Travis Paulson of Eveleth, Minn., has been buying lower-priced prescription drugs from a mail-order pharmacy in Canada for years, but each shipment came with the risk of being seized by U.S. Customs because it’s illegal for Americans to import prescription medications.
That could change under a proposal announced Wednesday by the Trump administration.
States would be empowered to launch their own drug importation programs so long as they take steps to make sure the medicines are safe and that consumers would see a “significant reduction” in costs.
Although the proposal is in its early stages, the news was welcomed by some Minnesota advocacy groups that hope it will bring needed relief to patients struggling with high and rising drug prices.
“We have heard from our members for a long time that they are sick of paying the highest prescription drug prices in the world,” said Will Phillips, state director of AARP Minnesota. “Our research shows that across all parties and ideologies importation is widely supported.”
But others expressed dismay when they learned that some medications would be ineligible for importation, including insulin used to control diabetes. Insulin prices have soared in recent years, causing some diabetics to ration medicine or even seek out black market sources.
“It is disappointing that one proposal would totally exclude insulin,” said Nicole Smith-Holt, who has been advocating for affordable insulin since her son died two years ago. He had been rationing insulin because he couldn’t afford its high price.
Smith-Holt said the importation proposal should not sideline ongoing talks among Minnesota lawmakers to finish an emergency insulin access bill that could be considered during a special session this year.
“I am pleased that they are continuing to work on it, but the ultimate hurdle is who pays for it,” she said.
Insulin could be imported under part of the proposal announced Wednesday, but only if drug manufacturers agreed to allow reimportation of their own drugs from foreign countries. The prospect of that seemed unlikely as the industry’s leading trade group, PhRMA, called the proposal “dangerous.”
Paulson, who has diabetes, said it appeared unlikely that insulin importation would be made legal under the current proposals. “They haven’t proven that they can do the right thing,” he said of the drug industry.
Paulson prefers to drive to Canada, where he can get an insulin vial without a prescription for $27. Mail order, which he typically uses only if winter weather makes driving difficult, carries a price of $57, mostly because of shipping charges.
So far, all his shipments have come through unhindered. The Canadian pharmacy requires him to sign release forms acknowledging that he can’t get a refund if the package is seized by Customs and that he bears legal responsibility. But compared to the $150 co-payment that a vial would cost him in Minnesota, he has been willing to take the risk.
State importation programs also could not import controlled substances like narcotics, drugs that are injected intravenously or through infusions, and biological drugs, which include insulin and popular but pricey medications for rheumatoid arthritis.
Several states, including Florida and Vermont, have recently sought approval to begin importation programs.
Others, including Minnesota, operated successful programs in previous years despite warnings from the Food and Drug Administration (FDA).
“We did it anyway,” said Kevin Goodno, who was Minnesota Human Services commissioner in 2004 when the program was launched. Then Gov. Tim Pawlenty wanted to provide low-cost drug options to residents, including seniors, who at that time did not yet have a Medicare drug benefit.
State officials vetted several Canadian pharmacies to make sure their suppliers were legitimate and that they could handle the Minnesota business. They then set up a website that created a pipeline to two of the Canadian providers.
“It was more of a recognition that people were doing this anyway and we wanted to protect Minnesotans,” Goodno said.
The FDA warned Minnesota that its efforts were illegal but never intervened. After Medicare added drug coverage, the so-called Part D benefit, demand waned and the program was shut down in 2010 after facilitating 25,000 prescriptions at a savings of $1.7 million.
Prescription drug prices have already emerged as a 2020 campaign issue. They were a popular topic at the Democratic presidential debates, and the timing of the administration’s announcement fell in the middle of the Tuesday-Wednesday cycle of debates this week.
Democrats and Republicans in Congress have been debating legislation that would allow importation of drugs to obtain cheaper prices, in addition to other measures to try to rein in costs. But leading members of Congress have said that major proposals will not be fully prepared before September.
The Trump administration is said to be considering other health care policies as the 2020 campaign approaches, but several other White House proposals to lower drug prices have faltered recently, including efforts to force drug companies to list their prices on television ads.
Canadian officials have warned their U.S. counterparts that an American importation program could jeopardize their own supply of drugs, leading to potential shortages, according to a Reuters report in July. Others have said drug companies could limit their supplies to those countries or raise their prices in response to any new U.S. policy.
The New York Times contributed to this report.