This week, Senator Chuck Grassley (R-IA) sent a letter to the Secretary of Health and Human Services and FDA Commissioner declaring support for the Trump administration’s drug importation plan but warning about the need to up our game inspecting foreign drug manufacturing establishments. Grassley cautioned that the U.S. must ensure new imports are properly tracked and traced within the supply chain. While there are some details in Grassley’s recently stated position that are a bit blurry, the essence of what the senator is saying is very good. We can use global trade to force down prices on prescription drugs in the U.S. while continuing to work on and improve the safety of our already-existing global pharmaceutical supply.
Senator Grassley has vociferously supported drug importation
for a long time. As reported
in The Hill in 2012, he was intensely critical of President Obama for going
back on his 2008 campaign promise to support dug importation:
This week, the Trump administration formally announced support for not only state prescription drug importation programs, but also HHS Secretary Alex Azar’s own importation plan. Until this week, it was known that Trump had instructed Secretary Azar to work with Republican Governor Ron DeSantis of Florida to help implement its new law to permit wholesale drug importation from Canada for public payers, which also includes importation from other countries for the private market. Now, there is real movement.
Before diving into Trump’s drug importation plan more fully, please take note that this plan actually allows for the importation of what the FDA has called “foreign unapproved drugs,” ones that they have said they don’t want Americans ordering online and importing for their own use. These drugs, as explained below, are safe and effective foreign brand versions of the same drugs sold here. This recognition of equivalent brand drug safety is a step in the right direction.
It’s true that while small-scale importation from Canada is
feasible, larger scale importation is not.
The future lies in pharmaceutical international trade beyond just Canada to include countries such as Japan and those in the European Union. Expanding importation programs to include the EU and Japan was recommended by Jane Horvath in a wonderfully written op-ed in Stat News earlier this week. Ms. Horvath is the leading healthcare policy expert working with the National Academy for State Health Policy and the states on drug importation programs.
Trump supports prescription drug importation, and he’s not alone. An article by Kaiser Health News reporter Phil Galewitz headlined Trump’s support for drug importation to fight high drug prices at the state level. His article delves into the history of earlier state importation attempts, which were personal drug importation not wholesale drug importation programs. But the coolest thing I took from it was that the three states that passed prescription drug importation laws have governors across the political spectrum. None are traditional right-wing Republicans or super left Democrats. What does that look like?
In Florida, you have Governor Ron DeSantis, fashioning
himself in the mold of a Trumpist Republican.
In Vermont, you have Governor Phil Scott, who can best be
described with a phrase practically unheard of these days: Liberal
Finally, newly elected Governor Jared Polis from Colorado is
a moderate Democrat.
While the state importation bill failed to advance in Utah, its vociferous champion in the state assembly is a very conservative Republican, Norm Thurston (Provo).
With drug prices in the spotlight of our national healthcare debate, one could certainly view Amazon’s entry last year into the pharmacy space as a welcome development. After all, when it comes to upending traditional business models by undercutting their prices, Amazon is king. For Americans, the tens of millions who don’t fill prescriptions each year because of cost, relief can’t come soon enough. For Amazon to succeed, Jeff Bezos should consider teaming up with Senator Bernie Sanders. Amazon’s support for The Affordable and Safe Prescription Drug Importation Act, introduced by Senator Bernie Sanders (I-VT)—to allow for the importation of lower-cost prescription drugs—would be the game changer that would have American patients cheering and the pharmaceutical industry crying.
Recent bi-partisan efforts
to bring lower-cost generic drugs to market faster are a great step in
the right direction, but they don’t infuse our captive pharmaceutical
marketplace with competition to lower prices on patented – brand name –
prescription drugs. Importation would fuel that competition. An unlikely
alliance between our country’s most successful capitalist and
trailblazing, Democratic Socialist is what we need!
Activists with diabetes, organized through advocacy group T1International, are trekking or “caravanning” to Canada to buy lower cost insulin. Why wouldn’t they? According to reporting in the Washington Post, they ended up paying $1,200 for products that would have cost $12,000 in the United States. One vial of Humalog in the U.S. can cost $300 compared to $30 in Canada.
According to the Post, the activists “see buying in Canada as a short-term emergency measure and a way to call attention to U.S. pricing — not the answer.”
I fully agree that personal imports of more affordable medicine are an emergency measure, and I’d be happy if it were a short-term one. A recent T1International survey found that 26% of Americans who take insulin rationed their medication at least once last year because of cost. That’s higher than the worldwide rate of 18%. People with diabetes should not be forced to travel to Canada to get affordable insulin when it can be mailed.