In July 2003 the city of Springfield, Mass., began the United States' first voluntary program to import cheaper prescription drugs from Canada as part of the city's employee health insurance.

Those participating in the program submit a prescription from a U.S. doctor to Ontario-based CanaRx, which has a physician review the script. CanaRx then fills the order and ships the drugs back to the United States.

Of the 20,000 city employees, retirees and dependents eligible for Springfield's program, the city reported that 1,600 people had enrolled as of mid-October 2003. The city waives prescription co-payments for those participating in the program, which has filled some 2,600 prescriptions in its first three months. According to the city's calculations it saved $600,000 on those prescriptions, which translates into $2.4 million in annual savings.

The city's program has attracted nationwide attention as governors and mayors throughout the United States grappled with the rising cost of providing drug coverage to local government employees. Along with this interest, Springfield's program also provoked criticism from the Food and Drug Administration. The agency cites safety concerns as the main reason behind its vocal opposition to importing prescription drugs from other countries.

After its initial criticism of Springfield's program did not lead to any changes, the FDA left open the possibility of pursuing legal action against the city and other local governments importing Canadian drugs.

"The drug safety laws that Congress has charged FDA to enforce require that drugs be proven to be safe and effective to be legal," said FDA Commissioner Mark McClellan in November 2003.

"While FDA will continue to do all it can to make safe and affordable drugs available, we are also committed to enforcing the law against those, whether governmental or private, who endanger Americans by profiting from 'buyer beware' schemes to import illegal, unapproved and potentially risky medicines," McClellan continued.

McClellan made this statement as the FDA also informed CanaRx that its operations were illegal and that the drug importation "circumvents measures designed to protect U.S. citizens." The letter stated that the agency was "reviewing [its] enforcement options" and was forwarding information about CanaRx to the Canadian government.

In response to the FDA's complaints against CanaRx, a statement on the company's Web site maintains that "we at CanaRx share FDA's interest in the health and safety of U.S. consumers. Contrary to the agency's assumptions and assertions, we take numerous steps to safeguard our customers' health and safety, and what we do creates no risk beyond that faced by U.S. consumers conducting similar transactions domestically ."

Canada has been reluctant to crack down on Internet pharmacies shipping drugs to the United States, arguing that it is the United States' problem. Canada's Assistant Deputy Minister of Health Diane Gorman told reporters in November, "My responsibility is to make sure that Canadian law ... is respected. The U.S. FDA is sharing some information with us. We are investigating a number of issues that they've brought to our attention. … At this point in time we don't have evidence of Canadian law being broken."

Bolstering Gorman's remark's, Canadian Health Minister A. Anne McLellan issued a press release in November stating that McClellan may have "left the impression that unsafe Canadian drugs are going across the border to the United States." She went on to say she wished to assure all Canadians that drugs approved for use in Canada are safe. "We have one of the most rigorous drug approval systems in the world to assure safety, quality and efficacy," she said, adding that no drug shortages have been reported due to Internet drug sales.

The FDA's opposition to the importation of Canadian drugs did not seem to have fazed former Springfield Mayor Michael Albano, who instituted the program. "If they are willing to prosecute Michael Albano ... then they better be prepared to prosecute 2 million Americans, many of them senior citizens, who are going to Canada to get their prescriptions filled," he said in November 2003, according to the Associated Press.

"We are not going to be intimidated," he continued. "If the FDA is prepared to prosecute the mayor for doing what's right for his constituents, then so be it."

Albano has emerged as a national spokesman for municipal frustration over high drug prices. In October 2003, government officials from Boston and New York joined him when he met with members of Congress to explore ways of lowering prescription costs.

Albano's term as mayor ended in January 2004, but Springfield's stance on drug importation is unlikely to change. Calling U.S. drug prices ''unconscionable,'' current Mayor Charles Ryan pledged to continue the program.

-- By Karyn Schwartz, Online NewsHour