PLAINSBORO, N.J. -- Worried about her elderly parents' struggles to pay for a dozen prescription medications each month, Karen Azarchi started researching how to get them cheaper from Canada.
She heard about other senior citizens skipping medication doses because they had little or no prescription coverage and couldn't afford the expense.
''It struck a nerve,'' Azarchi said, so the Trenton native decided to try to help, suspending her business as a computer software consultant.
In July, Azarchi opened Medications4-Less, which transmits orders from customers to mail-order pharmacies in Canada, where government price controls limit costs to patients. The two mail-order pharmacies with which Azarchi is affiliated ship medicines directly to her customers at savings of 30 percent to 85 percent off those of major U.S. drugstore chains, she said.
''Seniors are scared, but they have to do it because they can't afford their medicines,'' Azarchi said. ''The calls that I get, the people crying on the other end. One woman said she had to sell her house'' to pay for her prescriptions.
Some people calling Azarchi's toll-free number to inquire about the business have told her they pay as much as $1,500 a month for prescriptions.
''I'm cutting them in half,'' said Azarchi, who runs the business out of her Plainsboro townhouse. She claims several hundred customers, who can order through her Web site or call to have an order form sent to them.
American pharmaceutical companies say their prices are justified by their huge research costs. Their trade group, Pharmaceutical Research and Manufacturers of America, vigorously lobbies against any legislation to allow mass reimportation of drugs or speed availability of generic equivalents. It has been running newspaper ads on the dangers of ordering drugs via the Internet and now lobbies for Congress to enact prescription coverage under Medicare, a dwindling prospect this year.
AARP spokesperson Stephen Hahn said getting lower-cost drugs from Canada now is valuable for some people, but ''the Medicare drug benefit will do the most to lower drug costs'' for seniors.
The Food and Drug Administration has long allowed people to import a 90-day personal supply of drugs not available in this country, but warns of possible dangers.
''It's kind of buyer beware when you're ordering from an Internet site,'' said Thomas McGinnis, FDA's director of pharmacy affairs. ''You don't really know what you're getting.''
FDA has been working with the U.S. Customs Service and Canada's national health service to try to limit the flow of medications from there to here. The U.S. government has prosecuted operators of dozens of Internet drugstore sites, primarily ones offshore that don't require prescriptions or sell phony drugs.
Under FDA rules, U.S.-based Internet pharmacies must have licenses in states that require them.
In New Jersey, such a license is required only for those who actually dispense prescriptions, so Medications4Less is exempt, said Genene Morris, a spokesperson for the State Board of Pharmacy.
Azarchi said she interprets the U.S. law as allowing patients to import drugs for terminal illnesses, which technically covers her mostly elderly clientele. But she concedes that FDA would probably view her operation as illegal.
''I consider what I do to be a service,'' she said. ''I'm not in this to make big money.''
Azarchi said she is still losing money and living off her savings, but hopes to be turning a small profit within six months.
Many Internet pharmacies sell potentially dangerous drugs without prescriptions and send unsolicited ads to thousands of e-mail accounts, but Azarchi said she does not. Medications4Less does not handle narcotics, drugs for acute conditions such as infections, or orders sent without an American doctor's prescription.
The order form asks customers to list their medical conditions, other drugs they take, medication allergies, and height and weight -- to ensure correct dosage for some drugs. A physician in Canada reviews the information, checks it with the American doctor if needed, then writes a new prescription; Canadian pharmacies can only fill prescriptions written by doctors licensed there.
Medications are shipped in sealed, original bottles from U.S. and Canadian manufacturers. Azarchi said that reassures her customers that the drugs are not tampered with, counterfeit or expired -- concerns U.S. health and safety officials have repeatedly stressed in opposing legislation to allow mass reimportation of drugs from other countries.
Hu Warden, an 81-year-old retired architect in Dallas, just reordered a 90-day supply of six medications he takes for heart trouble, high cholesterol, an ulcer and other ills. He searched the Internet for medicine from Canada on his internist's advice after the stock market plunge cut his nest egg in half, forcing him and his wife to tighten their belts. Warden said last week that Medications4Less is saving him about half the $600 per month he had been spending.
''It's a good company to do business with, as far as I can see,'' Warden said. ''Everything is just like I get here, except two of them have a different label'' because they are generic rather than brand-name drugs.
Warden said Azarchi provides excellent service and he always gets to speak with a person immediately when he calls.
Michael Vetri, a 46-year-old father of four from Boothwyn, Pa., turned to Medica-tions4Less because his health plan has no prescription coverage. The real estate investor was paying $500 a month for a drug for a nerve condition that gives him constant, intense facial pain, despite two surgeries.
''Medications4Less had probably the cheapest prices I found'' after searching the Internet for alternatives, Vetri said. ''I just think it's preposterous that the drug is manufactured here and you have to go to Canada to get a fair price.''
On the Net:
Food and Drug Administration: http://www.fda.gov
National Association of Boards of Pharmacy: http://www.nabp.net
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