Delray Beach, Fla. Mary Jane Gregory walked out of Discount Drugs of Canada with a 33 percent savings that outweighed any doubts she might have had about using the new store, which gets her prescription filled in distant Winnipeg.
"I don't know whether it's illegal or not, but it's right out here in the open," said Gregory, 71, who takes medicine for osteoporosis. "How bad can it be?"
Shopping for cheaper foreign drugs is not a new idea: Americans have done it discreetly through Web sites and excursions to Canada and Mexico in recent years, as regulators look the other way at an activity that is technically illegal.
But buying and selling now have moved into small storefront operations that are cropping up across the country.
Pharmacies are unhappy about it, but regulators do not yet seem ready to crack down on buyers, many of whom are older people on limited incomes.
Drug sales are required by law to be conducted by licensed pharmacies, and importing drugs by mail is illegal. Federal regulations allow travelers to bring in a 90-day personal supply of drugs, but only if the medications are not yet approved for sale in this country.
Providing a service
Earle Turow, who opened Discount Drugs two months ago in a busy medical center, insists he is not breaking any laws because his store does not import or stock the medications people order. His store takes orders from customers and faxes them to a Canadian pharmacy, which then charges customers' credit cards and ships the drugs to their doors.
"We are strictly providing a service that people need," Turow said.
Turow said his customers save between 10 percent and 90 percent. In the case of Gregory, who is from Deerfield Beach, the drug she takes for osteoporosis costs her $130 for a three-month supply from Canada. At a U.S. pharmacy, the same money gets her only two months' worth.
Similar ventures in Atlanta, Scottsdale, Ariz., and at the Mall of America near Minneapolis, among other places, are attracting thousands of Americans -- many of them retirees -- who take prescription medicine regularly and have little or no insurance coverage for the drugs.
In Florida, there are operations in Fort Myers, Orlando and Naples. John Taylor, executive director of the Florida board of pharmacy, declined to say whether it is investigating Turow's company or others like it.
A booming business
The Food and Drug Administration, which oversees the pharmaceutical industry, said its enforcement resources are focused on large commercial drug shipments and not mail-order imports by individuals.
The FDA admits the foreign prescription business is booming and estimates that at least 2 million personal shipments of drugs will cross the nation's borders this year, twice as many as last year.
"I don't see what's illegal about getting something for cheaper somewhere else," said Mabelle London, another customer at Turow's shop.
London, 87, of Boca Raton, takes Plavix, a medication that helps prevent strokes. She pays $184 for 90 pills to get them through Discount Drugs. Her local pharmacist charges $357.
FDA officials warn that imported drugs could be contaminated with impure or unknown ingredients, and note that the pharmacies that dispense them are not under any U.S. supervision.
"What we are afraid of is when consumers are going outside the United States, they might be getting these risky drugs and suffer some serious and severe side effects," said Tom McGinnis, FDA pharmacy affairs director.
But many of these drugs are the same ones manufactured for sale in the United States. They are cheaper in Canada because of government caps on drug prices and because the U.S. dollar has more buying power in Canada.
Turow, a 72-year-old retired clothing manufacturer, said at least 300 people are placing orders each day at his store.
The practice of cross-border buying is gaining credibility.
Some pharmacy-benefits programs are moving to cover drug purchases made in Canada. UnitedHealth Group, the country's biggest health insurer, recently told the senior citizens lobbying group AARP that it will reimburse members of a benefits plan for prescriptions filled in Canada and other nations.