Minnesota Clears Path To Canadian Pharmacies

Brian Osberg, Minnesota's assistant commissioner of health care, offered attendees at a meeting of the National Academy for State Health Policy a step-by-step account of how officials established the first state-sponsored Web site providing access to prescription drugs from Canada.

The effort came about, he explained, because some Minnesota residents were being forced to choose between buying food and prescription drugs or were reducing their prescription drug doses to save money.

Osberg said, “As long as the price of drugs is exorbitant, we will have people doing desperate things.”

Minnesotans were already ordering drugs online from Canada, he noted, but with little assurance of safety.

In fall 2003 Gov. Tim Pawlenty (R) announced a three-phase initiative to provide state employees, retirees, and other Minnesota residents access to drugs from Canadian pharmacies.

First, all Minnesotans would be offered an opportunity to access information on purchasing medications from Canada. Second, state employees and their dependents would be able to order prescription drugs from Canada online.

Finally, state officials would work “to eliminate federal barriers to importing prescription medication at the state level.”

The aim is “statutory authority to allow Minnesota to import medicine after establishing a reasonable system that provides for the safety of Minnesotans.”

State officials solicited expressions of interest from Canadian pharmacies and selected nine of the 25 that responded for visits. Each of the nine was visited by a team from the pharmacy program of the Department of Health Services (DHS) and from the Minnesota Board of Pharmacy.

Each team issued a report covering quality of the facilities, operational procedures, apparent source of medications, staff response to questions, and evidence of licensure.

The DHS issued contracts to two pharmacies and launched the Web site<www.MinnesotaRxConnect.com> on January 30 with a list of 829 prescription medications. The medications cannot be ordered online. A potential user must obtain a prescription, which is then faxed or mailed to the pharmacy selected.

Osberg said, “We got a lot of media coverage and heard two questions repeatedly: Is it legal? Have you heard from the FDA [Food and Drug Administration]?”

The Web site contains a notice that states, “To our knowledge, the U.S. government has not stopped individual U.S. residents from buying small amounts of prescription drugs for their own personal use, or that of a family member, and the FDA has made statements to the media that [it does] not plan to interfere with such small individual purchases.”

Three weeks after the launch, Pawlenty received a letter from the FDA saying, “Active promotion of... [the Web site] is unwise and, most urgently, unsafe.”

Pawlenty regarded the letter as “good news” because it did not signify legal action to close the Web site.

In May the state launched<www.advantage-meds.com>, which enables state employees and their dependents who participate in the Advantage state employee insurance program access to 45 medications that can be ordered online.

A medication is available only in a three-month supply and only if a prescription is on file or is sent to the pharmacy by a doctor.

The Advantage insurance program selected “maintenance” medications for this program and dropped the prescription drug copay to encourage use.

In response to questions, Osberg said state officials were gratified by the attention the Web site brought to the problem of the accelerating cost of prescription drugs. Reimportation, however, is not the sole solution to access, he argued.

“We need to be able to negotiate with the drug companies on better terms,” Osberg said. He and other audience members pointed out that the new Medicare legislation specifically prohibits the federal government from negotiating to achieve lower drug prices.

At the “last minute,” the Centers for Medicare and Medicaid Services (CMS) had denied a request from Minnesota to join a state purchasing pool to negotiate discounts on prescription drugs for Medicaid patients.

After more than a year of negotiations with CMS, Alaska, Michigan, Nevada, New Hampshire, and Vermont were given permission in April to establish the pool. The five states estimated that the program would save them more than $12 million in 2004 (Psychiatric News, May 21).

Osberg told Psychiatric News that at press time CMS still had not granted approval to Minnesota and that the decision was perplexing in light of the approval in April for the establishment of the pool.

In related developments, Illinois announced plans to contract with a Canadian pharmacy benefits manager to form a clearinghouse of more than 35 pharmacies and wholesalers that state officials have said will offer discounted medications. The FDA has said it will send a team to Illinois to request more information about safety, according to<www.kaisernetwork.org> on August 24.

The Rhode Island Health Department is grappling with the requirements of a new state law that will allow Canadian pharmacies to ship prescription drugs to state residents. The law, scheduled to take effect in January 2005, stipulates that Rhode Island can grant foreign pharmacies the right to obtain pharmacy licenses. Both the FDA and Rhode Island state officials have expressed concern about the legality of the legislation, according to<www.kaisernetwork.org> on August 18. ▪