Even though she doesn't save "that much" money, Los Angeles resident Judith Aaronson, 89, purchases her medications from Pharmacy International, a Nevada-based company that procures drugs from wholesale distributors and drugstore chains in Israel, Spain, Sri Lanka, England and Canada.
"The drugs are mainly identical to what I would buy here," she said. "They look the same. My reasoning is to support Israel. I trust they know what they're doing."
Aaronson is one of the many people who obtain federally approved drugs from online business brokers, but instead of cost as the motivating factor, it's idealism that moves her and other Jews around the country to turn to Israel for their drugs.
Over the last several months, companies that procure discounted prescription medications from Israel and other foreign countries have placed advertisements in Jewish newspapers and sent promotional material to Jewish membership organizations, proposing to offer the public a way to support Israel's economy, while also saving money. In turn, consumers who rely on a heavy volume of medication to treat chronic conditions, including high blood pressure, depression and diabetes, are flocking to the Web sites to purchase their drugs and support small businesses.
"It's depressing enough having to be on something for five years," said Janice Epstein, 51, a breast cancer survivor who lives in Columbus, Ohio and buys her medicine at Pharmacy International (pharmintl.com). "I feel better knowing it's from Israel,"
She purchases Tamoxifen, used to treat advanced breast cancer,
The former New Yorker learned of the Israeli option through an advertisement in the New York Jewish Week, to which she continues to subscribe.
"I asked my doctor about it, and he said sure," Epstein said.
She also asked her husband, a rabbi, if it was ethical to buy the drug from a country other than Israel if it could be had for less.
"He said to do what was best financially," Epstein said. Fortunately, she added, at the moment, she does not have to make a choice, because "Tamoxifen is cheaper in Israel than anywhere else."
Others say supporting Israel is secondary to their need to save as much money as possible. According to reports, in the United States, the working poor and people living on fixed incomes spend a substantial portion of their income on medication.
"Seniors are going for saving money," said one 70-year-old New Jersey woman who spoke on condition of anonymity. "All things being equal, they may go for the one from Israel."
She purchased Tamoxifen and Fosamax, which treats osteoporosis, from Pharmacy International after seeing a company ad in her local Jewish newspaper.
"What would cost me $300 here for a three-month supply costs me $60," she said. "That's a lot of saving if you're taking something month after month."
Drugs sold overseas are often cheaper than those sold in the United States, because governments in other countries either regulate the price of drugs or negotiate those prices with pharmaceutical companies. For instance, while the unit cost of allergy medicine Claritin is 96 cents when purchased from Israel through Pharmacy International (on March 2), the unit price at Eckerd's drugstore chain in the United States is $2.80.
"It's a real sad environment," said Nathan Jacobson, president and CEO of MagenDavidMeds.com, an online Israeli pharmacy that sells FDA-approved drugs to U.S. consumers. "People are forced to make choices between eating, paying the rent and taking their medication."
MagenDavidMeds.com, based in Ramat Gan, launched a direct-mail campaign this month to members of Congress, synagogues and membership organizations.
For the most part, the companies -- Pharmacy International, MagenDavidMeds.com, Isrameds.com and a plethora of others -- operate in a similar manner. Customers mail or fax their prescription and medical information to the provider who, in turn, sends the prescription to a participating licensed pharmacist abroad.
In Israel, by law a doctor must first approve the prescription based on the customer's underlying medical condition before a pharmacist fills the prescription. The drug is then shipped to the customer. The average shipping price is $15.
According to Mike Oliver, founder of Pharmacy International, his company makes money by charging "more than we are charged. Since we do a lot of business, we get a price break anyway," he said.
Orders for medications from Israel totaling $160,000 a month represent an average of 10 percent of the company's monthly business. The company employs about a dozen people, mostly in customer service.
If there is a discrepancy between the U.S. and Israeli orders, the customer is contacted. Usually, these discrepancies relate to dosages.
For example, in the United States, Glucophage, which treats Type 2 diabetes, is dispensed in 500-milligram capsules to be taken three times a day; in Israel, doctors prescribe 850-milligram capsules twice a day.
Returns are accepted without question, but since it is illegal to resell drugs, unused, sealed medications are donated to clinics and physicians serving indigent populations.
While Pharmacy International orders drugs from chains, and in many instances has made deposits up front so that the pharmacies will fill their orders, MagenDavidMeds.com is working directly with Israel's independent drugstores.
"In this way, we're supporting small businesses, keeping them alive, generating tax revenue for Israel," said Jacobson, a Toronto-based entrepreneur who holds dual Israeli and Canadian citizenship.
So far, 20 pharmacists have agreed to fill prescriptions for MagenDavidMeds.com. Jacobson is hopeful hundreds more will sign on. Additionally, Jacobson plans to employ couriers to bring packages to the post office and in this manner, create jobs.
"I want to help the Israeli economy," he said. "I'm not hiding that we're for-profit, but we're spreading the wealth. It's really exciting."
Despite these altruistic intentions, the practice has also been met with skepticism.
Tom Glaser, the Southeast region president of the American-Israel Chamber of Commerce, said he received information on Isrameds.com six months ago but believed it was "not something we could get behind," because of questions the chamber had about "quality and legitimacy."
Likewise, he is not yet throwing his support behind MagenDavidMeds.com, from which he received a letter this month. As part of its marketing effort, for every order that comes from members of an organization that signs up as an "affinity partner," the company said it will give back 5 percent to the organization.
"I'd have to look into it," Glaser said. "I wouldn't do it without scrutiny. You'd have to prove to me that this is really benefiting the Israeli economy, and it's not just a pass through."
Glaser suggested that consumers visit www.buyisraelgoods.com for a list of U.S. retailers that sell Israeli products.
Pharmacists, who are losing business to alternative pharmacies (last year an estimated 2 million prescriptions were filled outside the United States), are mostly strongly opposed to offshore prescriptions.
"My reaction is it's illegal," said Mitchel Rothholz, a Washington, D.C., pharmacist who is the vice president for professional practice at the American Pharmacists Association, representing more than 50,000 pharmacy industry professionals in the United States.
The law that allows an individual to import a 90-day supply of medication is intended for products that are not available in the United States, he said. The Bush administration, however, is not currently enforcing the law.
"You'd have to stop it at the borders," Rothholz said. "They're not doing it."
In the last two years, the online pharmacy trade out of Canada amounted to $2 billion annually, according to Jacobson.
In addition, purchasing drugs from an unknown entity "is risky," Rothholz said. "You aren't actually seeing the pharmacies these drugs are coming out of. There is no inspection."
Furthermore, he added, customers lose an "essential" relationship with their local pharmacist when they purchase medication via telephone or the Internet.
"With medications becoming more powerful, patients need someone they can talk to," Rothholz explained. "Chronic and acute medications need to be kept in a central database to avoid risky drug interactions."
There are other ways to support Israeli entities, he said.
"Teva is one of the largest generic manufacturers in the world," Rothholz said. "When you go to your pharmacy, ask if there is a generic drug made by Teva that is available for you."
Ron Weddell, a majority owner of Pharmacy International, is unmoved by Rothholz' arguments. Regarding legitimacy, he said: "Customers take my word."