As American patients turn to Canada for cheaper drugs, Canadians are turning to generics to hold down their medication costs. Although Canadian price controls have held branded drug prices below levels in the United States, acceptance of lower-cost generic drugs has been slower north of the border.

That may soon change, however, due to a new pharmaceutical reform initiative being pushed by officials in Ontario. Legislative changes in the works there include a dramatic shortening of the approval process for new generic drugs and new rules allowing Canadian pharmacists to substitute generics for branded products without contacting the prescribing physician.

The pro-generic changes, which supporters say will lower health costs by $60 million a year in Ontario, are under heavy fire from Canada's brand name drug manufacturers, who fear the loss of market share. Meanwhile, Canada's generic drug makers are not happy with provisions of the plan that cut government payments for their products by 20%.