Shirley Erwin often works more than 100 hours a week for four different employers. But the Kansas Association of Public Employees (KAPE) member just can’t get ahead.

Erwin is not living above her means. She and her husband Albert, who also works full time, are raising two sons in southeastern Kansas. One son has a number of medical conditions, including Tourette’s syndrome and oppositional defiant behavior, which require prescription medication.

The hitch: Despite Erwin’s prescription drug coverage through the state, her primary employer, she pays more than $200 a month out of pocket for prescription drugs—and that is just for her son’s medication.

“Because I have a child with special needs who has to take the name brand medications, I have to pay 60 percent of the cost,” says Erwin, who has worked at the Parsons State Hospital for 19 years. “We tried taking him off the medication once—started weaning him off—but then we started having problems.”

The prescription benefits provider for Kansas state employees is AdvancePCS, which excludes Stratterra, one of the medications Erwin’s son takes daily, from its formulary list. If Erwin worked in Pennsylvania, however, not only is Stratterra on the National Prescription Administrators/Express Scripts Inc. (NPA/ESI) formulary list for state employees, it would cost her only $18 if she bought it at an NPA/ESI participating pharmacy because no generic exists.

The two-state comparison, however, is not to say that the prescription drug plan for Pennsylvania state employees is perfect. Randall Tenor, second vice president of the AFT Public Employees Pennsylvania affiliate, the Federation of State, Cultural and Education Employees (FOSCEP), has degenerative arthritis. His doctor has prescribed Celebrex. But Celebrex is not on the list of drugs covered under the prescription drug benefit program for employees.

As Tenor waits for the Pennsylvania Employees Benefit Trust Fund to respond to his request for an “exception,” which means Tenor would not have to pay the entire cost of the prescription out of pocket, he takes Tylenol, which is not comparable. “With my degenerative arthritis, I need something very powerful,” Tenor says. “I’m always in some discomfort.”

While Tenor is fighting for prescription drug coverage on a personal level, he also is working with FOSCEP to challenge a more widespread issue at his workplace. Effective Aug. 1, 2003, NPA/ESI dropped coverage of such popular allergy medicines as Allegra, Zyrtec and Clarinex, which means state employees taking these medications have to foot the entire bill.

That’s a problem for many, especially FOSCEP members working at the State Library of Pennsylvania in Harrisburg, where Tenor works. “There are people who work at the library who have allergies and believe that the library is the cause,” says Tenor. “I don’t know if it is from working in the building, but it certainly doesn’t help matters working here.”

Tenor has worked at the library, which was built in 1931, since 1974. “The commonwealth has not maintained it environmentally,” Tenor says, noting that several years ago, the lower stacks were closed for cleaning because of a mold problem. As for the rest of the stacks housed in the six-floor building, Tenor says the state “does a minimum of what it needs to do.”

Affordable prescriptions is a public policy issue

Access to prescription drugs is, in the most serious case, a matter of life and death. At the least, it is a matter of comfortable living. For FOSCEP members working at the state library, it’s even a matter of comfortable working.

“Dust and mold are natural in their work environment,” says FOSCEP president Judy Green, “and wearing a mask is not an acceptable remedy. Our way of combating this is having all the librarians apply for work-related disability. In that case, all of their medications would be covered.”

Delegates to the AFT national convention in 2000 passed a resolution calling for increased access to prescription drugs, including federal support to control their escalating cost. AFT affiliates have taken that resolution to heart—doing their part to move the issue into the public policy arena.

In fact, the North Dakota Public Employees Association (NDPEA), an affiliate of AFT Public Employees, is among the union’s affiliates with the most recent success. Last fall, NDPEA called on the  state’s Interim Legislative Committee on Employee Benefits Programs to study a Canadian drug purchasing program for state employees and retirees. Within weeks, the committee agreed.

NDPEA’s call for affordable prescription drugs was heard at the national level, as well. U.S. Sen. Byron Dorgan, a Democrat, proposed the Prairie Prescriptions Pilot Project in January. The initiative, which has been submitted to Tommy Thompson, U.S. secretary of health and human services, would allow North Dakota licensed pharmacists and wholesalers to purchase prescriptions from licensed Canadian pharmacies and wholesalers. In theory, the cost savings would be passed on to consumers. Sen. Dorgan said the program could save individual consumers, along with state and local governments, employers and health plans, as much as $81 million a year.

Grassroots action starts paying off

Sen. Dorgan is not the only elected official trying to force the Bush administration’s hand on prescription drugs using a provision in the Medicare Prescription Drug, Improvement and Modernization Act. The new law authorizes the U.S. secretary of health and human services to allow importation of FDA-approved medicines from Canada by licensed pharmacists and drug wholesalers for commercial resale.

Illinois Gov. Rod Blagojevich, a Democrat, also has submitted to secretary Thompson a proposed pilot drug importation program. Gov. Blagojevich said the state could save more than $90 million annually by importing prescription drugs from Canada for Illinois’ 230,000-member employee and retiree health plan. At press time, secretary Thompson had not responded to either request.

The governors of Minnesota and Wisconsin, on the other hand, are facilitating for their citizens direct purchasing from Canadian pharmacies. In January, Minnesota Gov. Tim Pawlenty, a Republican, launched www.MinnesotaRxConnect.com, a Web site with links to two state-approved Canadian pharmacies. Wisconsin Gov. Jim Doyle, a Democrat, followed that lead and launched the “Prescription Drug Resource Center” at www.drugsavings.wi.gov that connects interested consumers to three state-approved Canadian pharmacies.

The Web sites have generated terse remarks by the U.S. Food and Drug Administration, which critics say is the Bush administration’s frontline defense for pharmaceutical companies opposed to drug reimportation and cost controls.

North Dakota, Illinois, Minnesota and Wisconsin are just the beginning of a growing list of states determined to address the cost crisis. Localities are looking at Canadian importation and purchasing programs as well, including Boston and Burlington, Vt.

“Addressing the escalating cost of prescription drugs is not only good public policy,” says Steve Porter, director of the AFT public employees department. “It’s good politics.”

“Sixty-five percent of Americans are in favor of the federal government taking action that would make it easier for Americans to buy prescription drugs from other countries,” adds Porter, citing an Associated Press poll conducted by Ipsos-Public Affairs in late February.

Life, liberty and pursuit of affordable Rx drugs

Why are Americans paying more for prescription drugs than citizens of other industrialized nations? The answer is clearly written in the “2004 Economic Report of the President,” which was delivered to Congress in early February.

The Bush administration, which adamantly opposes instituting an across-the-board system of government cost controls that would decrease the bottom line consumers have to pay for prescription drugs, maintains that consumers in the “innovating” country have to pay the costs of research and development (R&D).

That explanation is flawed, however, considering that the nation’s largest pharmaceutical manufacturers have R&D and manufacturing facilities in other countries. Take Pfizer, the No. 1 drugmaker. Japan, France and Ireland are among the countries where Pfizer has R&D operations. The company’s hottest-selling drug, cholesterol reducer Lipitor, is manufactured in Ireland. Under law, drug manufacturers are allowed to import drugs from other countries.

Pfizer Global Manufacturing UK (United Kingdom) boasts on its Web site that “Production within the UK also has a global perspective, with 80 percent of production going overseas. In fact, for every 1 pound earned by Pfizer from its UK sales, a further 2.66 pounds was earned from export markets.”