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By Nathan Welton
The Tribune
September 6, 2004

EDITOR'S NOTE: Prescription drug prices have skyrocketed in recent years, and some seniors have experienced increasing difficulty paying for their medications. Some don't even take large enough doses because they can't afford to.

The Tribune reported Sunday that the advantages of the Medicare drug discount cards -- a key part of the recent overhaul of the health plan for seniors -- are overstated for all but the poorest beneficiaries.

Most would be better served by shopping online or in Canada for their medications, despite the fact that drug importation is currently banned.

Many state and federal legislators are pressing to open international trade borders but have met opposition from the Bush administration, which maintains that doing so could be unsafe.

Esther Adams downs a handful of pills a day to combat high blood pressure, heart disease, thyroid problems and breast cancer -- but it's the bill that's hard for her to swallow.

If she paid full price, the 87-year-old Templeton woman could spend more than $350 a month on her medicines. That would be a big chunk of the $738 that arrives every four weeks from the Social Security Administration.

That means that after figuring in her $150-per-month secondary health coverage, she'd have just under $240 left to pay for food, water and electricity.

So she's saving money by shopping in Canada, joining the ranks of seniors nationwide who go abroad for medicines that are often far cheaper.

While the practice is illegal, doctors are turning a blind eye, or even suggesting it, to their patients. What's more, the state of California -- in a nod to practicality -- has just vowed to produce a list of approved Canadian pharmacies from which to order drugs. The action follows similar moves by San Francisco and several other states.

The AARP is pushing for legislation that would legalize drug importation. Until that happens, many seniors would rather break the law than break the bank.

While she might not be the first to admit it, Adams has successfully navigated the maze of Medicare and medications -- and has found a deal on her drugs. By ordering medicines from Winnipeg, Manitoba, and taking advantage of the Medicare discount program, she has reduced her monthly drug bill to about $127, or $23 below the price offered by the most discounted Medicare card.

"I can still buy food," she said, "but when it gets to the point that I can't, I'll start screaming."

Adams' bills could shrink further. She could have a monthly drug bill of about $82 if she takes advantage of several programs offered by certain pharmaceutical corporations for low-income seniors.

Adams' drug bill wasn't so steep until it skyrocketed about two and a half years ago, she said, after a bout of breast cancer. Doctors then prescribed Tamoxifen, a powerful drug that helps reduce the disease's recurrence. The only problem: it cost more than $1,200 a year.

"I told the doctor that I wouldn't take it if it costs $4 a pill," she explained. "So he said, 'Well, let's see what we can get it for from Canada.' "

After a few letters to the pharmacy, Adams began receiving her Tamoxifen for a huge discount -- and began to save hundreds of dollars annually.

Her Canadian supplier is now offering three months of the drug for about $50, compared to the $311 price offered by her local pharmacy.

Then, when the Medicare drug discount cards went into effect in June, Adams realized she had another opportunity to save money and that she might qualify for an annual credit of $600 available to certain low-income seniors. Her monthly income of $738 allowed her to just squeak in beneath the credit's $776-or-less requirement.

But when the program's materials arrived, she said, the complexities left her bewildered.

The names of the medicines were bad enough, never mind the piles of paperwork that came from the government.

"I don't speak their language," she said while spelling out the name of an unpronounceable drug.

Of the 72 various discount cards offered by Medicare, she would have to figure out which ones would pay for her specific combinations of drugs. Then, of those 35 cards, she'd have to decide which ones her local pharmacy would accept -- and if the price offered at that pharmacy was the best one available.

"Drug stores negotiate different discounts themselves, so they might get a better buy on a certain drug on a given day," said Peter Ashkenaz, a Medicare spokesman. "Wal-Mart is charging $26.23 for Atenolol, while Sav-On is charging $8.20."

So Adams called the county's Health Insurance Counseling and Advocacy Program, where volunteers helped her sort out which cards were best for her. Many seniors elect to seek HICAP help instead of calling the Medicare number, which is reported to have lengthy waits.

In the end, Adams decided to buy some of her drugs with her Medicare discount and some of her drugs from her Canadian supplier. But what could help her out even more are the programs offered by various pharmaceuticals corporations.

Novartis, which makes the blood-pressure medicine Diovan, and AstraZeneca, which makes Nolvadex -- the trade name for Tamoxifen -- both offer their drugs at no charge to seniors who qualify and have used up all of the $600 credit. But those deals only apply to certain cards.

It turns out, by chance, that Adams' discount card had deals worked out with both companies -- so when she uses up her credit, she'll only pay for one highly-expensive medication: Tiazac, which she purchases more cheaply from Canada.

"I'm living on pills and borrowed time, believe me," Adams said.

Shopping for the best bargains

Esther Adams of Templeton pays about $127 per month for her Atenolol, Digitek, Diovan, Levoxyl, Tamoxifen and Tiazac. She orders some from her local pharmacy and the rest from Canada. That bill would decrease to about $81 if she takes advantage of deals offered to low-income seniors by certain drug companies.

Best monthly prices for all of her drugs from ...

Medicare: $149.14, but only at 10 local pharmacies $173.28, but must pay shipping and have Internet $134.72, but must order from Canada, which is currently illegal under American law