MEXICAN MECCA: DISCOUNTS ON DRUGS SEND SENIORS SOUTH OF BORDER

ALGODONES, Mexico -- They start streaming into Mexico at 7 a.m., wearing
shorts, T-shirts and sun visors. Some cross the border in wheelchairs,
others carry oxygen tanks over their shoulders. They come for fun, yes. They
also come for dental work, for eye glasses. But mostly, they come for
prescription drugs.

In this boisterous border town near Yuma, Ariz., Liqui's Pharmacy is often
their first stop. Touted as "The Pharmacy of the New Millennyum,"young men
lure elderly customers into the store with promises of free Viagra and sales
clerks offer shoppers tips on how to avoid scrutiny by U.S. customs
inspectors.

Once enticed inside, seniors on Medicare can find bargains on drugs for
everything from heart disease and asthma to arthritis and impotence before
moving on to haggle for trinkets, sip margaritas or dance the afternoon away
in the plaza.

"It's eat, drink and be merry," said Myrlane Powell of Fair Oaks who said
she and her husband, Lavar, buy drugs and sunglasses in Algodones. "It's
warm down here, and there is nothing but old people."

Watching the circus from a bench outside Liqui's, 77-year-old Rose Cooper of
Oakhurst held a yellow plastic bag filled with medicines for heart trouble,
gout, menopausal symptoms and other conditions. The retired beautician and
her 86-year-old husband, John, live on monthly $1,200 Social Security
checks. She said stocking up on medicine in Mexico is a matter of survival:
"I wouldn't be doing this if I had any help from Medicare."

A third of the 40 million seniors and disabled Americans on Medicare pay out
of pocket for all prescription drugs and can save thousands of dollars
annually if they buy them over the border, where U.S. government warnings
about the potential hazards of buying and importing drugs from Mexico go
largely unheeded. Prescriptions from U.S. physicians aren't required. Most
seniors simply bring along a list of the brand-name or generic drugs they
want and in what quantity and present it to the sales clerk.

And while shoppers swarm the counters at Liqui's like children buying Pokmon
cards, political leaders in Washington are butting heads over how to give
Medicare recipients a drug benefit so that seniors won't need places like
Algodones to keep their maladies under control.

Blasting the high drug prices seniors face, President Clinton has called for
a Medicare drug benefit as part of a 10-year, $168 billion expenditure.
Democrats and Republicans are offering their own reform packages.

But seniors such as Norman Smith of Branson, Mo., aren't holding their
breath. Patting the smorgasbord of drugs he and his wife purchased at
Liqui's, the 74-year-old remarked with a smirk and a wink: "You know,
Clinton is going to take care of this."

American and Canadian retirees congregate in dusty RV parks every winter in
and around Yuma, six miles from Algodones. They drive to a nearby Indian
reservation, park their cars, then walk across the border.

Even before they enter Algodones, visitors are handed fliers advertising
"special prices" on drugs and two-hour service for eyeglasses. Neither pesos
nor Spanish are required.

They walk -- no questions asked -- past a Mexican border guard and are
quickly funneled onto crowded sidewalks, sharing space with vendors of
leather cowboy belts and knock-off designer purses, plaster donkeys and
striped sarapes amid the barker-like banter of prescription drug peddlers.

Few can avoid Liqui's Hector Lopez, who shocks, cajoles and uses humor to
entice passers-by into the tidy pharmacy packed floor to ceiling with
prescription drugs, lotions, perfumes and other speciality items, such as
pure Mexican vanilla.

"How about you sir?" he said. "You look terrible. You sure you don't need
something from the pharmacy?"

To another man walking with his wife, he shouted, "I got a free sample of
Viagra for you. How can you go to the war without bullets?"

One morning, Lopez snared Marilyn and Donald Haugen of Northfield, Minn.,
known for its cows, colleges and contentment, with the line: "Welcome to
Viagraland."

First-timers, the pair were flabbergasted to find they would pay about half
as much for asthma medicine and estrogen in Algodones as they would with
their discount through an HMO policy that supplements their Medicare
benefit.

Haugen found her hormone replacement drug, Prempro,for $13.50 for a month's
supply, $8.50 less than the co-payment she pays in Northfield. Her brief
transaction with the Liqui's clerk went like this:

"How many can we buy?"

"As many as you want."

"Will you take a check?"

"Yes."

"Oh my God."

Haugen was giddy when she left. "I can't believe this," she said. "We'll
have more than enough (in savings) to pay for gas and motels driving home."

Elnora Crow, 77, of Washington paid 25 cents per pill for Lodine, the
medicine she takes for rheumatism. She pays $1.35 per pill -- more than five
times as much -- for it in the United States.

Several Medicare bills under consideration in Washington include
prescription drug benefits, but legislators say major reform could be years
away. Pharmaceutical companies caution that any plan to control drug prices
will cripple their ability to develop drug therapies.

In the meantime, Liqui's owner, 34-year-old Hector Cha, is cashing in on the
tens of thousands of other Americans without drug coverage. He and his
32-year-old brother, Pancho, who runs a second pharmacy across the street,
benefit from Mexican government price controls on American-made
pharmaceuticals, scads of foreign customers and inexpensive labor.

The Chas are relative newcomers to Algodones. Dentist Bernardo Magaa sparked
the trend after opening a tiny dental office in 1969 when the town was
nothing but "cantinas, girls and dogs in the streets," he said. Soon Yuma
residents discovered they could get good, low-cost dental care just over the
border and a health care industry was born.

Today, the small town's business district extends five square blocks and
features about 20 pharmacies, 45 dentists, five optometrists and 15 doctors.
Rarely are appointments required, and the dentists and optometrists have
on-site or nearby laboratories that can make a crown or a pair of trifocals
in just hours.

Magaa's sprawling office includes a pharmacy and cosmetics counter, covered
floor-to-ceiling in marble. He lives in a 4,000-square-foot home on a ranch
with Arabian horses and bullfighting arena. He makes no apologies for his
success catering to foreigners in a country where many people get inadequate
health care.

"I have my family," he said. "They want to live comfortably with a good
house, a swimming pool, horses. They want lobster, shrimp, beef stew."

Americans who patronize Algodones rave about the quality, cost and
convenience of the Mexican services.

"I am the type who will not go to the dentist unless I am in extreme pain,"
said Butch Koretz of Yuma, who was getting a root canal with a gold inlay
crown for $500. "I have never been in any pain here."

The Cha brothers say their pharmacy business is successful because they are
honest, friendly and offer products identical to those found in the United
States, for a lot less.

"This is not just, 'Give me the money, here are the pills,' " said Pancho
Cha.

But the U.S. Food and Drug Administration, which regulates food and drug
imports, worries that American consumers could be putting themselves at risk
buying drugs in foreign countries that may be counterfeit, contain dangerous
ingredients or have been subject to substandard storage or transportation
practices. FDA spokesman Brad Stone could not cite specific cases or
quantify the problem, however.

"We can't be your doctor and we can't be your big brother," Stone said. "If
you are bound and determined to get (prescription drugs), chances are at
some point you can. But be aware you are putting yourself or loved ones at
risk because we can't vouch for the safety of these products."

Most of the Americans who shop in the Mexican pharmacies look for the names
of major drug manufacturers on the labels, which helps assure them of their
authenticity. The drugs are usually sold in sealed packages, not in pharmacy
containers.

The FDA has rules about individual importation of prescription drugs, but
the agency leaves it up to U.S. Customs to enforce them. Customs inspectors
are supposed to see that individuals import only FDA-approved drugs; that
the drugs are only for the person who purchased them; that they have no more
than a 90-day supply of any one medicine; and that they have a prescription
signed by a doctor.

But these rules appear easy to skirt.

As one of the sales clerks at Liqui's told a woman buying up to 10 months
worth of drugs for herself and her husband, "When you cross the border, just
say you have a three-month's supply of medicine for yourself."

For customers who want a prescription in writing, in case Customs asks to
see it, the clerk simply lists the medicines purchased on a pad presigned by
an Algodones doctor who rarely meets the patient face-to-face.

Dr. Sanchez Diaz, who runs a tiny clinic a couple of blocks away, said he
signs the prescriptions for Liqui's because they occasionally send him
patients. Most of those referred to Diaz are people who want one of the few
types of drugs that require a prescription directly from a doctor in Mexico,
such as narcotics and anti-depressants.

It's a practice that disturbs U.S. pharmacists, who say seniors have enough
trouble keeping track of their medications, let alone those with information
written in Spanish.

"It's too easy to get medication down there," said Yuma pharmacist Tom
Burrell. "These people (dispensing drugs) often are not pharmacists so they
have no idea how drug interactions occur."

Diaz recognizes the risks, but said he isn't bothered that his name is on
prescriptions given to folks he knows nothing about. "When we are equal to
the U.S., and you have to go to the doctor for penicillin, we will be valued
more. But this is how Mexico is."

And if Mexican doctors seem nonchalant, so do Customs inspectors at the
border with Algodones, who tend to limit their inquiries of visitors to
their citizenship.

On a recent weekday, when the line of people heading back into the United
States snaked a quarter of a mile through Algodones, inspectors ushered
hundreds through the customs house asking only if they were U.S. citizens.
Canadians also easily passed through. None was asked to "declare" what they
had purchased or asked to open their bags.

"We still do what we need to do," said William Brooks, U.S. Customs port
director at the California border with Algodones. Inspectors are limited
because of inadequate space and growing numbers of visitors, he said. More
than 248,000 people passed through his port in January.

"You don't want some guy on oxygen keeling over while waiting in line to
cross the border," he said.

Marilyn Haugen and her husband waited about five minutes in line, then
breezed past inspectors. "They didn't check a thing," she said with wide
eyes. "You think, what's the logic of this?"

And then the couple climbed into their car with plans of spending the money
they saved by shopping at Liqui's.