Cheaper drugs outside U.S. But what about the risks?

When Janice Jessup wanted to save money on her high blood pressure medicine, she Googled pharmacies in Canada.

The Virginia Beach senior found a deal she liked for a generic drug that wasn't available in the United States. She discussed it with her doctor, and he wrote the prescription.

Now, Jessup pays $78 for a 100-day supply, compared with $120 for three months of the brand-name medicine on her supplemental Medicare plan. She said she's happy with her choice.

"It's an alternative," said Jessup, a real estate broker. "Especially since the drugs are so expensive here in this country."

As health care bills continue to rise, more than 1 million Americans are turning to other countries to fill their medicinal needs. The savings can be substantial: up to 80 percent.

However, it's illegal for Americans to buy medicines from vendors in foreign countries. U.S. Food and Drug Administration officials say they don't strenuously enforce the law when an amount for three months or less is purchased for personal use, but they warn that in such cases, the government can't guarantee the safety of the supply or the legitimacy of the source.

Over the years, some lawmakers have tried unsuccessfully to ease restrictions on importing medicines for personal use. A recent effort was rejected last month by the U.S. Senate.

Brand-name drugs cost less in Canada and some other foreign countries because the governments negotiate prices for their citizens with pharmaceutical manufacturers.

In the United States, the government regulates drug prices only for certain programs, such as Medicaid.

Pharmaceutical companies maintain that the higher prices pay for research and development of new medicines. They have argued for prohibiting price controls in other countries, saying the United States bears the brunt of those costs.

Medicare recipients struggled with medicine costs before the government insurance program began offering a prescription drug option in 2006.

In more recent years, seniors have sought ways to avoid paying higher costs for medicines in the Medicare coverage gap known as the "doughnut hole." That gap - between when standard benefits in a Medicare drug plan run out and catastrophic coverage kicks in - costs some seniors thousands of dollars.

In one year, Kenny Chauncey paid $4,000 for his medicines in addition to monthly drug-plan premiums. The 72-year-old Chesapeake resident saw an advertisement in the newspaper for an Internet pharmacy called "Better Than Medicare," and he decided to give it a try.

It offered 90-day supplies of his diabetes and blood-thinning medications for about $75 each. The price was slightly less than the $100 Chauncey paid for each through his drug plan, but he saved several hundred dollars by keeping his total under the limit for reaching the "doughnut hole."

Now, he fills his two most expensive prescriptions through betterthanmedicare.com, a website that describes itself as a global mail-order pharmacy located on the South Pacific island nation of Vanuatu. He buys his four other medicines in the United States.

"I was paying so daggone much money for these drugs that it was worth taking a chance on," Chauncey said.

Most of the Americans filling prescriptions for chronic conditions through the Canadian International Pharmacy Association are seniors like Jessup and Chauncey, said Tim Smith, the group's general manager.

The licensed retail pharmacies in the association distribute about 3.2 million packages of medications a year valued at about $500 million to more than 1 million U.S. patients, according to a 2010 Arkansas Democrat-Gazette article on the association's website.

"We often talk about people who can't afford their drugs," Smith said. "There are also customers who are just outraged by the cost of drugs in the States."

But some say lower prices come at a higher risk.

FDA-approved drugs meet government standards of safety and effectiveness, as well as guidelines for manufacturing and labeling.

Drugs "sold in foreign countries/areas as 'foreign versions' of approved prescription drugs sold in the United States are often of unknown quality with inadequate directions for use and may pose a risk to the patient's health," according to the FDA website.

So-called "rogue" Internet pharmacies have sent versions of brand-name medicines lacking the active ingredient, substituted copies of the drugs, shipped from a different location than indicated on the website and failed to fill orders, according to a recent study in an online journal run by the Public Library of Science.

"There are a lot of Internet pharmacy sites that are run by criminal networks that try to make the sites look legitimate when they're really not," said Jennifer Wall, a senior director with the Pharmaceutical Research and Manufacturers of America.

Thousands of rogue pharmacies dispense prescription drugs without requiring a valid prescription, contributing to abuse, according to a study by the National Association of Boards of Pharmacy.

Others might send drugs that aren't what buyers believe they are purchasing.

"Just because you're not having an immediate adverse event doesn't mean that what you're doing is safe," said Kevin Nicholson, a vice president with the National Association of Chain Drug Stores. "Unless you run some sort of chemical test, there's really no way of knowing what exactly is in those tablets, in those capsules."

Organizations, such as the National Association of Boards of Pharmacy, run programs that check the legitimacy of online pharmacies based in the United States. They award a seal of approval for display on the websites.

The programs ensure that the pharmacy is licensed, requires valid prescriptions, encrypts private information, provides a valid phone number and street address and meets other standards.

The Canadian International Pharmacy Association and other groups provide similar verification for sites based in other countries. They reject the idea that all international online pharmacies are suspect.

"Other jurisdictions have high standards as well," said Gabriel Levitt, vice president of White Plains, N.Y.-based PharmacyChecker.com. "We believe that rogue online pharmacies are definitely life-threatening, but properly credentialed international online pharmacies are actually lifelines."

In the early 2000s, several states took steps to connect their residents or employees to legitimate foreign pharmacies for drug savings, but some of those programs ended in recent years at least partly because of dwindling participation.

Medicare's prescription drug option lessened the urgency of addressing importation, said Sharon Anglin Treat, executive director of the National Legislative Association on Prescription Drug Prices.

The need might decrease further as the Medicare doughnut hole gradually closes under the national health care overhaul law.

Jessup and Chauncey said they plan to continue with their international online pharmacies as long as they like the service and the prices. One of Chauncey's drugs has increased to $95, but he still feels that he's saving money.

"If I had problems with it, if I didn't think it was doing me as well as the other drugs, then I would go back," said Chauncey, a retired office manager for a trucking company. "So far, that hasn't happened."

Amy Jeter, (757) 446-2730, amy.jeter@pilotonline.com