Editor's note: This story has been updated with the Florida bill signing.
En español | Florida Gov. Ron DeSantis signed legislation Tuesday authorizing the state to import prescription drugs from Canada and other countries, potentially lowering the cost of lifesaving medicines that millions of people take every day.
Colorado Gov. Jared Polis signed a similar bill in May. Vermont was the first state in the country to enact a drug importation law. All three states need approval from the federal Department of Health and Human Services (HHS) to begin their programs, and while HHS officials have signaled their opposition to such measures in the past, President Trump has directed Secretary Alex Azar to work with Florida on its program and told Polis in a phone call that he supported Colorado’s effort.
“On behalf of more than 2.8 million AARP members throughout Florida, we applaud the governor’s signature on this legislation,” says AARP’s Florida acting state director, Jack McRay.
“Importing safe, affordable, Food and Drug Administration-approved prescription drugs from Canada and other countries is one of several important steps to bring down the high cost of prescription drugs for millions of Floridians.”
The Florida law creates two prescription drug importation programs:
- The Canadian Drug Importation Program focuses on bringing down the cost of drugs to state-funded programs, such as Medicaid and the state prison system.
- The International Prescription Drug Importation Program would allow medicines to be imported from Canada and other countries. The drugs would get to consumers through wholesale distributors, pharmacies and pharmacists.
“Floridians have been paying inexcusably high prices for prescription drugs for far too long, and today, we are taking action,” says DeSantis.
“This legislation is not only significant for what it will accomplish, but it also sends a powerful signal to Washington and other state capitols across America,” McRay says. After decades of inaction, bold, bipartisan action that could bring down the high cost of prescription medication is achievable. We look forward to implementation of this legislation in the coming months and additional action in Congress and in other states on this critical issue.”
Colorado’s new law creates one drug importation program under which the state would develop a list of high-cost drugs that are cheaper in Canada. The state, using a private company, would then purchase the medicines from Canada and sell them to participating pharmacies that would then market them to consumers.
Vermont passed its law last year but has not yet applied to the federal government for approval to start its program. The Colorado law says the state must seek federal approval by September 2020, and the Florida law requires an application be filed with HHS by July 2020. A provision in the 2003 Medicare Part D prescription drug law permits drug importation, but HHS has never approved such a program.
Under all three states’ laws, the imported drugs would have to meet Food and Drug Administration (FDA) standards for safety and effectiveness.
The National Academy for State Health Policy has identified a number of widely used and expensive prescription drugs that consumers could save a lot of money on if they could be purchased from Canada. For example, as of 2017, one capsule of Lyrica, a common treatment for nerve damage, cost $6.04 in the United States, compared with 63 cents in Canada. And the price of one tablet of Xarelto, used to prevent and treat blood clots, was $12.44 in the U.S. and $2.11 in Canada. Drug prices in Canada are lower in part because the government helps ensure that pharmaceutical prices are not excessive.
Colorado state officials point out that consumers wouldn’t save the entire cost differential because of costs associated with the importation programs. But they are confident consumers would save a considerable amount of money under these importation plans. The Colorado and Florida laws specifically say that only drugs that generate cost savings could be imported.
Supporters of the laws see these drug importation measures as an important first step in a nationwide campaign to lower the high cost of prescription drugs.
“It shows that public officials around the country are willing to start making decisions on this issue and dealing with it in an affirmative way,” said John Hishta, AARP senior vice president for campaigns. “In many ways, the states are showing the way for the federal government.”
Public opinion surveys leading up to and since the 2018 elections consistently have shown that lowering the cost of prescription drugs has been a top priority for the vast majority of Americans. This spring, AARP launched its Stop Rx Greed campaign, designed to convince state and federal officials to act on this issue.
Lawmakers, Hishta said, “are responding to a lot of the anger they are sensing from their constituents about the high price of drugs they’re faced with. We’re starting to see some broad momentum around the country. When one governor or legislature acts, others see they can be successful and are following suit.”
Action in the states
Hishta said more than 20 states are working on legislative proposals dealing with the high price of prescription drugs. For example, the New York Legislature is considering measures that would allow the state to import prescription drugs, force pharmaceutical companies to reveal any deals they have with generic manufacturers to delay the release of new generic drugs and empower the state attorney general to prosecute drugmakers for price gouging.
Several states this year already have passed bills to help reduce what consumers pay for vital medicines. For example, Minnesota, Montana, Nebraska and Wyoming enacted laws banning so-called gag clauses that prevent pharmacists from telling a patient that paying cash for a prescription might be cheaper than using their insurance. Congress passed such a law last fall to take effect in 2020, but these state measures put these bans in place immediately.
New Mexico enacted a law creating a purchasing council to review and coordinate strategies for buying prescription drugs across state agencies more affordably. A new Maryland law establishes a drug affordability council, and a Missouri measure institutes a prescription drug transparency committee.
And in California, Gov. Gavin Newsom signed an executive order directing the state to start negotiating drug prices for the 13 million enrollees of Medi-Cal, the country’s largest Medicaid program, by 2021. His administration also will study how state agencies could band together to buy prescription drugs in bulk and allow private companies to participate. One of the pillars of AARP’s Stop Rx Greed campaign is allowing the Medicare program to directly negotiate prescription prices with manufacturers, which would save Medicare beneficiaries and taxpayers money.