Importing from Canada

Expensive drugs in America

Drugs sold in countries where their governments negotiate with pharmaceutical companies, such as Canada and the United Kingdom, tend to be far cheaper than in the United States.

The public knows this and they are demanding our leaders do something.

Can I order online from Canada myself?

Technically no. Prescriptions cannot be mailed into the United States by foreign e-pharmacies.

However, FDA officials are employing "enforcement discretion" when it comes to small orders for personal use. Orders up to a 90 day supply of the medications.

Knowing which pharmacies are legitimate requires some effort.

♦ That said, Canada has an accrediting organization for licensed pharmacies. There are currently 49 accredited pharmacies listed. A complete list with web address can be found here.

Action at state level

Update January 5, 2024

♦ The FDA has authorized Florida’s drug importation program from Canada for a period of two years.

Even with FDA approval, Florida will need to meet additional requirements before the plan can be implemented and overcome other potential roadblocks.

For example, before Florida is permitted to import any drugs from Canada, it will need to submit a pre-import request to the FDA for each drug they seek to import, and can only import that drug if the FDA approves that request.

The state of Florida will also be required to conduct quality testing of the drugs and ensure that drug labels meet FDA standards.

It is possible that the Canadian government may impose barriers for importation to the U.S. Canadian law limits the sale of drugs outside of Canada that could create or worsen supply issues for Canadians.

♦ States are trying to do what the federal government has failed to do. They are passing legislation to allow the importing of prescription drugs in the hope that prices will come down.

Florida, Colorado and several New England states are moving ahead with efforts to import prescription drugs from Canada. Florida and Colorado are working on a plan that would create a middleman. Most people are hoping for the right to import directly.

• It is not clear who would be helped by these efforts, especially if a middleman takes a cut. All plans would ultimately require federal approval to become legal.

♦ In July 2021, the Biden administration issued an executive order directing the Food and Drug Administration (FDA) to work with states to import prescription drugs from Canada.

• They will also need to survive court challenges from the pharmaceutical industry and their allies.

The public has been clamoring for years now that CMS be given the right to negotiate drug prices for Medicare participants. The drug industry with the support of Republicans in Congress have been able to prevent this.

♦ In August 2022, President Biden signed the Inflation Reduction Act. It contains a provision for CMS to negotiate some prescription drugs for Medicare beneficiaries. It will take several years to implement but at least it is a start.

♦ The Trump administration talked the talk but never walked the walk.

President Trump quietly gave-up on his plan to ban rebates that drugmakers pay to pharmacy benefit managers. Then there was the idea to make pharmaceutical companies list their prices in television ads. That one went down in flames when BigPharma sued and won.

President Trump did come out in support of Colorado’s plan. But he did not help to make it happen.

All initiatives by states must first be approved by the U.S. Health and Human Services (HHS) Secretary. In those days Alex Azar was the head. A former pharmaceutical lobbyist and former drug company executive. It was no surprise he never got onboard with the idea of imported drugs from Canada.

♦ The new head of the HHS, Xavier Becerra has come out in support of importing drugs from Canada if there are clear rules. Who is going to write the rules? BigPharma will definitely try to put their fingers on the scale.

• The new head of the FDA, Robert M. Califf may be on a different track. He has been vague about his stand when it comes to importing drugs from Canada. He was critical of the idea in the past but we have to wait and see if he helps or hinders.

Pharma to control the flow

U.S. drugmakers argue against imports, saying they would put the safety of the U.S. drug supply at risk. Knowing they cannot prevent imports forever; they hope to control the flow of imported drugs by helping to set the rules of the game.

♦ Pharmaceutical companies are in a position to withhold supply. In doing so, they could cause both Canadian and import prices to go up.

The industry is already trying to scare Canadian officials into thinking that U.S. importers would drain the drug supply in Canada. They are encouraging Canada to push back on American’s importing from Canada. Have Canada be the bad guy.

There is a fear that drug companies will retaliate against Canadian pharmacies that sell medicines to U.S. buyers. Senator Bernie Sanders introduced a bill to try to prevent drug companies from doing this. The GOP won’t allow a vote on it.

The threat is real. In the past, some large manufacturers threatened to penalize internet pharmacies that shipped cheaper drugs to the U.S. Some pharmacies were even forced to report shipment details.

Canada is not happy

The Canadian government hasn’t done anything yet. But they are worried.

So far, the U.S. has not done anything other than talk. The Congress is not likely to pass a bill any time soon.

In 2005, an earlier Canadian government promised a bill that would restrict drug exports in response to similar U.S. proposals to allow imports. The Canadian government never followed through.

♦ Canada’s prices are cheaper than the U.S. but they tend to be more than what most Europeans pay.

If U.S. imports or manufacturers actually create shortages and start driving up prices in Canada then we can expect push back on U.S. imports.

“There’s no question that Americans are paying too much for drugs”, says Amir Attaran, a health-law specialist at the University of Ottawa. “But ... tapping out your neighbor is a nasty, rotten thing to do.”

What to expect

It is not likely that we will see any broad reining in of drug prices in the near future. The GOP continues to resist anything that even remotely resembles a type of price control.

Medicare beneficiaries will get some help in the near future but everyone on private or employer sponsored health plans have to wait.

Follow the money

Seventy-two senators and 302 member of the House of Representatives cashed checks from the pharmaceutical industry ahead of the 2020 election. This is more than two-thirds of Congress.

While we wait for Washington, you might like to read the article Buying Prescriptions Online.