side in Nuevo Progreso. Some use catchy names like the "Almost Free Pharmacy" and the "U.S. Pharmacy." On wooden or metal stands on the sidewalk, their handwritten advertisements announce the availability of pills for all that ails Americans, including impotence, arthritis, heart problems and bacterial infections.
A few barkers beckon to tourists: "Pharmacy! Come in!"
In May, state Rep. Ron Wilson, D-Houston, gave recognition to this ingrained form of drug-running. He introduced legislation to make the Texas Department on Aging provide low-cost transportation for the elderly and others from Texas to the Mexican border pharmacies so they can save money on their medications.
The bill failed after a debate in which state Rep. Arlene Wohlgemuth, R-Burleson, said the state would be placing its elderly in harmful situations.
"We have no idea what they would be facing," she said.
The remark would raise a bilingual chuckle in Nuevo Progreso. Americans pack Mexico's streets with no signs of tension, especially on weekends and during the winter, when "snowbirds" from the northern United States live in Texas for a few months.
Besides, the kind of low-cost transportation sought by Wilson is already available on a limited basis. Cockrill arrived on a one-day charter bus jaunt from the Corpus Christi area that costs $20 for a round trip.
Rockport Tours runs the trips, which take place at least once a month and fill up weeks in advance, often attracting shoppers from Houston, according to the company. Shoppers ride on a modern, air-conditioned bus that offers complimentary refreshments and videos and patriotic U.S. stickers on the windshield.
"In case you don't already know about this little Mexican border town, Nuevo Progreso has become THE place to shop for prescriptions, vanilla, liquor, tobacco," Rockport Tours chirps on its Internet site.
But U.S. government and drug industry officials say there is danger in Nuevo Progreso -- inside the pill bottles and salve tubes that the flourishing pharmacies dispense.
"Looks can be deceiving. The medicine you buy across the borders may be unsafe or ineffective," the FDA warns in a leaflet that it recently started giving to U.S. residents entering Mexico and Canada. "Don't risk your health."
The FDA and the Pharmaceutical Research and Manufacturers of America, a private industry group, say that about a quarter of the medicines sold across the border are counterfeit. The FDA and the industry group work closely in the fight against counterfeit drugs, especially when the fakes make it into general circulation in the United States.
But, drug industry spokesman Mark Grayson said, "Our government is not responsible for the Mexican drug supply." So the government and the industry warn buyers of drugs in Mexico to beware.
Legitimate, noncounterfeit prescription drugs sold in Mexico are largely manufactured in Mexico, for consumption in Mexico, by U.S. manufacturers. The drugs are made outside the reach of FDA regulations, which is why, theoretically, they are not supposed to enter the United States.
Additionally, the FDA warns that people who obtain medicines without a prescription in Mexico can end up making judgments about dosage levels and drug combinations that instead should be made by their physicians.
AARP, formerly known as the American Association of Retired Persons, makes a similar argument, saying that cheap prices for drugs in Mexico are not worth the health risks.
But Pearl Hoffman, a retired "don't print my age" Kansas rancher, brushed aside the doubts as she stood at the counter at Pharmacy Progreso.
She said she recently went to her doctor in Rockport, where she spends the winters, and was tested for high blood pressure and diabetes. Her blood samples, she said, showed that the drugs she had bought in Mexico were keeping her illnesses under control. So she was back for more.
"It's the same companies -- their names are on the box," she said.
Hoffman said it was "just prudent" to make drug-buying trips to Mexico every two or three months because she saves half the cost of her medicines, which include expensive, cholesterol-lowering Zocor.
Hoffman said she, too, is a widow whose only health insurance coverage comes from Medicare.
"I don't know what to make of it," she said of U.S. prescription drug prices. "Everybody ought to pay their own way. But on the other hand, some people have to (either) eat or pay for their own medicines.
"I'm not at that point. But now I can come down here and save money and buy jewelry for my grandchildren."
U.S. drug companies charge less for their products in Mexico not because of lower manufacturing costs there, but because Mexicans who need the drugs have less money, industry spokesman Grayson said.
Also, prices are higher in the United States because that is where the drug companies recoup their costs for the research and development of new drugs, he said.
Critics say the industry spends heavily on marketing to doctors and the public, increasing the demand for the most expensive drugs and leading to higher profits.
Grayson said the low drug prices in Mexico are nothing to covet.
"Mexico is a developing-world country. Would you like their whole medical care, their whole standard of living?" he asked. "If that is the case, you can be in Mexico."
The Mexican government ducks the issue. Miguel Monterrubio, press secretary for the Mexican Embassy in Washington, D.C., said no one in the U.S. media had asked about prescription drug prices before and that he would need time to research the issue. He never responded to follow-up calls.
If President Bush gets his way, this debate will be moot -- and Nuevo Progreso will have to play up tequila or some other product as a chief income source.
With the Iraq war and a tax cut behind it, Congress this month is debating the president's $400 billion Medicare package, which would offer a prescription drug benefit through subsidies to private insurance companies. Each of the nation's 40 million Medicare beneficiaries could stay with the traditional plan and have no drug coverage or switch to one of two new plans offered by HMO-type companies.
Democrats say insurance coverage for drugs should be available through the traditional government plan to all of the elderly and disabled. Several Medicare reform plans by previous presidents have failed.
If a Medicare drug benefit plan of any type is passed -- and both major parties are facing political pressure to get that done -- people like Cockrill and Hoffman will have much less incentive to buy their medicines in Mexico.
But for now, Nuevo Progreso hums with commerce, music and sales pitches.
There is market competition between pharmacies, sometimes leading to 30 percent cuts in the already low prices, according to Sergio Zapata Narvaez of J.C. Pharmacy. His store on the main drag, called Benito Juarez Avenue, is typical. On one side of a long, narrow space, wooden shelves painted white hold neat stacks of white boxes that contain prescription drugs.
Some pharmacies buzzed with staffers in white lab coats who tapped on computer keyboards and consulted English and Spanish versions of the Physicians' Desk Reference, a drug encyclopedia. In other stores, sole attendants waited for business while watching black and white TV sets under wooden crucifixes attached to the walls.
Along with vendors who sell sunglasses, rings and toasted nuts, Nuevo Progreso offers medical and dental services, too. But physicians are hardly in evidence when customers in the pharmacies buy drugs that supposedly require prescriptions written by Mexican doctors.
At Pharmacy Progreso, pharmacist Rivera told Cockrill she would need a Mexican doctor's prescription for a medicine she wanted to buy. In a moment, Rivera handed over such a prescription, signed by a local doctor who had not examined Cockrill. Another worker explained later that the pharmacy has a doctor who serves as a medical adviser.
At the border crossing a few hundred yards away -- and at regulatory offices in Washington -- the laws about bringing prescription drugs into the U.S. likewise can be confusing and contradictory.
Some FDA documents say that importation is illegal and that people get away with it only because border agents -- who are also on the lookout for illegal immigrants and marijuana smuggling -- have leeway from the FDA to let in prescription drugs in amounts fit for personal use.
Other FDA documents say the importation of a 90-day supply of prescription drugs is perfectly legal as long as the buyer declares the purchase at the border, has a U.S. or Mexican prescription and is carrying the medicine in its original container.
"This has been confusing for us," said U.S. Customs and Border Protection spokesman Jim Michie.
With bags that bulged with medicine boxes, Cockrill and other passengers on the Rockport Tours bus returned to the U.S. side without border agents looking in their bags or asking them to declare their purchases.
On the Texas side of the international bridge for vehicles and pedestrians, near the city of Weslaco, at least one U.S. price is hard to beat.
All-day parking, for those who want to leave their vehicle in Texas and walk into Mexico to buy medication, is $1.
Marie Antonete (I probably miss-spelled that).
Sadly, we in the US pay the R&D costs for the latest drugs. It isn't the socialization, its price controls in Canada. While I'm not one to favor price controls, I wouldn't mind if it were illegal to sell a drug in the US for a higher price than it is sold for elsewhere. I'm not saying to dictate how much any company can charge - I'm saying (or at least proposing) that drug makers cannot sell in the US for a price higher than the same product is sold elsewhere. That's all.
I spent 27 years in pharmaceutical R&D. I guarantee that $60-70 million drugs are few and far between. $600-700 million is more like the average. And the cost of discovering the drug, where government labs or academia may play a part, is a minor part of the total cost. It is the 2 week, followed by 4 week, followed by one year, toxicology and pathology studies, each in 3 species, followed by lifetime (~3 year) carcinogenicity studies in rodents, and the phase I, II and III and sometimes IV clinical studies, none of which the government helps with that add up to hundreds of millions of dollars.
The prices for drugs are no more outrageous than those for food, clothes, cars, whatever else we use. These prices support someone else family just like your or mine.
Of course, we have a President who happily signed legislation to continue Welfare Farmer and steel-subsidy programs, so I'm not holding my breath for a little more freedom from Big Stupid Government.
Less novel products are a safer bet to develop since they are a bit less apt to have surprise toxicities. But any chemical change at all is defined as a new chemical entity (it will have different chemical precursors, and a different route of synthesis) that must go through all the same toxicity and clinical tests. And these are by far more expensive than the basic research the government supports that you and others have been led to believe is such a big part of the equation. And more often than you might believe, adding one methyl group to an old compound, which is about the simplest modification you can make, can at the end of 3-4 years and hundreds of millions of dollars of studies, prove to have been a toxic or tumorigenic modification.
If you could force current drug prices down by 50%, which is what the trips to Canada and Mexico make you think can be done, you could say goodbye to anything remotely close to the current level of bringing innovative new medicines to market, and I suspect most who are complaining about prices would still be complaining.
And yes, I agree that it is very difficult or impossible for some of the elderly to afford prescription drugs. But consider that they have probably never paid anything to insurance during the years they did not need the drugs. Doesn't matter if that is not their fault. The only way that kind of insurance, or almost any kind of insurance, can work is if you pay for it long before you need it. So we must resign ourselves I suppose to the Federal government taking the responsibility. Thats what happens when we (collectively) do not plan ahead
Good question, Sonny. The simple answer is the medical lobby, which pumps millions into Washington won't allow it.
If there was a real free(capitalist)system, the Govt. wouldn't care less how much you paid for Doctor prescribed drugs.
The way it is now, is because of the powerful medical lobby making you pay thru the nose.
Regards
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