States look to lower drug costs, consider Canadian imports

MONTPELIER, Vt. -- Lawmakers in more than two-thirds of the states are considering ways to reduce prescription drug costs, including importing them from Canada, as they strive to balance budgets without knowing for sure what their government's share of the tab will be.

A total of 87 bills in 34 states of all political stripes seek to save money on prescription drugs, according to the nonpartisan National Academy for State Health Policy. Six of those states are considering bills that would allow drugs to be imported from Canada, where they cost an average of 30 percent less than in the United States.

One is liberal Vermont, where lawmakers have revived a nearly 2-decade old proposal. Conservative Utah is considering a similar proposal. Maryland is looking at creating a commission that would regulate drug costs.

"States have to balance budgets," said Trish Riley, executive director of the National Academy for State Health Policy, based in Portland, Maine. "You budget a certain amount of money for drugs in a state employee health program or a Medicaid program, and you're surprised by the mid-year increases that are unpredictable and huge."

The stakes are high not only for state governments, government employees and Medicaid recipients, but also for anyone else paying for prescription drugs. The federal government does not control drug prices, which are set by drug companies and are subject to costs and competition, while Medicaid negotiates cheaper drugs for low-income Americans.

But one hope is that importing drugs can put downward pressure on domestic costs for all, said Utah state Rep. Norm Thurston, a Republican who introduced a drug-import bill in his state.

"It's not a liberal-conservative thing," he said. "It's not a Democrat-Republican thing." Of the pharmaceutical industry, he said, "it makes them compete against themselves."

The Pharmaceutical Research and Manufacturers of America, a trade group for drugmakers, argues the proposals would threaten people's health because quality could not be assured.

Safety has nothing to do with the potential for tainted drugs from Canada, said Thurston, whose bill could be debated by the Utah House today.

"The No. 1 threat to patient safety related to prescription drugs in our state is that the drugs are so expensive that people don't take them," Thurston said. "We don't have any widespread problem in our state with counterfeit drugs."

Allowing patients to buy medication from other countries with strict drug standards, such as Canada, is an idea that long has been floated in Washington by lawmakers of both parties. But each time, it has been blocked by the powerful drug lobby.

President Donald Trump has supported opening up imports, and in his State of the Union speech called drug prices an "injustice" and promised action this year. But it's still unclear whether his administration will take the importation route. New Health and Human Services Secretary Alex Azar has favored other steps to increase competition domestically.

Federal law since 2003 has allowed the U.S. health secretary to give states permission to import drugs, but such permission has never been granted. Federal drug-import legislation, introduced by Vermont's independent U.S. Sen. Bernie Sanders last year, is once again being considered by Congress, though states are taking the bolder approaches.

The drug-import concept was highlighted almost two decades ago by Sanders, at the time a U.S. representative, when he took busloads of Vermonters to Quebec to visit Canadian doctors and fill prescriptions.

Leukemia patient Jayne Rivera, 59, of Lyndonville, Vermont, has been living on Social Security disability, and her medical costs have been paid by Medicare. While most costs are covered, a year ago she still was paying $60 to $70 a week for about 20 prescriptions.

She just learned a $2,000-a-month prescription will be covered, bringing her monthly drug bill down to about $40 a month. But the affordability question still nags at her.

"It's that worry," she said. "OK, I need this medicine because it's keeping me alive. I live on disability. With all my other bills and everything, I don't have extra money for medication."

While many states are focused on their budgets, the New Hampshire legislature is considering a proposal designed to ensure pharmacists are allowed to tell customers whether they are getting the best deal.

In Vermont, a Senate committee Feb. 4 approved a proposal to create a bulk purchasing program that would import drugs from Canada, following strict safety guidelines, so they could be distributed by pharmacies at a fraction of their American price.

State Senate President Pro Tem Tim Ashe, a liberal, said the idea isn't as far-fetched as it once was. He pointed to Utah, a conservative state with a powerful congressional delegation, as being furthest down the path toward legalizing prescription drug imports from Canada.

"There seems to be a bipartisan coalition that the American people are getting ripped off," Ashe said, "and these huge spikes in prices in recent years have been a more egregious story than what we knew back in the '90s when Bernie was starting to take those road trips."