Because so manydetails are still being hashed out, it's not yet clear who would behelped by the states' efforts or if the plans can ultimately gainfederal approval and withstand likely court challenges. (Photo:Shutterstock)

Seeking a solution to the soaring costs of drugs, Colorado,Florida and Vermont are making plans to import medications fromCanada, where prescriptions are cheaper.

President Donald Trump has offered his support, marking thefirst time drug importation has won a presidential endorsement.

The states' plans are in their infancy. But they signal howfrustration among consumers — especially those shouldering greaterportions of their health bills through high-deductible health plans— is putting pressure on federal and state officials.

Related: Comprehensive drug price reform comingsoon?

Because so many details are still being hashed out, it's not yetclear who would be helped by the states' efforts or if the planscan ultimately gain federal approval and withstand likely courtchallenges.

In the early 2000s, attempts by a few states, led by Illinois,to allow drug importation fizzled, and any new plan faces stiffregulatory and legal hurdles. But drug prices are at an all-timehigh. The increasing popularity of high-deductible plans means agrowing number of patients are spending more money on health care.And Trump's endorsement and current consumer demand for loweringdrug prices could yield a different result this time around.

“Everyone is eager to get going into uncharted territory,” saidTrish Riley, executive director of the National Academy for StateHealth Policy, a nonpartisan group of state health officials, whichhas been working with Vermont on its importation plan.

Gabriel Levitt, president of PharmacyChecker.com, which verifiesonline foreign pharmacies for customers, said the high prices fordrugs make the efforts worth pursuing.

“It certainly will be helpful to reduce costs for some in thestates that go ahead, and that's a great start,” he said. Plus, headded, Trump's support “puts the wind at the sails ofimportation.”

Tempering expectations

The 2003 Medicare Modernization Act allows states to importcheaper drugs from Canada but only the Health and Human Servicessecretary verifies their safety. Previous attempts by states toallow importation failed because the secretary opposed them.

Vermont, Florida and Colorado plan to work together to set up aprogram to buy drugs from Canada, said Riley. That coalition ofstates — with governors from the center, right and left — shows howpowerful the issue of high-priced drugs is with voters.

The same medicines are often cheaper in other countries than theU.S. since most developed countries negotiate with drugmakers toset prices.

State officials said they expect that the effect of theirprograms would be modest to start, generally first permitting theimportation of only certain types of high-priced drugs and forspecific populations.

For example, infusion medicines used for cancer or autoimmunediseases that are administered in medical offices would not beavailable to import from Canada under the programs the states aresetting up. Nor would drugs such as insulin, which needs to berefrigerated. Prices for these types of drugs have come under firein the U.S., with patients calling them unaffordable.

“It's a few states and a few drugs,” Riley said.

No tampering with safety

Vermont, which passed legislation to start planning the programa year ago, is still trying to find a way to ensure the safety ofimported drugs and so far has identified only 17 medicines thatwould save enough money to be worth bringing over the border. Thosedrugs include treatments for conditions including diabetes,hepatitis C, cancer and HIV/AIDS.

After a review, officials decided it was not worth importingdrugs for Medicaid enrollees because the state already receiveshefty rebates on those medications from U.S. manufacturers andpatients do not have copayments. So Vermont's program is beingdesigned to help residents who have commercial insurance.

Florida's legislature authorized a blueprint this spring with astrong endorsement from Republican Gov. Ron DeSantis. The programaims to help bring down drug costs for the Medicaid program, whichcovers the more than 4 million enrollees in the state, prisonersand patients at free health clinics. The legislature alsoauthorized a separate program that would provide drugs forindividual Florida residents.

DeSantis signed the bill June 11 and called on federal officialsto “get this done.”

Colorado approved its legislation in May, but state officialssaid they do not yet have details on what it might cover.

Officials in all three states have high hopes that the programswill succeed in ways not possible the last time around.

Between 2004 and 2009, Illinois, Kansas, Missouri, Rhode Islandand Vermont defied the federal government and allowed residents toimport from a Canadian retail pharmacy under a joint program, whichflopped. Just 5,000 people participated, far fewer than the millionspredicted, partially because the federal government declared theprogram violated federal law and warned against using the drugs.Also, in 2006, it established a Medicare drug benefit to help those65 and older, further weakening demand.

Besides, after several years, the Canadian health ministerthreatened to prohibit pharmacies from participating over concernsthat the program might cause shortages, and the main Canadiansupplier pulled out due to lack of demand.

In 2014, Maine briefly allowed residents and employers to buyforeign drugs. Under that law, some employers, including the citygovernment of Portland, established a program for workers to useCanaRx, a Canadian company that connects customers withbrick-and-mortar pharmacies in Canada, Great Britain andAustralia.

After pharmaceutical manufacturers and pharmacists sued, afederal judge overturned the law in early 2015, citing its conflictwith federal law.

Then and now, opponents of importation say sending drugs overthe border will increase the chances Americans get counterfeitmedications, a claim often boosted by the drug industry. Levittnoted that states now intend to work directly with and inspectCanadian wholesalers, which should make Americans more comfortableabout drug safety.

With prices so high, individual Americans are more open tobuying drugs from Canada, anyway — some have for decades beendriving over the border, using online pharmacies or going intostorefronts that connect buyers to pharmacies in Canada and othercountries. Although these strategies are technically illegal, thegovernment does not prosecute individual offenders. Nor has itmoved to stop the dozens of cities, counties and school districts across theUnited States who have programs for employees to buy drugs fromCanada and other countries.

Canadian health officials are watching the debate and said theyare weighing the effect a robust importation program would have onCanadian consumers.

“Collaborative efforts among implicated parties would beimportant in addressing any potential adverse impacts on the drugsupply in Canada that may arise from increased cross-border trade,”said Eric Morrissette, a spokesman for Health Canada, thegovernment agency responsible for public health.

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

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