By Jeff Swiatek, The Indianapolis Star Knight Ridder/Tribune Business News
Aug. 29--With the click of a computer mouse, visitors to government Web sites in four states can fill orders for prescription drugs from private pharmacies in Canada.
It's a controversial Internet option that won't be offered by Indiana anytime soon.
Neither Gov. Joe Kernan nor his Republican challenger Mitch Daniels plans to try to put the state's stamp of approval on north-of-the-border drug buys.
And even if state legislators consider such a service, they would face potent opposition from drugmaker Eli Lilly and Co., Central Indiana's largest private employer.
While fewer politicians seem willing to stand in the way of Americans importing low-priced Canadian drugs, Indiana political leaders aren't pushing for the state to encourage a deed that falls under a gray area of federal law.
The governor, says spokesman Jonathan Swain, "does have some concerns . . . about safety and security issues" with ordering drugs from Canada. "It's not something we're directly working on" doing in Indiana, he said.
Daniels, for his part, "believes a better idea would be improving access to existing drug discount programs" offered by drugmakers and other health firms, perhaps by putting online referral services in senior citizen centers, said Daniels' deputy campaign manager, Ellen Whitt.
"Many who qualify for those programs are unaware of them," she said of the more than 50 discount-card programs that let low-income users buy prescription drugs for less. The programs cater to the elderly who don't have private health insurance that covers medicines.
The state government links to Internet pharmacies in Canada began with Minnesota setting one up in January. Wisconsin, New Hampshire and North Dakota soon picked up on the idea. Illinois Gov. Rod Blagojevich said last week his state also will help residents buy Canadian drugs.
While thousands of Americans buy prescription drugs from Canadian pharmacies on their own, or with the help of private programs, state endorsement of the purchases lends legitimacy to purchases that the U.S. Food and Drug Administration says are illegal. Despite its position, the FDA has done little to crack down on the widespread buying.
The FDA warned Wisconsin Gov. Jim Doyle in July that "the endorsement of the practice of purchasing foreign drugs over the Internet by a public official such as yourself undermines one of our nation's key consumer protection statutes" and puts residents at risk of buying unsafe drugs.
The FDA doesn't oversee the safety or efficacy of foreign drugs. But that hasn't stopped U.S. consumers from turning to Canadian pharmacies by the thousands, to buy brand-name drugs that often cost 20 percent to 60 percent less than in the United States because of Canadian-imposed price controls.
In Indiana, any attempt to set up a state program to aid Canadian drug-buying would be sure to bring opposition from Lilly. A formidable lobbying force, the Indianapolis drugmaker has opposed efforts to liberalize drug-buying from Canada.
"With the political clout that Eli Lilly has, I suspect this will be the last state in the nation that would seriously consider addressing that," said Paul Severance, executive director of United Senior Action, a statewide group representing seniors.
Severance said his group will seek a legislative sponsor in the next session of the General Assembly to push for a state program to help people buy drugs from Canada.
Kernan spokesman Swain said Lilly's opposition is "not something that is necessarily a factor" in the governor's decisions on Canadian drug imports.
Daniels, Kernan's opponent in the upcoming election for governor, is a former Lilly executive.
Indiana's legislature is likely to study the issue of helping people import cheaper-priced drugs, said state Sen. Patricia Miller, R-Indianapolis, a member of the Health Finance Committee. "As other states look at this, Indiana legislators also are going to look at it," she said. "The bottom line is what's best for the patient. Not only is it cheap, but is it good and cheap?"
House Speaker B. Patrick Bauer, D-South Bend, said he'd be open to the state making it easier for people to order lower-priced drugs from Canada. "There is something wrong when in our country we pay two to three times as much as other countries" for many prescription drugs, he said.
Lilly argues that state-sanctioned import programs "further expose their citizens to a real threat" from counterfeit or federally unapproved drugs sent in the mail from foreign pharmacists the customer never meets.
To help low-income consumers afford its drugs, Lilly runs a discount program that makes its drugs available for $12 a month. The LillyAnswers program has enrolled almost 300,000 people, including 15,200 in Indiana, who have received 1 million prescriptions through the program, said Lilly spokesman Ed Sagebiel.
The Minnesota program, open to anyone, supplies an order form to mail to a Canadian pharmacy. The state doesn't get any financial benefits from the program.
"We get comments from people all over the country praising our governor for taking on this initiative," said Jane Kennedy, a spokeswoman for Minnesota Department of Human Services.
Wisconsin's program, begun in February, forwarded 428 prescription orders worth $58,768 in June, the latest month tracked, said Melanie Fonder, spokesman for Gov. Doyle. She said Doyle has ignored the FDA warning that the program encourages possibly unsafe importation of drugs.
She said Wisconsin officials checked out the quality and reliability of the three Canadian pharmacies that service customers via the Wisconsin site. "We think this is a safe and affordable way for people to get their prescription drugs," she said.
In the Indianapolis area, at least two private services help people order drugs from Canada. One is run by United Senior Action, which has aided 450 people with its program since it began in June of last year, Severance said. The other is a for-profit business called Canada Drug Service, which operates in a store on the courthouse square in Noblesville.
Canada Drug Service serves several dozen customers a day by phone or in person, said owner Indi Singh, a Noblesville businessman who owns several area oil-change shops.
The Indiana Board of Pharmacy warned Singh last year that he was illegally operating what amounts to an unlicensed pharmacy. But Singh ignored the warning, saying his store only processes orders and doesn't give advice on drugs or handle prescriptions or money.
Singh said Canada Drug Service gets revenue by collecting a fee from the Canadian pharmacy to which it sends prescriptions. So far, the business has not been profitable, he said.
A national chain of prescription-processing centers called Rx Depot, which had an outlet in Indianapolis, was shut down on orders of a federal judge last year and hasn't reopened.
Pharmacy board spokeswoman Lisa Hayes said she thought Canada Drug Service had also shut down.
Told it was still operating, she said the board's investigators "could look at it again" to see if another warning letter might be warranted.
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