Florida Gov. Ron DeSantis is challenging traditional Republican doctrine with a plan to import prescription drugs from Canada to lower costs for seniors, the first major legislative initiative of his young tenure.
DeSantis, appealing to the gray vote, announced the plan in February at the retirement community The Villages, receiving an outpouring of support and cheers. Now, a state Senate version of the bill is moving quickly, with the appropriations committee voting overwhelming in favor of the bill.
DeSantis’ plan calls for the Florida Agency for Health Care Administration to choose Canadian wholesalers and license them to export specific, high-cost drugs approved by the Food and Drug Administration to Florida. The cheaper medications will then be dispensed by local pharmacies to any Floridian with a prescription.
“One of the biggest drivers of this country’s out-of-control healthcare spending is the cost of prescription drugs,” DeSantis said in his announcement. “While our prices remain high, our neighbors in Canada are spending significantly less for the same drugs.”
Xarelto, a common blood thinner prescribed to prevent blood clots and strokes, costs over $13 per tablet in the United States. In Canada, that cost shrinks to about $2 per tablet.
Florida has unlikely company in its goal of importing drugs from Canada. In 2018, the Vermont state legislature unanimously passed its own importation plan to allow high-cost FDA-approved drugs to be purchased through licensed Canadian wholesalers, but it has yet to get the necessary approval from the federal Department of Health and Human Services.
DeSantis, a vocal supporter of President Trump, is projecting confidence that the Trump administration will sign off on his bill if it’s enacted.
“President Trump and Governor DeSantis have spoken many times about the unsustainable increases in the cost of healthcare,” a spokesman for the governor said. “President Trump encouraged Governor DeSantis to proceed with this initiative and with the President’s support, we feel confident that this can get done safely and effectively.”
Aside from Trump, the Republican Party generally opposes drug importation. Even Trump’s top health officials have criticized the idea. Health and Human Services Secretary Alex Azar called it a “gimmick” last year.
Douglas Holtz-Eakin, president of the conservative think tank the American Action Forum and an adviser to John McCain’s 2008 presidential campaign, says DeSantis’ plan is a “false hope.”
“Importation won’t work,” Holtz-Eakin said. “The notion that Canada will send back all of the drugs it authorized for themselves — they’re not going to let them get away. It makes no sense.”
The conservative Wall Street Journal editorial page also criticized DeSantis this month for the plan, saying that he is aligning himself with progressive legislators in Vermont.
While DeSantis doesn’t have the backing of mainstream conservative experts for his plan, he does the support of Florida seniors, an important constituency in a state that has been trending red. Seniors take the most prescription drugs, and are often liable for high prices that Medicare does not cover. For many seniors on a fixed income, out-of-pocket costs for necessary medications are unsustainable. The AARP has come out as a strong supporter of DeSantis’ importation plan.
Pharmaceutical companies, however, have scrambled to stop the importation measure. A coalition of industry leaders and pharmaceutical executives launched a TV ad campaign throughout the state, warning that the cheaper drugs would come with greater health risks. One ad quotes a tweet from former FDA Commissioner Scott Gottlieb, who said that the imported drugs would come from “unreliable parties and counterfeiters.”
Pharmaceutical lobbies, including PhRMA, say the origins of the drugs cannot be tracked or traced, and may not be Canadian at all.
Priscilla VanderVeer, vice president of public affairs for PhRMA, says most drugs from Canada are actually from all over the world, and could be collected by a single opportunistic wholesaler “who sets up shop in Canada and then slaps a Canadian logo on them and sends them to the United States.”
Shabbir Safdar, executive director of the Partnership for Safe Medicines, said that the group opposes the bill “because unlike all other proposals, this one sacrifices safety.”
Proponents of importation defend the bill by noting that the chances of taking a tainted drug are minor relative to the potentially fatal effects of not importing drugs and facing high prices. “There are very serious risks that are involved in the prescription drug issue that I don’t hear anyone talking about,” said Dave Bruns, a spokesman for the Florida AARP. “And that’s the risk for people who are skipping doses, going without their medication, cutting pills in half, because they can’t afford them.”
DeSantis’ bill includes measures meant to address the safety criticisms. Only FDA-approved medications can be imported, and only from FDA-licensed suppliers. The Canadian providers also would have to comply with a product-tracking law that Congress enacted in 2013 to keep counterfeit and hijacked drugs out of the supply chain.
The bill’s defenders argue that, with extensive safety measures in place, drug importation could save lives. They say that, when prices rise as steeply as they have over the past decade, people in need of medications are more likely to turn to shady online shops where they can find their blood pressure or diabetes medications for much less. Relying on unverified sellers and unlicensed pharmacists to get necessary care, Bruns of the Florida AARP said, is the real risk factor.
Trish Riley, executive director at the National Academy for State Health Policy, says she is optimistic that Florida’s importation plan could move to Azar’s desk based on early support in the Florida legislature. The group was the primary architect behind Vermont’s importation plan.
