USA/CANADA (By Jane Bryant Quinn, Newsweek) Sept 27, 2004 - You're in trouble if you have to buy your own brand-name prescription drugs. Over the past decade, prices leaped by more than double the inflation rate. Treatments for chronic conditions can easily top $2,000 a month—no wonder that one in four Americans can't afford to fill their prescriptions. The solution du jour? A hearty chorus of "O Canada." North of the border, where price controls reign, those same brand-name drugs cost 50 percent to 80 percent less.

The Canadian option is fast becoming a political wake-up call. If our neighbors can buy health-giving drugs at reasonable prices, why can't we? Even to whisper that thought brings the furies down. "Socialized medicine!" "Un-American!" And—the propagandists' trump card—"Wreck our brilliant health-care system." Supersize drug prices, they claim, fund the research that sparks the next generation of wonder drugs. No sky-high Lipitor price today, no cure for cancer tomorrow. So shut up and pay up.

Common sense tells you that's a false alternative. The payday for finding, say, a cancer cure is so huge that no one's going to hang it up. Nevertheless, if Canada-level pricing came to the United States, the industry's profit margins would drop and the pace of new-drug development would slow. Here lies the very nub of the American dilemma. Who is all this splendid medicine for? Should our health-care system continue its drive toward the best of the best, even though rising numbers of patients can't afford it? Or should we direct our wealth toward letting everyone in on today's level of care? Measured by saved lives, the latter is almost certainly the better course.

Which brings me back to low-cost Canadian drugs. The sainted American drug industry, together with the Bush administration, doesn't want you to have them.

The drug companies, defending their profits, employ "Godfather" muscle. They've warned Canadian wholesalers and pharmacies not to sell to Americans by mail, and are cutting back supplies to those who dare.

Meanwhile, the administration is playing the fear card. Officials from the Food and Drug Administration will argue, at the drop of a hat, that Canadian drugs might be counterfeit, adulterated, mishandled, even a potential tool of international terrorism. Anthrax in a Paxil bottle. Funny, I recently spent a weekend in Canada and their pharmacies didn't look like Al Qaeda's caves to me.

Do bad drugs fly around the Internet? Sure—and the more we look, the more we'll find. But I haven't heard of any raging epidemics among the hundreds of thousands of people buying cross-border.

Please remember: this story isn't about unapproved or ineffective drugs. These are all popular brand names. By law, only manufacturers can import them. By custom, the FDA won't roll up grannies who import "illegally." But, in what amounts to a civil-disobedience action, cities and states are finding ways around the law. Municipal workers in Burlington, Vt.; Montgomery, Ala.; Portland, Maine, and Springfield, Revere and Worcester, Mass., can now buy Canadian drugs through their employee plans, says Neva Kaye of the National Academy for State Health Policy. Official Web sites in New Hampshire, Minnesota, North Dakota, Wisconsin and San Francisco link drug buyers to Canadian pharmacies. Politically, they carry weight.

Most users of prescription drugs don't worry about costs a lot. They're cosseted by employee insurance, owing just a $20 copay. The financial blows rain, instead, on the uninsured, especially the chronically ill who need expensive drugs to live. This group will still include middle-income seniors on Medicare, who'll have to dig deeply into their pockets before getting much from the new drug benefit that starts in 2006. How to control your costs:

Get a Medicare drug-discount card. They range in price from ZEROto $30 a year and are good through 2004. Sign up at medicare.gov (this site compares the various cards, which don't all cover the same drugs) or by calling 800-MEDICARE.

Get a drug-company card for low-income seniors. You'll find them, plus a list of state programs, at RxAssist.org. For a card for the low-income uninsured regardless of age, check pfizerhelpfulanswers.com.

Buy generics. They're especially cheap in the United States, usually beating the Canadian brand-name price.

Shop for low prices. Drugfeedback.com compares prices of drugs at different U.S. online pharmacies.

Shop Canadian. Prices up north are often cheaper than you can get from discount cards. Choose a site that requires a prescription from your doctor and follows Canadian safe-drug procedures. Possibilities include CanadaDrugs.com, DoctorSolve.com, CanaRx.com, Universal Drugstore.com and HometownMeds.com.

The Big Scare for drug companies isn't really Canadian imports, despite all the noise they've made. It's the threat that the government will step in to negotiate prices once the new Medicare drug benefit gets underway next year. The Feds already negotiate prices for Veterans Administration insurance and pay about the same as the Canadian price, says Bill Hubbard, an FDA associate commissioner. Wouldn't it be nice if the rest of us could, too?