When you walk across the International Bridge from Laredo, Texas, to Nuevo Laredo, Mexico, the change isn't just geographical. The dirt intersection at the end of the long bridge marks the beginning of pharmacological nirvana: ground zero for "drug tourists" who have come to this border town to stock up on cheap prescription drugs at any of the dozens of pharmacies that cater to Americans.

Entrepreneurial Mexican men stand around the intersection verbally besieging these drug tourists, aiming to be louder and quicker than the others in trying to grab the foreigners' attention.

"Hey, vato, you want to visit a pharmacy?"

"Guera, guera, you need medicine?"

Any of these men will walk you about half a block from the dirt intersection, to an area where pharmacies and doctors' offices occupy almost every available space. Here, Americans mill around carrying pink-and-white-striped plastic bags from the farmacías.

Welcome to Mexico. It is here that Claritin costs $0.93 per pill, compared to $1.94 in the United States. It is here that hormone replacement therapy drugs cost a fraction of the price of their northern cousins. It is here that high blood pressure pills, painkillers, antibiotics, and antidepressants fly from the shelves. These drugs are some of the most popular medicines imported by the senior demographic, according to U.S. Customs. And in Mexico, customers do little more to get written prescriptions for them than glance at a laminated price sheet and hand over the cash.

This virtual open medicine cabinet might seem odd to Americans, who are used to doctors' visits, lab tests, and restricted access to prescription medications. But for many seniors, this approach isn't odd at all. It represents what many feel should be a reality in the United States: affordable prescription drugs. This is especially true for those seniors who are on Medicare, which offers no prescription drug coverage, and for those with inadequate private health insurance. Mexican medications are cheap and accessible -- to a senior, a simple trip across the border can mean hundreds of dollars per year in savings.

Why bother with the border?

From Texas to California, seniors travel to Mexico to save money on their medications. Although the United States has more life-saving drugs than ever, the prices are skyrocketing, leaving many seniors asking themselves the uncomfortable question: Just how much is my health worth?

Conrad and Cora Ramirez have personal experience with this dilemma. The border is just ten miles from their home in El Paso, Texas, and Mr. Ramirez used to buy his cholesterol-lowering medications just across the Rio Grande River in Juarez, Mexico. Under Medicare, Mr. Ramirez had no prescription drug benefits, and the drug that kept him healthy cost 50 percent less in Juarez.

Even though a lot of Medicare recipients have secondary insurance to help cushion the blow of expensive medications, half of all recipients -- including those with the secondary insurance -- spend between $500 and $999 out-of-pocket on prescription drugs in a given year. In fact, 40 percent of those recipients spend over $1,000 a year. With costs like these -- which are expected to more than double in the next decade -- a trip to Mexico as a drug tourist can be the economical option.

American doctors understand their patients' need for affordable medication and will even recommend that they make a trip across the border. "My doctor more or less said, 'You can get them cheaper in Juarez,'" says Mr. Ramirez. Now that he has a benefit plan that covers prescription drugs, Mr. Ramirez prefers to get his medication closer to home, but he and his wife still buy some over-the-counter items in Mexico to save money.

Why the price difference?

Why is there such a discrepancy in drug prices between Mexico and the United States? Mexican drugs are subject to government price controls, explains Marvin D. Shepherd, Ph.D., professor of pharmacy at the University of Texas. Mexican pharmacies may also discount a drug to as much as 20 percent below the government-set price to compete for customers.

On the northern side of the border, American pharmaceutical companies are responsible for the majority of the world's pharmaceutical innovation. Consequently, the cost of their research and development efforts is massive. According to the Pharmaceutical Research and Manufacturers of America, drug companies spent $24 billion in 1999, and they are projected to spend almost $27 billion in 2000. Seniors who buy American-made drugs are also paying for the expensive marketing, advertising, and lobbying done by the pharmaceutical industry.

The downside of this active, thriving pharmaceutical industry is that American consumers bear the brunt of the industry's research and development costs, Shepherd says. Also, health care professionals like Shepherd question the safety and efficacy of Mexican-made drugs and the place of such drugs in caring for the health of aging Americans.

More drugs, more danger?

One concern for many health care professionals, according to Shepherd, is the lack of government-regulated quality control in Mexico. In the United States, the Food and Drug Administration regulates all prescription medications -- in Mexico, there is no equivalent organization. This absence could have dangerous results, particularly for seniors.

Shepherd explains that in the United States, "quality assurance is extremely strict - we have the highest standards in the world." In Mexico, however, there is virtually no quality assurance in pharmaceuticals. In addition, medications that seniors take in the United States have no exact equivalent, and the pills could even be counterfeit.

The question of chemical composition is key. All medications have both active ingredients and filler ingredients. Fillers affect the medication's bioavailability, the body's ability to use the medicine effectively. In Mexico, the fillers could be any of several things, and this could affect the medication in any number of ways, notes Shepherd. "There may be variations in the quality of the product and there may be variations in the bioavailability of it," Shepherd says. "That could be scary."

His advice: Seniors should use caution when buying prescription drugs from Mexico. Once they start on an American prescription, they should stick with it and not switch between American and Mexican versions of the drug. With any drug taken daily, it is important to keep a steady amount in the body, and the different bioavailabilities of various versions of a drug could interfere with that.

Drug benefits debate

Mexican border towns offer easy access, both in terms of price and availability, to the medications seniors want most: antibiotics, hormone replacement therapy drugs, pain relievers, and others. The inability of many seniors to afford American drugs underscores the importance of the ongoing debate about Medicare and drug benefits -- an issue many worry is getting lost in the rhetoric of an election year. It's a painful reality, but it can be expensive to grow old in America.

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