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Monday, December 22

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In October 2004, Governor Blagojevich launched the I-Save Rx drug reimportation program to provide Illinois residents with a safe and affordable way to purchase many of the most commonly used prescription drugs from pharmacies in Canada and Europe; eventually the program approved pharmacies in Australia and New Zealand as well. The program's Pharmacy Benefits Manager is Pegasus Health Services Limited, which operates a network of online pharmacies in Calgary, Canada. Medicine costs up to 70 percent less in these countries than it does in the U.S. I-Save Rx is intended for senior citizens and the uninsured, and is available to the citizens of Illinois, Kansas, Wisconsin, Missouri and Vermont.

It's probably worth mentioning here that more than 45 million people of all ages in the U.S. do not have health insurance. 45 million is equal to the combined populations of 24 states. That's 24 states worth of uninsured people. Virtually all other industrialized, capitalist countries have some sort of large-scale bulk-purchasing program. It's just like Wal-Mart using its purchasing power to buy in bulk and provide cheap goods to customers. Insurance companies do this all the time — they buy drugs for all of their members, to get cheaper prices.

But, many people who do have health insurance are finding I-Save Rx to be a money saving alternative when their insurance companies don't cover their medicines. In fact, it's not an alternative — it's the only viable way to afford medicine. And using I-Save Rx is surprisingly easy.

Well, sort of.

The Illinois Auditor General in a report released in September 2006 said the I-Save Rx reimportation program has low participation rates. The office of the Auditor General also complained that purchasing prescription drugs from abroad is "illegal and in violation of federal law" and in some cases "unsafe." However, to date, the FDA has seized and tested approximately 1 percent of the prescription drugs imported through I-Save Rx and has never found fault with any of the medications. But with President Bush so distracted with the stress of coming up with a new tagline every two months, the Administration has yet to crack down on the consumers propelling the current reimportation revolution. These are sick people, some chronically ill, others in need of temporary medicine.

These revolutionaries are confidently waving their prescription label flags at the health care reformists who seem to be paralyzed by incremental policy changes, bureaucracy, and the pharmaceutical lobby while people without access to affordable medicine are dying across the country. Because I manage my own chronic illness, I set out to see why more people aren't violating federal law.

So, what is the first thing I do when in need of health care in the United States? I call my doct– I go online.

01082007_isaverx.jpg

Friday, September 29

I visit the I-Save Rx website to obtain their phone number. The customer service representative cheerily asks, "Do you have access to the Internet?"

"I sure do!" I said excitedly, sounding like Dennis the Menace talking to Mr. Wilson.

They advise me to use the website to register for the program online. I ponder the impressiveness of my individual effort and congratulate myself on the guts I demonstrate in being a modern sophisticated patient.

A pioneer.

A revolutionary.

My health care system navigation skills as a thirtysomething who expresses herself with keystrokes and cell phone messages rather than office visits and paper are serving me well.

I-Save Rx seems viable so I continue down the online path to affordable healthcare hoping to find the little pharmacist behind the Canadian curtain at the end of the yellow brick keyboard.

"Great!" he says. "You can do everything online! And, Ms. Soenen, One last question? How did you hear of I-Save Rx?"

I thought for a moment, then told him it was either that I saw an ad on a blimp at last summer's Air and Water Show or possibly Blue Cross Blue Shield lit up the windows of their building on Randolph Street to spell out "afford medicine now."

"Call us if you have any questions" he said flatly, unimpressed by my jabs at our profit driven private health care system.

In the first 19 months of the I-Save Rx program nearly 18,000 orders for prescription medicine were placed made by the residents of Illinois, Wisconsin, Kansas, Vermont and Missouri. Illinois has had the highest number of participants, with nearly 4,000 unique individual orders for medicine placed. That's nearly 4,000 participants willingly violating the federal law.

Let's look at those numbers again: nearly 18,000 orders. Is that underutilization?

That's near to the population of Hinsdale. It's close to the population of New Lenox, Palos Heights, Prospect Heights and many other Illinois cities. The 4,000 Illinois residents who have ordered medicine to date through the I-Save Rx program are equal in number to the populations of Aledo, Illinois, or Baldwin, or Barrington Hills, or Cairo, or Knoxville. Entire cities of people are reaching out for affordable healthcare, "knowingly violating the federal law" in most cases to manage their health, and in some cases to save their own lives.

Saturday, September 30

I go online to the I-Save Rx website again.

I do extensive research on the program, and also consult two of my friends who practice law. I fill out the Authorization for Prescription Transfer form, The New Customer Agreement form, and the New Patient Profile form.

I'm given a choice of countries. I select Canada as my country of choice for drug fulfillment. New Zealand is friendly in my American mind but I assume they'd take their time. The UK seems to still think we actually voted Bush into office and continues to hold a grudge, so I wanted to avoid them altogether. I thought the Australians might not ever get around to filling the prescription at all.

So I select our rational, sensible friends to the North. Canada will send me affordable medicine. I can count Canada. They are kind and healthy because they vacation more than us. They can be trusted to send me my medicine.

I agree to the Customer Agreement. It's a long contract and contains lots of words in very small print. I feel protected by the governors of the five states who endorsed this program. I am confident that we would all be imprisoned together.

Of the three medicines I need, I-Save Rx only has one available for fulfillment. It happens to be Astra Zeneca's top seller. I win the health care lottery! My illness is du jour, en vogue, hip. I've made the formulary! Now I'm online and battling my hip illness with hip, web-savvy expertise! I'm surfing to save myself. I'm reaching out to international friends in the name of medicine! I'm using my computer skills to better my situation and save money!

I order a three-month supply of the medicine.

01082007_pills.jpg

The Medication Pricing Form is next. It calls for my medical history, current medications, doses, allergies, pharmacist, physicians, billing information and shipping information. The price comparison charts reveal an accurate savings table for reference. Through I-Save Rx, a three-month supply of my medicine from Canada costs about $200. In the United States they list the estimated cost as at $600.

I visit Walgreen's the same day to investigate what the cost of my medicine would be without insurance and the pharmacist quotes me $720 for a three-month supply.

Let's consider those numbers again. For three months of medicine:
Canadian pharmacy cost: approximately $200
United States cost: approximately $600
United States pharmacy cost: $720

I submit all the forms electronically to Pegasus Health Services in Calgary, relying on their chosen company called Thawte to secure my records online. I say a prayer to the encryption gods that they are protecting my most private and sensitive records online. My instincts tell me not to release anything of the sort online, but I "send" in the name of affordable health care. And in a split second virtually all of my personal records and my medical history are catapulted into the virtual stratosphere. After the click of a mouse, I put my head down on my desk in fear. I submit an email to I-Save Rx inquiring about credit card authorization and I request a receipt or email confirmation of the final transaction.

I never receive a reply.

The process of reviewing the website, and filling out the forms takes nearly three hours.

Monday, October 2

I go to Walgreen's to pick up my usual monthly prescriptions.

Each of my three medicines cost $15 with my insurance co-pay. The I-Save Rx program doesn't offer the two other medicines I need, so if I was uninsured the program wouldn't be a solution for me. Also, if one is uninsured, it's often cost prohibitive to afford the physician visits needed to obtain prescriptions. Out-of-pocket costs for the uninsured include the need for periodic mammograms, preventive dental check-ups, annual physicals and any other medicine one might need. Prescription drug programs do not, unfortunately, qualify as health care. But I wanted to go through the process as if I was uninsured to see where the obstacles and pitfalls were in the program.

How would someone without access to the Internet navigate this program and how long would it take to be processed with the paperwork requirements and snail mail demands? I email a question to I-Save Rx about confidentiality online and wait for a response. I never receive a response.

Later that day I fax a letter to my physician requesting a three month prescription of the one medicine for I-Save Rx. He writes the prescription and I pick it up from his office.

Tuesday, October 3

I send my prescription via snail mail to Pegasus in Canada. I send it through the mail to hoping it doesn't get lost or misdirected in the mail. I wait a few days and in my sleep am haunted by a recurring dream with millions of prescriptions raining from the sky along with red, white and blue colored frogs.

Monday, October 9

I call the I-Save Rx to determine if my prescription had reached them.

"Not yet," they tell me.

"Wait a while longer. These things take time," they say.

Wednesday, October 10

I receive a call at work at 8:58 in the morning.

"Hello?"

"May I ask who is calling?"

"Louise...?"

"From Pegasus Health Services in Calgary, Canada ...right."

"Verify my medical records ...right."

It sounded as if one of Bob Barker's showgirls was at the other end of the line, but her head appeared in my mind's eye like one of the subjects in an Aphex Twin video. She spoke to me with the familiarity my sister might exude. She asked me about my illness and my medicine and my address and my history and my physician and to confirm my physicians' phone and fax number and many more questions I can't recall because I was only midway through my first cup of coffee.

"Louise?" I said softly. "What is your title?"

"My title?" she asked.

"Yes. Are you... an assistant to the pharmacist?

"No."

"Are you a nurse or a nurse's aid or a health care professional of some sort?"

"No."

"An administrator then?"

"No," Louise responded enthusiastically. "I'm a Cyber Agent!"

Agent Cybernétique, I thought. In my mind Louise transformed into a mutt between The Terminator's Linda Hamilton, Dick Cheney and Kimpossible. Louise was flying high though the phone lines of North America saving the medically bankrupt and uninsured in the U.S. by offering the promise of affordable medicines and audible sweetheart smiles. And as she landed with two feet firmly planted on my desk at work, hands akimbo, the glow of socialized philosophy and universal health care policy and best practice all around her, I gave her all of my medical history, my personal information, confirmation on my Authorization for Prescription Transfer, my Customer Agreement and my New Patient Profile without blinking an eye, in hopes that we would someday have the sensibilities and promise of our fairy cyber agent Louise.

"Thank you Kimberly. I look forward to working with you again," she said as she flew away wearing a magical headset and waving her pen. "You'll have the medicine within seven to 10 days" And she flew from my desk with the healthy skin only a Canadian could have in October.

The deal was closed. My medical information was now in the hands of a Cyber Agent named Louise and anyone with access to the Internet, I'd bet. I felt sick.

"Seven to 10 days," she said.

And so, I wait.

Thursday, October 26

Today it finally arrived. Wrapped in a shiny, waterproofed Express Post Package from Calgary Canada. There was also an "Official Prescription Receipt" with a bright pink sticker on it that said "RUSH." Although I had specifically requested that they not rush the order, evidently it was rushed anyway. Strange to wait so long for a "RUSH" package. Below that form is the "Refill Request" form and below that is information on how to use the "Total Care Pharmacy" program again. There are also four pages of information about my medicine and a copy of the original prescription that had been written by my physician here in Chicago.

Friday, October 26

I check the dosage, the ingredients and the inactive ingredients on the label. I check the DIN number and the Rx number. I check the address of the pharmacy. I check the manufacturer's name and logo. And then, while seated on the edge of my bathtub, I willfully violate a federal law. In the name of the Prescription Drug Reimportation Revolution I peel my prescription label off of the bottle, stick it high on my index finger, and wave my flag at the reformists and incrementalists who legislate the systematic denial of affordable health care in the United States. I raise my glass of water, toasting my healthy friends to the North and the governors who have so boldly set precedent with I-Save Rx.

I swallow my daily dose of medicine, straighten up, take a deep breath, and wait.

 

About the Author(s)

Kimberly Soenen writes from Chicago. She is currently at work on "Sin Alma," a collection of essays about our failed healthcare system.

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