Revere is joining a small number of Massachusetts communities that have decided to buck federal law and give their municipal employees and retirees the chance to buy low-cost prescription drugs from Canada.
Starting Oct. 1, approximately 1,700 employees and retirees, plus their family members, who are enrolled in the city's self-insured health plans will have the option of purchasing drugs on a mail-order basis from CanAm Health Source, a pharmaceutical company in Montreal.
The only employees and retirees not eligible for the voluntary program, which is being called The Revere RX Direct, will be the small number who subscribe to the city's indemnity, premium-based insurance plan.
As an incentive to get employees and retirees to use the plan, the city is not charging them copayments when they purchase drugs from Canada.
At least four other Massachusetts communities -- Boston, Springfield, Worcester, and Pittsfield -- have initiated programs to give employees and retirees the ability to purchase prescription drugs from Canada. Other communities are considering the idea.
Drugs sold in Canada are 20 to 80 percent cheaper than those sold in this country because of price controls in Canada. Many Americans have been purchasing drugs from Canadian pharmacies over the Internet to save money.
Federal law prohibits the importation of drugs from Canada. But the US Food and Drug Administration to date has not taken action against localities offering import plans.
Mayor Thomas G. Ambrosino initiated the program in Revere after the city's Insurance Advisory Committee, which includes representatives from all the city's unions, recommended it.
Ambrosino said he had initial reservations about the idea because of the legal issue. But he said ''a couple of things changed my thinking."
''At the time we were [first] looking at it, Springfield was the only one doing it," he said. ''But now, other communities have joined the fray" and have had a ''good experience with it."
He said the FDA has also ''clearly backed off the issue." Plus, the city's insurance consultant, Cook and Company of Marshfield, ''has been working in other communities with a Canadian pharmacy and they've had a good experience with that situation," Ambrosino said. ''So I'm confident we can handle it efficiently. And philosophically, I think our employees and retirees could use a bit of a break. They'll be able to get these drugs without the need for a copayment, which can be significant for someone on maintenance medication."
Copayments can range from $5 to $25 depending on the medication. Ambrosino said, he, himself, probably will take advantage of the program, to fill prescriptions for Lipitor, a drug he takes to lower his cholesterol.
He said the city, which has seen its health insurance costs double from $5.3 million to $10.7 million over the past five years, could potentially save money through the program from the lower costs it would have to pay for the drugs. But he said, ''We are not assuming any savings this year."
The program only allows the purchase from Canada of brand name drugs that are offered cheaper than what the city regularly pays. Generic medications, narcotics, and drugs requiring refrigeration are excluded. A list of approved drugs will be posted on a website the city is establishing for the program.
Police Captain James Guido, who chairs the Insurance Advisory Committee, said the program is a plus for the city and its employees.
''It's voluntary," he said. ''It's up to each and every individual. It's a chance for them to save some money; the city is waving the copayment. It's a chance for the city to save money on the cost of drugs. We had the company come down. It appears very safe to me. . . . So I think it's a worthwhile program and should be tried out."
''As more cities and towns do it, it may be that drug companies in the United States will get a wake-up call," he said.
Roy McNamee, marketing director for the workers' compensation division of Cook and Company, said the firm is partnering with CanAm Health Source to arrange for US communities to have their employees buy drugs from the Canadian company.
Ambrosino said the city did not have to solicit bids in selecting CanAm Health Source to provide the drugs because the city is not being charged any fees for the program.
McNamee said Revere employees or retirees will send their prescriptions to CanAm Health Source. A staff physician will rewrite the prescriptions and send them to the company's pharmacy in Edmonton, Alberta. The drugs, contained in factory-sealed bottles from the original manufacturer, will then be shipped to the consumer by mail. Refill requests can be made by mail, telephone or the Internet.
William Hubbard, the FDA's associate commissioner for policy and planning, said in a telephone interview from Washington that he is not aware of Revere's plan. But he said the agency is not happy about communities offering such plans ''because we are concerned that the mayors pushing these plans have taken insufficient account of the safety risks from unregulated drugs."
He said the FDA has refrained from taking enforcement action against cities and towns offering the plans ''and focused instead on trying to communicate with those localities about the risk and helping them understand they are doing something particularly risky."
But Peter Kenney, president of Cook and Company, said the safety issue ''has been fabricated to some degree as a way of dissuading people from doing this. There is virtually no safety issue."
He noted that ''thousands and thousands of people have gotten prescriptions over the Internet and there have been no problems."