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Bush Accused of Influencing Canada on Drug Exports

Mail-Order Industry Says U.S. Is Behind Health Ministry's Plans to Curb Inexpensive Shipments to Americans

By Doug Struck
Washington Post Foreign Service
Friday, January 7, 2005; Page A13

TORONTO, Jan. 6 -- The Canadian health minister plans to restrict the supply of inexpensive prescription drugs shipped to about 2 million patients in the United States each year, and industry officials here are saying President Bush is behind the move.

Bush "is getting Canada to do the dirty work" of shutting down a cheap supply of foreign-made drugs that are popular with American consumers but unpopular with U.S. drug companies, charged David MacKay, executive director of an association of Canadian mail-order pharmacies.

A White House spokesman, Trent Duffy, said Bush "did not make any suggestions on what Canada should do" about the mail-order drug industry. But Duffy said by telephone from Washington that the issue was discussed at a Nov. 30 meeting in Ottawa between Bush and Prime Minister Paul Martin. Canadian officials confirmed this account.

Since then, Canada's health minister, Ujjal Dosanjh, has stepped up his criticism of Canadian firms that supply mail-order prescription drugs. His spokesman, Ken Polk, confirmed Thursday that Dosanjh planned to ask "in the next couple of months" for regulatory restrictions on the industry. MacKay and others asserted that the changes would shut down their industry, but Polk denied that was the intent.

"The intention is to create a regulatory framework in which Canadians can be assured the business is being done ethically and that they need not worry that the [U.S.] demand for drugs threatens the Canadian drug supply or price," Polk said in a telephone interview from India, where Dosanjh is reviewing tsunami relief efforts.

Last year, at least 1.8 million Americans sent prescriptions written by U.S. doctors to Canada. The prescriptions were reissued by Canadian physicians, and the medicines were then mailed to the U.S. consumers, at a cost typically 30 to 40 percent cheaper than at U.S. drug stores.

U.S. drug companies have chafed at the arrangement, saying it undercuts their market. But officials in several U.S. states and cities have encouraged people to shop in Canada for low-cost prescriptions.

The Bush administration has questioned the safety of getting prescriptions filled in Canada. An administration panel studying the matter concluded that there was "a significant and untenable risk to Americans" who send prescriptions north of the border, Duffy said.

Canadian authorities reject that concern, saying Canadian pharmacies are tightly controlled and regulated. But health officials here worry that Canada's pharmacies could be overwhelmed if the doors are open to the huge American market.

"It's common sense that Canada, with 33 million people, cannot be the drug store for 295 million Americans," said Polk, the Health Ministry spokesman.

He said Dosanjh is considering asking the cabinet to create a list of drugs that could not be exported if there were a shortage in the country. Dosanjh also might prohibit Canadian doctors from rewriting prescriptions for patients outside Canada.

Those changes would likely "shut us down," said Andy Troszok, president of the Canadian International Pharmacy Association, which represents 35 major mail-order pharmacies. He said Canada's Health Department was supportive of the four-year-old mail-order industry until Bush came to Ottawa.

MacKay said Canadian authorities "turned on a dime" after that meeting. He said he has learned that "President Bush threw out an ultimatum," demanding that Canada shut down the mail-order sales, possibly in exchange for U.S. concessions in lifting the ban on imports of Canadian beef. He said Bush did not want to publicly oppose the sales because many U.S. senior citizens and members of Congress are fans of the lower prescription prices.

But spokesmen for Martin and Bush denied that the president made any demands of the prime minister. White House press secretary Scott McClellan, speaking at a news conference in Washington, called MacKay's charges "nonsense," while Polk said "no such pressure was put on whatsoever."

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