In the far north of New York State, only a few miles from Canada, is the command point for the Seneca Trading Post. Here, a group of Native Americans, members of the Seneca tribe, have hung out a shingle as the middleman for U.S. citizens looking to purchase discounted drugs from Canada. The practice of importing drugs from foreign markets for sale in the U.S. is generally illegal, but it has been on the upswing for the past few years.

Glancing over the Seneca Trading Post's advertisements, everything seems legitimate. The ads offer more than 6,000 brand-name drugs, everything from the popular cholesterol-lowering medicine Lipitor to depression fighter Prozac. Seneca promises through its ads prices "25% to 60% less than you paid on your last prescription."

The Seneca Trading Post declined to respond to repeated requests for elaboration on its prescription business. But Major Robert Pittman from the Indian Health Service, a Rockville (Md.)-based division of the U.S. Health & Human Services Dept., confirms the practice of Native American tribes providing drugs purchased in Canada to fellow Americans. Pittman says the service is especially appealing to people who "have large co-pays or have no private insurance."

"A VIOLATION." According to the Seneca Trading Post Web site, customers must provide a copy of a valid prescription and fill out several forms. The paperwork is relayed across the border from Irving, N.Y., to Canada, where a Canadian doctor rewrites and fills the prescription and sends the medicine directly to the customer.

Is it illegal? Perhaps. In March, 2003, in a letter to RX Depot, another outfit allegedly importing drugs from Canada for sale in the U.S., the U.S. Food & Drug Administration warned that such a practice violates the Federal Food, Drug & Cosmetics Act. The letter states: "It is a violation of the Act for anyone other than the U.S. manufacturer [of a prescription drug] to import the drug into the United States...such drugs [those imported to the U.S. from Canada] are unapproved, labeled incorrectly and/or dispensed without a valid prescription."

An FDA spokesperson, while declining to specifically discuss the Seneca Trading case, said anyone who makes a profit from the selling and importation of foreign prescription drugs is breaking the law.

ROAD TRIP. Yet, Uncle Sam has been reluctant to crack down on those acting as intermediaries for access to drugs from foreign countries such as Canada. "Generally, the FDA and U.S. Customs don't enforce those rules," Pittman says. The reason: A populist backlash in the U.S. against the high price of prescription medicines, which has led the White House and Congress to embrace proposals for a new Medicare drug benefit.

On Capitol Hill, Republican leaders, with the backing of big pharmaceutical outfits, are now trying to block legislation that would make it legal for Americans to purchase less expensive drugs from Canada and other countries. Such a measure passed the House on July 25, but it faces an uncertain future in the Senate. Still, many lawmakers have been eager to show their opposition to such bans. Several years ago, a handful of congresspeople accompanied a busload of seniors into Canada to purchase Canadian drugs, even though the act was technically illegal.

"To date, there have been no complaints about the Seneca Trading Post," says a spokesperson for the New York State Attorney General's Office, who adds that no state law deals with Native American trading. The spokesperson also notes that local prosecutors are aware that a constant stream of prescription drugs is being imported over the state line from Canada and says if it found out that any person was being defrauded or harmed by this activity, then the office might pursue the issue.

BETTER ANSWERS NEEDED.Under longstanding U.S. law, every Native American reservation is regarded as a sovereign nation. According to the FDA, however, that wouldn't protect persons selling prescription drugs obtained in foreign lands.

While the FDA has been hesitant to bring legal action against procurers of Canadian prescription drugs, it has sent letters to three other outfits this year, notifying them that their current business practices were in violation of the law. All three moved to comply with the agency's concerns, the FDA says. It declined to comment on whether it might be sending a similar letter to the Seneca Trading Post.

The growth of pharmacies operating outside the current legal system, however, shows that a broader solution must be found that will both end a questionable market in prescription drugs and satisfy consumers.