Prescription medications can be 50 percent cheaper in Canada, where they are purchased by the national government at a lower price. U.S. law prohibits individuals or governments from buying foreign medications, but Maryland could join a growing number of states bucking that rule.
Under the proposal, if the federal government grants permission, Maryland would establish a Canadian drug purchase plan for Medicaid recipients and current and retired state employees by January.
Lawmakers voting for the bill said they wanted to try any effort - even a modest one with a small chance for success - to bring relief to elderly and poorer residents burdened by the cost of medications.
"When we go home to our constituents, we can say we did something," said Sen. Paul G. Pinsky, a Prince George's County Democrat who is lead sponsor of the bill.
State health officials expressed doubts that the federal government would grant Maryland permission to establish such a program. Federal regulators say they are worried about the quality and authenticity of drugs obtained through foreign Internet pharmacies.
Minnesota and Wisconsin have incurred the wrath of federal regulators by providing links to Canadian drug providers on their Web sites, allowing state employees to spend less and saving the states money. Four other states have applied for the type of waiver called for in the Maryland legislation.
An initial proposal from Pinsky would have required the state Department of Health and Mental Hygiene to launch immediately a Canadian mail-order plan. He altered the idea amid concerns that the program would violate federal laws. "This is a start," Pinsky said. "There's nothing illegal about it."
But opponents of the legislative plan charged yesterday that Maryland was about to interfere in an area best left to federal regulators, and that the potential health risk was too great.
"It sounds good, but there is no way that this kind of scheme is going to work," said Sen. Andrew P. Harris, a Baltimore County Republican and an anesthesiologist.
Despite questions of legality, federal officials have yet to crack down on state and local governments buying drugs from Canada. Employees in the city of Springfield, Mass., for example, have been purchasing imported medications for months, and locally, Montgomery County is considering such a plan. Still, the U.S. government has issued warnings about safety threats posed by counterfeit foreign drug companies, raising doubts that the Bush administration would grant waivers officially authorizing the practice.
Such businesses are "used not only by profiteers masquerading as pharmacists, but outright criminals who do not pause before actively feeding counterfeit drugs into the marketplace," a federal health and human services official wrote to Minnesota Gov. Tim Pawlenty last month.
"It seems to me that going through this motion of asking for a waiver is an exercise in futility," said state health Secretary Nelson J. Sabatini. "What Maryland should be doing is being more aggressive in leveraging its buying power, and putting more pressure on the industry to get better deals."
If it receives final approval, perhaps this week, the Senate plan would head to the House of Delegates, where its prospects are uncertain. Yesterday's tentative Senate approval came on a 37-10 vote.
Acknowledging that Maryland would be following a trail blazed by other states, Del. John Adams Hurson of Montgomery County, chairman of the Health and Government Operations Committee, said he preferred a plan that would lower prescription costs by combining Medicaid and several other state programs into a single purchasing group to negotiate lower costs.
"I don't want to say I don't like the effort and the intent," Hurson said. "But I want to look at more concrete solutions that might achieve savings."
Hurson and others say high profit margins of drug companies - provided by U.S. consumers paying top prices - are fueling anger and attempts by lawmakers to restrain the industry.
But drug company representatives say high profits are necessary to entice investors to provide the capital needed for research and development. "It isn't like aspirin has jumped up 150 percent in price," said J. William Pitcher, a lobbyist who represents the Pharmaceutical Research & Manufacturers of America. "It's new drugs, for serious diseases."
Four other states are seeking waivers from Health and Human Services Secretary Tommy Thompson for reimportation programs: Illinois, Iowa, New Hampshire and North Dakota. They are among 19 states whose legislatures are considering bills or resolutions aimed at making it easier for state employees and retirees to buy drugs from Canadian mail order pharmacies.
The Medicare Modernization Act that President Bush signed in December allows Thompson to approve a prescription drug reimportation program.