JPR: That’s correct. There’s also a $13 flat shipping fee per box, whether you order one medicine, two medicines, five medicines or ten medicines. FDA policy is that an individual can import for personal use up to a 90-day supply of each medication. There are no insurance premiums. There are no membership fees.

JPR: I run the program. Two years ago I ran for the State Senate here in Pennsylvania and one of the issues was that I, and many physicians, have patients who need help to pay for their medications. My stance was that we could do this that day here in the Commonwealth and that there was the need to do this. Unfortunately, being a Democrat and running in a heavily Republican district, we didn’t get the chance to go to Harrisburg. So I decided after the election that I would simply to do it on my own—that we didn’t need government to set up this program. The program works as follows. If a patient wishes to participate, we have a special form on which they list their medication name, the dosage and the frequency in which they take the medication. They send that form to us, we process it and send back to them three forms. The first is the consent for them to participate in the program in which we spell out that we are a physician practice and this is a clinical program—we are not a pharmacy. The second form is a consultation request that their physician must complete to us. On that form we list the patient medications, dosages, frequency. The family doctor then reviews those medications, makes any corrections and can say, "Yes, please obtain this medication," or "No, this patient may not have this medication." They sign that request for consultation and the patient will send that back to us with a third form which is the actual form that lists prices of the medications. We never initiate any prescriptions. Everything must be requested of us from their family doctor. We take all the medications on the list, put it through the Medical Letter Adverse Drug Interaction Program, then prepare a report that goes back to the family doctor. The Medical Letter is a non-profit organization out of Yale University Medical School that has a program allowing you to put the medications the person is taking into it and you get a printout that says what’s in the literature about it.

JPR: Because nobody does it. There was a study that was published a few months ago in the Journal of Emergency Medicine that tracked 300 consecutive patients age 65 and older who came into an emergency room. Ten percent of them were in the emergency room because they were experiencing an adverse medication reaction. When run through a program such as the one we use, another 30 percent had an unidentified potential adverse drug interaction. So, four out of ten were either having a problem or were at risk.

JPR: We send that report to the doctor. If the doctor makes another change, that change is noted and we repeat the process. Then we send the patient’s order to a wholesaler in Canada.

JPR: We don’t release that information. There are a number of people who are preying on senior citizens, telling folks they can get them their medication at a cheap price. I don’t want people who are less than honest saying, "We get our medicine from such and such a price, or from such and such a source" when they’re not really doing it. I don’t want people falsely using our wholesaler as their reference when they’re really getting their medication from who knows where. We chose our wholesaler based on honestly and reliability—that the medications are indeed what are being ordered and that they are properly prepared, because the official policy of customs is that every package that is imported by a patient is inspected.

JPR: The primary limitation is time. Even though we make it look seamless to the family doctor and patient, there is a significant amount of back office work that must be done. We are not a pharmacy. You can’t run out of pills and call us up and say, "Dr. Rudolph, I need my pills." The whole cycle takes four to six weeks. We are for people who are on chronic medications. So, even though antibiotics may be very expensive and they are technically more affordable with our program, this is not a means to obtain antibiotics that you need today to treat your infection.

JPR: Those constraints are primarily administrative. You must have the address correctly written, and that it is the patient who is importing the medication for personal use upon the exportation order of a physician.

JPR: No. They have oversight but there is no application that has to be made to anybody.

JPR: No. They have no authority for oversight except as far as the practice of medicine, so the Commonwealth of Pennsylvania Board of Medicine can certainly come in and say, "Dr. Rudolph we want to look at your records." They will see that we have a complete record on each patient and we are consistent with the rules of the Board of Medicine. You have to go through your personal physician because this is a physician-based program.

JPR: As an example, the local price here for Tamoxifen for 100 pills is $383. Our list price is $40.22. Our cost is about 50 percent to 55 percent of the local price, on average. For example, Coumadin is $81 locally for 100 pills. Our price is $32. We had a lady who recently came in and she was just all smiles. She had got her first shipment of medication and said this was the first time in years where she has not had to take her social security check directly to the pharmacy to pay for her medicine.

JPR: I fund the program personally. This is my way of personally giving back to the community which has been so generous in their support of my medical practice. We will take it as far as we can. I’m hoping that other physicians will join with me—maybe somebody in Philadelphia, or in Lancaster, or in Erie, or in Scranton. First of all, you have to have somebody who is willing to give time and money. Those people are very difficult to find. We would train them and provide the software. I had to write 56 different programs in order for this thing to work. Unfortunately, I have had other colleagues who have called me and said, "We want to do this and make money," and my statement is, "No, if you’re going to do this, you will do this as a public service as we are doing it." To really run a program like this, you are going to need a part-time person maybe 20 or 24 hours a week. So, perhaps if you have a spouse who’s retired or maybe even a retired physician who is interested in participating. At this point the easiest thing to do is, if there’s a physician who wants to help their patients, simply give their patient our hotline telephone number at 412-653-4900 and we’ll take it from there.