In late July, the Canadian supplier for the program, Winnipeg-based Total Care Pharmacy, sent a letter to city officials saying the firm was terminating its agreement because there were so few participants. When the last Canadian drugs from the company are shipped to Boston retirees in December, it will mark the quiet end to an initiative that generated headlines for Menino.
Menino administration officials blamed the end of the program on a lack of interest from city retirees eligible to participate.
"If things are grossly underenrolled, that's the market saying they're not really interested in that product," said Meredith Weenick, the city's associate director of administration and finance.
Boston's experiment with Canadian prescriptions has been mirrored in other parts of the country. After a wave of interest, sparked in large measure by then-Springfield Mayor Michael Albano's 2003 move to give city employees access to Canadian prescription drugs, most of the city and state programs have died down, said Gabriel Levitt, vice president of New York-basedPharmacyChecker.com, which helps patients find safe Canadian pharmacies online.
In 2006, Springfield decided to stop offering its own health insurance coverage, including the Canadian drug importation program, and saved more money by enrolling employees and retirees in the state's Group Insurance Commission. The decrease in interest in Canadian supplies nationally was driven in large measure by the new Medicare prescription drug benefit, which provided seniors a lower-cost alternative for domestic drugs, Levitt said.
"You see a diminishing market of seniors who are shopping from the Canadian online pharmacies," Levitt said. "Add to that, the competitive prices of generic drugs in the US and a growth of generic drug programs."
Brand-name Canadian drugs are typically cheaper than the same products in the United States because of national price controls in Canada, but studies have shown that generics in the United States are often less expensive than Canadian prescriptions.
Menino launched his pilot drug reimportation program in July 2004, less than a week before Boston hosted the Democratic National Convention and about a year after Springfield started the trend. The city made the Canadian option available to a group of about 2,500 city retirees.
But while Springfield officials said they saved as much as $3 million a year by making Canadian drugs available to all city employees and retirees, Boston saved, for example, just $4,300 in 2006 on a total of 73 prescriptions. When Total Care decided to end its relationship with the city, only 16 Boston retirees were still participating.
Menino press secretary Dorothy Joyce said the program's end was not for lack of effort by the mayor.
"The mayor himself went out to the neighborhoods to present it, and he was a strong supporter of this program," she said. "In the end, people decided this wasn't what they wanted."
Albano said he was not surprised that Boston's effort never really got off the ground. Springfield waived the copayment on Canadian pharmaceuticals as an incentive for its employees and retirees to participate. Boston participants who chose the Canadian option still had a copayment, although it was less for a three-month supply than the city's regular plan.
"There was really no incentive in Boston that I could see other than to help the city save some costs on prescription medication," said Albano, now a consultant to political campaigns and businesses. "I'm surprised even 16 people participated."
Boston City Council member Michael Ross said he believes the city was forced to abandon the program because of federal pressure. The Food and Drug Administration strongly opposed efforts by cities and states to offer Canadian prescription drugs, saying the suppliers were not regulated by the United States and that the safety of the drugs could not be guaranteed.
"We're being forced to buy into a system that rewards drug companies and punishes individual payers and municipalities and taxpayers," said Ross, who has called for a hearing on what went wrong with program. "The idea was to grow the program, but the program was never allowed to get off the ground."
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