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An Unlikely Pair Fights For Cheaper Medications Congressmen Support Drug Reimportation Plan

By Ceci Connolly
Washington Post Staff Writer
Monday, September 1, 2003

CHICAGO -- To lure a crowd, the two members of Congress promised ice cream, direct from the Chocolate Factory. But the North Park Village residents hardly needed the extra enticement.

Fed up with paying top dollar for the pills that thin their blood, lower their cholesterol and soothe their aching joints, the seniors poured into the community center here with one request: They want the right to buy their medications from whichever country has the best price, whether it's Canada, Ireland, Australia or the United States.

"If it's cheaper in Canada, why not?" asked Paul Frost, 73. Even with four drug discount cards, he shops at three pharmacies to save $2 on the insulin that keeps his diabetes in check.

Frost's question is music to Reps. Rahm Emanuel and Gil Gutknecht, the congressional odd couple pitching just such a plan. So far, Emanuel, an Illinois Democrat, and Gutknecht, a Minnesota Republican, are winning the fight, despite opposition from corporate and political heavyweights. In defiance of the Bush administration, Republican congressional leaders and the pharmaceutical industry, the House in July approved a bill that would allow Americans to shop for prescription medications outside the United States.

The 243 to 186 vote, with 87 Republicans in favor, rattled Capitol Hill, where seasoned vote-counters had predicted a 50-vote victory for the drug industry.

The fervor expressed at the Chicago gathering helps explain why so many Washington insiders were caught off guard -- and why the proposal's opponents anticipate a difficult fight this fall. Unlike many legislative battles, the debate over drug prices directly affects virtually every American and is especially salient with retirees who lack prescription drug coverage.

Pharmaceutical companies say drug reimportation, as it is known, could bring unsafe medicines into the United States -- and they have partnered with the Food and Drug Administration to make that case. But many voters, particularly in retirement complexes such as North Park Village, are embracing the idea and urging their representatives to do the same.

"The fact the pharmaceutical companies control what we get is just so ass-backwards," said Linda Engberg. "There should be something more radical we can do."

The rebellion began quietly, with an unlikely leader.

"A few years ago it was me, my charts and a handful of radical seniors," Gutknecht said. Once a loyal foot soldier in Newt Gingrich's 1994 GOP takeover of the House, Gutknecht has fallen from favor with his party. But late one night, in the deserted House chamber, he picked up an unlikely partner: Emanuel, the fast-talking freshman who mastered the art of partisan warfare in the Clinton White House.

The bipartisan pair is crisscrossing the country this month, hoping to put grass-roots pressure on the Senate, which did not adopt the House's broad reimportation plan. When Congress returns next week, House-Senate negotiators will tackle the issue as part of a massive Medicare prescription drug bill. After opening on Emanuel's turf, the road show went to Gutknecht's district last Monday.

"We need this one," Ron Gregory, 72, told Gutknecht as the lawmaker moved from table to table in the community center. "Prescription-wise, I'm broke every month."

Then Gutknecht mounted the podium, flanked by his charts. They listed 10 common drugs and their prices at the Munich Airport and in the United States. Total cost in Germany: $373.30, he said. In the United States: $1,039.65.

"Wow!"

"Ouch," many seniors hooted in anger.

"You're going to get angrier as I read the list," Gutknecht warned. Coumadin, he said, referring to the blood thinner his father and many in the crowd take daily, sells for $21 in Germany and $90 here.

The grumbling grew louder. "Awwww."

"Oh brother!"

The congressman cited other drugs. Glucophage, for diabetes. Zocor, for high cholesterol. Anti-depressants such as Prozac and Zoloft. Lifting a small white box, Gutknecht told the 150 seniors the story of tamoxifen, the breast cancer therapy developed and tested with the help of the National Institutes of Health. A wonder drug, he said. Sixty tablets for $60 in Munich. The U.S. price: $360.

"And the worst thing is," he yelled over the din, "you paid to develop it."

In Washington, the smart money is betting against Gutknecht and Emanuel. Food and Drug Administration chief Mark McClellan says his agency cannot guarantee the safety of drugs from Canada and Europe. In a letter to lawmakers, McClellan said the House bill would "erode" the FDA's ability to oversee the nation's drug supply and create "a wide channel for large volumes of unapproved drugs," including counterfeits, to flood the U.S. market.

Six hundred lobbyists for the pharmaceutical industry -- which has made more than $40 million in political contributions in the past four years -- have campaigned vigorously against reimportation. Within hours of the House bill's passage, 53 senators signed a letter opposing the provision. With House leaders and most senators lined up against the proposal, Gutknecht and Emanuel face long odds in conference committee.

"These guys are sincere, but the rest of those clowns in Washington, I don't know," Gregory said. "The drug companies have all those lobbyists. It's all, 'You scratch my back, I'll scratch yours' down there."

But Gutknecht and Emanuel say the pharmacy industry, like tobacco in the late 1990s, may have pushed too hard this time. They say the 53 senators were embarrassed when it was revealed that pharmaceutical lobbyists had drafted their letter.

More damaging was a batch of letters the industry sent to antiabortion lawmakers, warning that reimportation would make RU-486, called the "abortion pill," as easy to get as aspirin. That medication, like all others, would still require a prescription under the proposed legislation.

On the day Gutknecht and Emanuel met with the North Park seniors, the morning papers reported that Pfizer was joining three other drug manufacturers in a plan to drastically limit supplies to Canada. The company said the move was necessary to keep patients safe, but others interpreted it as a thinly veiled threat to reimportation proponents.

"That type of intimidation politics is backfiring," Emanuel said. "They played their hand horribly. If they're going to play hardball, we have an obligation to push back."

Jeffrey Trewhitt, spokesman for the Pharmaceutical Research and Manufacturers of America, would not discuss political strategy but said the industry's objections stem from FDA concerns that "reimported medicines [are] unsafe and risky for patients."

AARP, the nation's largest advocacy group for people older than 50, has sided with Gutknecht and Emanuel, although with the caveat it prefers a three-year Canadian pilot program. Mike Naylor, AARP's director of advocacy, said drug representatives miscalculated when they asked AARP to join an anti-importation campaign spearheaded by "all the phony groups that drive us crazy," such as the Christian Seniors Association, which rely heavily on industry support.

An experienced lobbyist, Naylor has been struck by the reimportation issue's punch. After observing several focus groups and attending the Chicago meeting, he concluded that Gutknecht and Emanuel have tapped into two potent forces: the yawning price gap and the "almost unqualified low esteem in which the big drug manufacturers are held."

The high cost of medicine is a topic so vital and visceral to elderly Americans that it can prompt otherwise polite grandmothers to fling epithets at faceless, nameless drug executives.

"You bastards," said a petite, white-haired woman attending the Chicago meeting. "You're robbing us blind."

Although the FDA opposes legalizing reimportation, the agency has been reluctant to prosecute individual violators, in part fearful of the image of federal officials rounding up elderly people seeking essential medications.

"The FDA works for us," Gutknecht told the Chicago crowd. "You should not be treated like common criminals for wanting to get a fair price!"

Six blocks from the Chicago gathering, at the corner of Pulaski and Foster, Nick Hano was filling prescriptions at the Osco pharmacy for residents of North Park and other neighborhoods. He knows most by name -- as well as their allergies, financial woes and personal quirks. If Emanuel, his congressional representative, succeeds, Hano will lose customers.

Drug imports from Canada, he said, are "already affecting our business tremendously." After 20 years in the business, Hano abandoned his dream of running his own pharmacy. The big chains squeezed out independent pharmacists, he said, and now the chains "are getting squeezed by Canada."

If policymakers were truly concerned about safety, Hano said, they would crack down on counterfeiting in this country and reimburse pharmacists for the valuable counseling they provide. He has no sympathy for drug makers, an industry he said has jacked up prices every year, foisted expensive medications on patients who can't afford them over the long term and spent millions of dollars wooing new customers with slick advertising.

Though Hano worries that some of his patients will have unanswered questions about medicine they buy from Canada, he never argues when they tell him they cannot afford to continue shopping at Osco.

"If I were in their position," he said, "I'd probably do the same thing."

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