This is another installment in an ongoing series about the high cost of health care and health insurance.
In September, the governors of Illinois, Minnesota and Iowa grabbed national headlines when they asked their staffs to find ways to cover Canadian prescription drugs with state insurance.
West Virginia has been exploring that possibility for three years, said Tom Susman. "The governor asked us to start looking at it early in his term," he said.
"When we have seniors who must decide whether to eat or buy prescription drugs because the drugs cost so much, it's no longer simply a political or economic issue," Gov. Bob Wise said Friday. "This is getting to be a moral issue.
"We can't wait for Congress. We've got to do all we can here."
Canadian drugs cost, on average, about half as much as their U.S. counterparts.
The U.S. Food and Drug Administration insists that, if you buy a prescription drug from Canada, it's not safe, and you are breaking the law. West Virginia is the fourth state in four weeks to publicly question those assumptions.
"I don't want to raise false hopes that it's going to happen," said Susman. Many questions still have to be answered. "But we're talking with the same people Illinois is talking with."
In late September, PEIA Pharmacy Director Felice Joseph traveled to British Columbia and talked with Canadian officials about multistate bulk buying and reimportation of Canadian drugs.
Friday, she took part in a conference call with employees of CanUSA, a Canadian pharmacy that contracts with the city of Springfield, Mass. They discussed practical problems that would have to be resolved before Susman could provide Wise with a viable plan, she said.
West Virginia spent $476 million on prescription drugs in fiscal 2003, she said, including $116 million for prescription drugs for state employees. With drug prices rising an average of 15 percent a year, PEIA's drug costs have risen 57 percent since 2000, when the overall cost was $66.4 million.
"Anything that will keep prescription drug costs down, we're looking at it," Susman said.
Is it legal?
The governors of Illinois, Minnesota and Iowa all say they expect a legal confrontation with the Bush administration. "This is a question of states' rights," Abbie Ottenhoff, press secretary for Illinois' governor, told the Sunday Gazette-Mail. They may end up in court, she said.
William Douglas, who directs the West Virginia Pharmacy Board, disagrees. "It is disheartening to hear that states are considering risking public safety in order to save money," he said. "It is still illegal and — according to the FDA — unsafe to import drugs from a foreign country."
The Pharmacy Board is trying to shut down Fairmont's order-from-Canada storefront, Discount Prescription Center.
"What proof is there that there is a significant risk?" Iowa governor Tom Vilsack asked the Washington Post. "If there is a risk, let's do something about it."
The FDA has never prosecuted an individual who orders from Canada. But, as the number of Americans ordering from Canada multiplies, the FDA is escalating its efforts to shut down the ways Americans order from Canada.
Illinois takes the position that the federal government has no authority to tell states where to buy prescription drugs, Ottenhoff said.
"Illinois has taken a viable legal position," said West Virginia University law professor Kevin Outterson, who specializes in health law. "It is a good faith interpretation of law.
"Two Constitutional provisions are in potential conflict. On one hand, the commerce clause says that Congress can regulate commerce between the U.S. and foreign lands. On the other hand, states have police power over the health and safety of their citizens, particularly when they're doing it for their own employees and retirees. There is a question of which law prevails."
The health and safety of Illinois citizens is definitely at stake, said Ottenhoff. "We have one out of four seniors skipping drug doses or not taking them at all because they can't afford it. Prescription drugs are eating up our budget, and we've got the worst budget crisis in our history.
"If the federal government isn't going to take action, the states will have to," she said.
"We'll be watching closely," Susman said.
Thursday, Minnesota's governor, Tom Pawlenty, upped the ante. He announced that Minnesota will definitely buy from Canada and also put up a Web site through which all citizens can order from Canada.
"I think, politically, these states are putting pressure on the federal government," said Richard Stevens, director of the West Virginia Pharmacists Association. "They are saying, 'If it's illegal, stop us from doing it.' The question is: What's that action going to be?"
Meanwhile, on other fronts
Many hundreds of miles from the Canadian border, the Wise administration is attacking high drug costs on many fronts. It has:
"We try to take a total system approach," Susman said. "Leave no rock unturned."
Even if the three states win in court, practical questions must be resolved before West Virginia would order from Canada, Susman said. It's not as clearcut a proposition as it might seem.
First, he said, the Canadian supplier would have to agree to work through West Virginia's pharmacy benefits manager. CanUSA wants to be the manager, he said, but he feels uncomfortable with the idea of sending public employee information to another benefits manager.
"We want our information in one place, where we know we can spot possible negative drug interactions.