Illinois drug import program falls flat with doctors

When Illinois Gov. Rod Blagojevich unveiled the "I-Save Rx" program in October 2004, he did it with great fanfare, touting it as the nation's first state-sponsored program that not only helps patients order low-cost prescription drugs from pharmacies in Canada and Europe but also ensures the medications' safety and quality.

Since then, Illinois has worked steadily to expand the program, despite the federal ban on prescription drug reimportation. Congress came close to lifting the ban this year but stopped short, opting instead to approve an amendment that prevents the U.S. trade representative from including language in future trade agreements that explicitly prohibits reimportation.

Meanwhile, the Illinois-led, multistate program continues to enlarge its supplier network, which now includes pharmacies in Australia and New Zealand, and to welcome other states into the fold. So far, Wisconsin, Kansas, Missouri and Vermont have signed on to "I-SaveRx," and more states, including Tennessee and Michigan, are considering it.

But despite the national publicity the program has attracted, physicians' support for "I-SaveRx" appears to have declined. Doctors who were once enthusiastic about the program say they no longer recommend it to patients who are seeking affordable prescription drugs. Few prescription orders have been processed under the system.

The Wisconsin Medical Society opposes "I-SaveRx" because of safety concerns, despite the program's multiple safety checks that include annual inspections of all pharmacies and wholesalers in the network. "There is no assurance that the drugs are what they are purported to be," said WMS spokesman Steve Busalacchi. "So our medical society has advised its members not to participate."

But doctors in Illinois, where the state medical society has not taken a position on the program, say their support has waned primarily because they have received little or no information about how it works or how to help patients use it, and because patients who have tried to order drugs through the system have found it far too confusing.

The program "seemed like a good idea," said Matthew Johnson, MD, a family physician in Park Forest, Ill. "But my patients who looked into it got frustrated very quickly and gave up on it."

Dr. Johnson estimates that as many as 15 of his patients tried to order drugs through the program during the past year but were unsuccessful. "Every single one that I know of ended up giving up or dropping out because it either wasn't saving them as much as they expected or it was too confusing for them," he said.

When patients told him they had encountered difficulties with the program's Web site, Dr. Johnson tried to use it himself but found it just as confusing as they did. "It seems simple on the surface, but it's difficult to navigate. I got flummoxed pretty quickly."

The experience was disappointing because the program had seemed like such a good opportunity to help patients gain access to affordable medication, said Dr. Johnson. The Illinois governor's office says "I-SaveRx" -- which is open to all residents, regardless of income -- offers average savings of between 25% and 50% on the cost of the most common medications for chronic conditions.

Illinois has tried to make the enrollment and ordering process user-friendly, said Abby Ottenhoff, a spokeswoman for Blagojevich. "But you're dealing with different currencies and different dispensing numbers for the different countries, so it is somewhat complicated," she said.

Still, patients who want to order medication through the program shouldn't find it impossible, said Ottenhoff. If they have trouble, she said, they can call the program's toll-free hotline for help. "We're actually right now in the process of revamping the Web site to make it more user-friendly," she said. "And hopefully, that will avoid any future confusion. We want it to be easy."

Information lacking

But some physicians said they and their patients haven't even gotten as far as the Web site or the hotline because they know so little about the program at all.

"I don't know any of the details," said Patrick Tranmer, MD, MPH, who chairs the Family Medicine Dept. at the University of Illinois in Chicago. "I have no experience with it."

Dr. Tranmer said he's surprised he hasn't heard more about "I-SaveRx," given that he's very familiar with other opportunities to help patients cover their medication costs.

"I take care of patients from all walks of life, with all kinds of insurance, and I'm exposed to everything else that's out there -- all of the patient questions and concerns," he said. "But I've heard nothing from patients on this."

Ottenhoff said the Illinois governor's office sent a letter to some 40,000 physicians in the state during the program's first few months. The letter was intended to introduce doctors to the system and it included copies of the enrollment kit so doctors would know what it looked like, she said.

But Dr. Tranmer said he wasn't aware of having received any information that was targeted to physicians. "I don't know who they're targeting, but they're not targeting me, as a practicing physician, to try to get patients aware of it," he said.

The program hasn't been marketed well to patients either, said Mark Macumber, MD, a family physician in solo practice in Chicago. About 80% of his patients are uninsured, and many have trouble affording their medications, he said.

Dr. Macumber has tried to encourage his patients to use "I-SaveRx" but has found that they don't understand what it is or how it works. "I don't think I've had a single patient who has actually taken advantage of it."

In response to the criticism, Ottenhoff points out that there must be some patients who are using the program because "I-SaveRx" has processed more than 16,200 orders to date. Most of those orders have come from Illinois, she said. By comparison, retail pharmacies in Illinois alone filled more than 141 million prescriptions in 2003, according to Verispan LLC, which collects prescription data.

Ottenhoff said the Illinois governor's office and state agencies had tried to publicize "I-SaveRx" through grassroots outreach, including partnering with labor and senior organizations that have helped get the word out to their members. But there hasn't been a large marketing effort to promote the program, she said.

"We've done some letters and some photocopying and things here out of our office, but it's really been pretty minimal," she said.