Illinois Governor Rod Blagojevich (D), with support from former Clinton administration political strategist and freshman U.S. Representative Rahm Emanuel (D-Illinois), hopes to make the Prairie State the first to receive permission to import drugs from Canada for use by state employees, their dependents, and retirees.
Over a span of barely three weeks in September, Blagojevich:
- gave the Illinois Office of Special Advocate 90 days to prepare a report on drug importation from Canada for persons covered under state health insurance plans;
- petitioned the U.S. Food and Drug Administration to waive rules barring drug importation;
- sent letters to governors across the country encouraging them to lobby the federal government to allow states to pursue drug importation; and
- flew to Washington, DC to press his case personally; and
- sent a delegation to Canada to explore contract opportunities.
“If the federal government is not able to correct serious drug price disparities between the U.S. and the rest of the world, then it should give states the flexibility to pursue better prices on their own,” Blagojevich said at a September news conference in Chicago.
The response to the Blagojevich proposal has been mixed, with support and opposition coming from some unexpected quarters. Illinois State Senator Chris Lauzen, a Republican known for his conservative viewpoints, has come out in support of Blagojevich, a liberal Democrat. Chicago Mayor Richard Daley, a powerful Democrat known for his liberal politics, has come out against drug importation.
Blagojevich also has encountered opposition from the Food and Drug Administration (FDA) and U.S. House Speaker Dennis Hastert (R-Illinois), whose congressional district includes a portion of suburban Chicago. Pharmaceutical companies, Illinois retail association members, and drugstore operators also oppose the move.
Blagojevich says he wants the state to be allowed to import drugs from Canada, where the government controls drug prices, as a way to save money. Illinois last year spent about $340 million on prescription drugs for its 230,000 state employees and retirees and $1.8 billion on prescription drugs for all the state’s health programs combined, according to the governor’s office. Blagojevich’s staff estimates the state could cut those costs 30 to 50 percent by importing drugs from Canada.
The governor’s office projects a budget deficit of $1.5 to $2 billion through the middle of 2005. Illinois’ annual state budget has climbed from $35.8 billion in 1998 to almost $53 billion this year.
While the state Office of Management and Budget (OMB) blames “wasteful and unchecked spending” for much of Illinois’ budget problem, it also cites a 41 percent increase in Medicaid payments for prescription drugs since fiscal year 1999. “These increases are attributable to expanding enrollments, skyrocketing drug costs, and natural increases in health care costs,” according to the state OMB report.
Safety at Issue
For more than a decade, the directors of the federal Department of Health and Human Services–Donna Shalala during the Clinton administration, and Tommy Thompson under the current Bush administration–have repeatedly stated they cannot guarantee the safety or quality of imported drugs.
The FDA opposes drug importation, arguing there is no way to guarantee the quality or safety of imported drugs from across borders. “There are a lot of bad drugs out there,” FDA Senior Associate Commissioner William Hubbard told the Washington Post in response to Blagojevich. “We fear a program like (Illinois’) would put people at risk.”
Merrill Matthews, Ph.D., director of the Council for Affordable Health Insurance and visiting scholar with the Institute of Policy Innovation, agrees drug importation is a risky scheme. Matthews told Health Care News, “The governor of Illinois apparently wants to flaunt U.S. law and the safety concerns of the U.S. Food and Drug Administration in order to get access to cheaper drugs. If elected officials, sworn to uphold the law, not break it, spent as much time educating their constituents about the price variations among different local pharmacies and the availability of numerous programs for low-income households, they could help their constituents rather than putting their lives at risk.”
There have been many, mostly under-reported, instances of tampering with prescription drugs. (See “Drug Importation Roulette.”)
Earlier this year, for example, a counterfeit version of Pfizer’s Lipitor, the world’s top-selling cholesterol-lowering drug, was discovered in Nebraska after pharmacists and patients complained the medicine tasted unusually bitter and dissolved too quickly.
In Florida, prosecutors recently announced a grand jury had indicted 19 people on charges of watering down or selling fake drugs to storefront and Internet businesses fulfilling prescriptions for consumers.
Interpol, the international police agency, said it had identified a large factory in the Bekaa Valley of Lebanon that may be the world’s largest producer of counterfeit medications being sold worldwide to wholesalers and distributors.
The FDA cites incidents such as these to bolster its position that imported drugs, even from neighboring Canada, could pose an unacceptable health risk to American consumers.
Prescription drugs have been a major issue for Blagojevich and Emanuel, who succeeded Blagojevich in Congress after Blagojevich ran for Illinois governor in 2002. Emanuel made health care a central issue in his campaign for Congress, and he is one of the leading proponents of a bill allowing pharmacies and drug wholesalers to import drugs from Canada without FDA approval. The measure, which passed by a single vote in the U.S. House of Representatives, is being held up in a conference committee.
The states of Maine and Vermont and the city of Springfield, Massachusetts, are also considering ways to import drugs from Canada.
Steve Stanek is an Illinois-based freelance writer. His email address is [email protected].