As acts of rebellion go, it's mostly a matter of symbolism - more like the Boston Tea Party than the battles of Lexington and Concord - but more and more states are trying out some form of civil disobedience on the pharmaceutical front. They keep looking for new ways to flout federal law by encouraging citizens to purchase less expensive prescription medication from abroad.
The federal Food and Drug Administration, of course, has issued regulations that are supposed to prohibit them from doing this. It says it can't guarantee the safety and reliability of drugs bought from other countries. But most states have been skeptical of this reasoning, and their incipient rebellion was given renewed momentum earlier this year when Congress failed to enact legislation that would have created a system allowing the importation of cheaper prescription medication from Canada and other Western industrialized countries under controlled regulatory conditions.
The proposed law, which was strongly opposed by U.S. pharmaceutical interests and by the White House, died in the Senate in spite of some important Capitol Hill converts to the cause. In an column explaining his conversion, Mississippi Republican Trent Lott noted: "I can no longer explain to my 90-year-old mother why her medications cost more than the same drugs from other countries."
That cost disparity - which is as high as 60 percent in some cases - is why a dozen states are trying harder than ever to accommodate cross-border purchases in ways that skirt the rules of the Food and Drug Administration.
Not all the state efforts amount to brazen defiance of the federal government. Some of them are merely non-binding resolutions calling for an end to the federal ban on imports. But some of them go quite a bit further, such as the 2005 Maine law establishing a program for residents who are over 62 years old and/or disabled that allows them to buy drugs from out of state or over the border, if they can save money that way.
By far the most common acts of disobedience, though, have been state legislative and executive efforts aimed at helping residents (and, not incidentally, state employees in some cases) access foreign pharmaceuticals via the Web.
About a dozen states have gone the Web site route, and five of them - Illinois, Kansas, Missouri, Vermont and Wisconsin - have gone so far as to coordinate their Web-based purchasing accommodation through a uniform site known that is known as "I-SaveRx (www.i-saverx.net).
Two states, meanwhile, have taken an even more direct thumb-in-the-fed's-eye approach to offering their citizens access to foreign pharmaceuticals. Rhode Island and Nevada both have laws allowing Canadian pharmacies to register with their respective state pharmaceutical boards, provided that the foreign pharmacy lives up to the same licensing and inspection requirements as other domestic and in-state pharmacies.
The Nevada and Rhode Island rebellions are particularly interesting because they directly address the issue of safety.
Both states have approved Canadian pharmacies only after those pharmacies were inspected. The Nevada law restricts the medications that can be imported to pills, maintaining a ban on injectables and other medications that might have to be refrigerated. Nevada also requires that the imported drugs meet FDA standards. As of last year, the state had licensed four Canadian pharmacies. One of the supporters of the law, state Assembly Minority Leader Barbara Buckley, said it will allow Nevadans to buy safe drugs at greatly reduced cost "while we wait for the federal government to do something."
Nevada Attorney General George Chanos opposes the scheme - he has issued an opinion that the program should not proceed because the Canadian drugs in fact don't meet FDA standards. But Chanos' opinion is non-binding; he can't prevent the Canadian pharmacies from being certified.
As prescription drugs continue to be one of the most significant drivers of health care costs, and as constituents clamor for access to less expensive medication, "waiting for the federal government to do something" is an option that fewer states are going to view as viable. And so it shouldn't be much of a surprise if the state rebellion on imported drugs continues to spread.