The House voted July 11 to make it legal for Americans to purchase prescription drugs from foreign countries by mail order or through the Internet, a step that could lead to significant savings for older Americans who use the most prescriptions.
If the proposal becomes law, they could forgo travel and instead legally use the Internet, the mail system or a fax machine to order FDA-approved drugs from foreign pharmacies. Many drugs sold in the United States are far less expensive in foreign countries where governments often impose price restrictions.
The measure easily passed the House by a vote of 324-101. But it faces an uncertain fate in the Senate and tough opposition from the Bush administration, with the Food and Drug Administration citing possible safety concerns for drugs ordered through the mail from abroad. And the idea poses a threat to the profits of the pharmaceutical industry, which deploys one of the richest and most powerful lobbying organizations in U.S. politics.
Passage of the House bill underscores the growing importance of prescription drug costs as a political issue.
President Bush will offer his proposals Thursday for Medicare reform, highlighted by a call for Medicare's 35 million beneficiaries to participate in discount purchasing programs when they buy prescription drugs.
Insurers such as Blue Cross and Blue Shield offer discount cards to members who purchase Medi-Gap supplemental insurance policies.
"The president is very troubled about the price of prescription drugs and the lack of access that senior citizens have to prescription drugs," Ari Fleischer, the White House press secretary, said Wednesday.
The White House hopes to create a clearinghouse that will enable seniors who do not have access to discount cards to enroll with companies -- called pharmacy benefit managers -- that buy prescription drugs on behalf of insurance companies and health plans.
Fleischer, at his daily White House briefing, said the president's discount-card proposal is "very important -- even before Medicare reform can be enacted -- to help senior citizens to get the best prices possible so that the cost of prescription drugs can be lowered."
The potential for even deeper savings for consumers could come from the House-approved measure allowing imports by mail. Rep. Gil Gutknecht, R-Minn., sponsor of the measure, cited an example in which a constituent using a special ointment for a skin problem paid $130 for a tube in the United States but on a trip to Ireland bought the same medication for $46.
"The bottom line is if you are wealthy enough to travel to Europe twice a year, you can bring back all the drugs you need for the year," he said. "But if your are a senior living on a fixed income, you pay the full price.
If the measure approved by the House becomes law, "Web sites can be up and running at senior centers, connected with pharmaceutical supply businesses in Geneva or Paris," Gutknecht said. The legislation was an amendment to an appropriations bill providing funding for the FDA, which enforces drug safety laws.
Modern computer technology allows for verification that a doctor has written a prescription, that an order has been placed with a legitimate supplier, and that a package is on its way to the United States. "If we can transfer millions of dollars with the push of a button, we can do this," Gutknecht said.
But Alan F. Holmer, president of the Pharmaceutical Research and Manufacturers of America, or PhRMA, argues that the amendment "would open up the possibility for individuals to bring into the country medicines that may not be as safe or effective as they appear."
"Because the danger still exists," he said, "we will continue to oppose the personal-use exemption in the Senate."
Earlier, the House rejected an amendment by Rep. Bernard Sanders, I-Vt., that would have allowed companies -- distributors and marketers -- to import pharmaceuticals for sale to U.S. consumers. Sanders said he was pleased by the final approval of Gutknecht's measure, calling it a "solid victory" in the quest for lower pharmaceutical prices.
The amendment passed Wednesday applies only to individuals, allowing the freedom to order drugs -- something that is ambiguous under current law. People are deterred because the FDA often sends letters to those who get drugs from abroad, warning they might be in violation of federal law. "For most folks, this letter is a very intimidating thing," Gutknecht said.
In the Senate, the timing for consideration of the bill is uncertain.
Separately, Bush still intends to make good on a campaign promise to propose adding a full prescription drugs coverage plan under Medicare, Fleischer said. He said there is "no question" that there will be sufficient funds left in the surplus to finance such a plan.
Fleischer said the separate "immediate helping hand" proposal to give the states money to help indigent people older than 65 buy prescription drugs remains in Bush's budget -- and "the president still is committed to it."