Last month Florida got approved to start importing cheaper prescription drugs from Canada a move that’s gotten lots of attention well today the FDA signed off at a program to make Florida the first state in the nation to import prescription drugs from Canada the approval covers treatments for asthma
COPD diabetes HIV and AIDS and Mental Illness but Florida’s not alone in looking North for medications several other states are also planning to to do this and the next in line is Colorado the globe’s international correspondent Nathan Vander clip recently visited Colorado to learn about its plan to bring in drugs from Canada
He’s on the show to explain how states are trying to do this why drugs are so much more expensive in the US and what this could all mean for Canadians access to medications I’m man ramman welms and this is the deciel from the globe in mail Nathan thanks for being here thanks for having me there seems to be a lot of excitement right now about Florida potentially importing drugs from Canada can you just explain though what exactly was recently approved right so on January 5 the Food and Drug Administration in the United States gave
Regulatory permission to Florida to import certain prescription drugs from from Canada and this is part of a long process that has been taking place in the United States where there have been legal authorizations there have been presidents both president Trump and President Biden that have pushed for
This sort of thing um but states have had to put together programs uh that would meet a set of regulatory requirements by the Food and Drug Administration in order to import prescription Pharmaceuticals from Canada uh Florida was one of the first out of the gate on this in terms of uh making
An application they actually sued the FDA to secure this decision and in January the FDA said the Florida program meets its requirements it’s the first time a state has gotten this kind of regulatory approval but this kind of thing is open to States and Indigenous tribes in the US which are allowed to
Import certain prescription drugs from Canada if they can make a that matches with the FDA requirements to actually bring drugs in they will have to get specific approval drug by drug to do so they have to ensure that they have a testing regime in place to confirm their
Safety and then any drugs that are brought in from Canada are going to have to be relabeled uh for the US market and so with Florida this is essentially like wholesale drugs that will be distributed by by government programs right so that it’s said that level that they’ll they’re trying to get
The medication in for correct that’s that’s what Florida’s done other states and we can talk about this in a moment are looking at at broadening that but in Florida they are looking at government back programs the state uh Department of Corrections and other government programs that are bringing in
Pharmaceuticals into the state okay so that’s Florida uh and Nathan you were recently in Colorado which is also looking to get approval from the FDA similar to to Florida how is their application different though well it’s different in in a couple of ways one of the reasons I was in Colorado is because
It looks as if they are the beginning of an expansion of what’s taking place I mean Florida is not an inconsequential player there the population of Florida is is is about half the population of Canada um but there are a number of other states there is about a half dozen
Um States in total all of which have put together numbers uh looking at you know their estimated cost savings if they are able to access Canadian pricing and in Colorado they they’ve had an application before the FDA um they are now drafting a new application based on some of the
Things that they have learned from Florida and what Florida managed to get approval for that application in Colorado is meant to go forward later this month later in February um and where Florida was looking uh primarily at state-backed agencies uh Colorado is looking at expanding the opportunity to import from Canada to non-government
Back players the sort of thing that might bring drugs imported from Canada into pharmacies in Colorado so people could you know theoretically the idea is people could go to a pharmacy in Colorado and pick up those drugs themselves correct and just to be clear I guess people from the states can get
Drugs from Canada uh but I guess how do how does that work now and what would be very different with these these new plans well the new plans would allow for really large bulk Imports the sort of thing that has done done by wholesalers as opposed to
Individuals and Nathan I know you talked to some people in Colorado so so what did they tell you how are they feeling about this plan right and and so one of the people I I spoke with was uh state senator there Sonia hakas Lewis uh she had she’s a pharmacist herself and was
One of The Originators of the legislation that pushed Colorado towards moving for imports from Canada she’s uh says what happened in Florida is has given a great deal of optimism to other states about the possibility of doing this I mean her words was you know the FDA saying they’re going to give
Approval to Florida tells me the gate has opened and so there there’s a real hope that if Florida can gain permission other states too will now be able to gain permission after years of trying and of course a lot of this comes down to the money the cost for drugs so do we
Know what is the difference in price between a pharmaceutical drug in Canada and and the same same kind of drug in the US we do yeah um and and again we’re sort of relying on State numbers for this um because each of the states have
Had to make this case this is from the Colorado application they’ve identified 112 drugs and they’ve assembled the some of the differences in prices and so for example for a.3 milligram EpiPen us price $264.83 um cyclosporin a dry eye treatment 66 in the US a154 uh to import Latuda which is an
Antic psychotic 4344 in the US $42 to import and and you know the differences are really big but they’re especially big when you think about the number of doses that are required so in the Colorado application they they looked at Latuda uh in particular it’s it’s used to treat schizophrenia and
They’re saying right now someone without insurance in that state would have to pay about $1,500 a month to use Tuda uh Canadian prices would bring that down to about $120 per month so I mean if if you sort of factor that out you can really
Get a sense of how that kind of change in price would be life-changing for someone and so you know you know you you kind of expand these things out Florida’s estimate and again these are state-based estimates and and they are looking for approval um but their estimate is that they could save $180
Million a year um by importing drugs from Canada Colorado is saying 53 to 88 million dollar um and then and then if you look more broadly um at Medicare which is one of the two big federally backed healthare Insurance programs in the United States Medicare is is primarily for the elderly and some
People with disabilities you know if there’s if there’s greater ability to negotiate again this is you know looking at Bringing Down the cost of prescription drugs in in the US to sort of levels that are more comparable to perhaps other countries um and Medicare they’re talking about um a 988 and a
Half billion dollar reduction in spending on the cost of uh prescription Pharmaceuticals over a decade so the these are really considerable numbers that are being bandied around we’ll be right back the big question Nathan is is why do we get different prices for the same drugs I mean some of those numbers the
The the difference is really astonishing so how is the same drug so much more expensive the US than it is in Canada uh well there’s a number of reasons for that uh but one of them is Medicare uh in 2003 Congress expanded Medicare to include coverage of
Prescription drugs uh but at that time it’s now more than 20 years ago there was a specific provision that prevented Medicare from negotiating on the price of those drugs and so what that has meant is that you know there’s been an ability to charge some of these government programs very very high
Prices without any negotiation and and the US is a very sort of complicated Health Care System um with a whole bunch of different players in it and so Medicare is a big deal it’s 32% of the prescription drug Market in the United States private insurers make up about
40% and some of those private insurers have their own negotiations and negotiate their own discounts or rebates um with pharmaceutical manufacturers and you guaranteed patient volumes etc etc ET ET um but some of the big government um programs haven’t been able to do that and there’s been a series of arguments
That have been made and are being made by the way by drug manufacturers against negotiation they’re saying you know if the government negotiates down drug prices it’s going to harm Innovation which is going to result in less research spending and create less fewer life-saving drugs um they’re saying
These sorts of negotiations are going to uh provide savings to the government as opposed to patients and and they’ve even made constitutional arguments saying that you know the very process of negotiating prices by a program like Medicare would constitute uh violations of freedom of speech or The Taking of private property without just
Compensation and there’s a series of lawsuits that have been filed some of which will undoubtedly end up before The Supreme Court on this broader issue of negotiating on prices inside the United States um but the degree of opposition and and the nature some of those arguments I think give you a real sense
Of why it’s been so difficult uh to achieve negotiation on drug prices in the United States and by the way this I think we don’t always realize just how much the US spends on Healthcare it’s about double per person what Canada spends on Healthcare wow really there’s some really Stark numbers there some
Stark differences Nathan um and I guess let’s focus on this idea of the drug negotiation for for another couple minutes here because this seems like a really key part of this so in the US they don’t have this kind of same ability to negotiate the price of a drug
Uh so how does that work differently in Canada what do we do here well in Canada in 2010 there was an agreement by a number of Premier to begin uh negotiating together on drug prices and there’s something called the pan Canadian pharmaceutical Alliance which was formed it which is active today and
It it takes credits for some fairly substantial savings their suggestion is that they believe that they’re saving Canadians something like $3.5 billion dollar a year on uh the cost of of some of these Pharmaceuticals both um generics and brand name drugs again that’s their number but but it’s it’s a
Sense of you know what can be achieved um by negotiating together which is something that we’ve had in Canada we also have some Federal Regulation on prices in Pharmaceuticals there’s Federal intervention on certain certain Pharmaceuticals and and the prices that can be charged okay so it sounds like in
Canada I mean we we kind of go to the negotiating table as a single body you said there’s this this pan Canadian pharmaceutical Alliance that goes to negotiate with the drug companies together as one unit but in the states there’s all these different units that are kind of negotiating their own thing
And that’s why you have kind of a peac me system and and different drug costs then and then you have very very large bodies like Medicare that have been prohibited from negotiating whatsoever and so you can imagine if you Medicare alone is 32% of prescription drug spending in the United States if they
Are allowed to begin negotiating some of those prices you can imagine the degree of change this would be and actually there is this thing that might change that the the inflation reduction act which could allow Medicare to negotiate prices so and Nathan can you talk about
That so the the what what the inflation reduction act did was it gave new powers uh to the US Department of Health and Human Services U to negotiate the price of some drugs used by Medicare and there’s been the start has been um 10 drugs that are currently under
Negotiation in terms of price uh and there also seems to be optimism around these plans to get drugs from Canada but I understand there’s also some hurdles in that so so Nathan what are these hurdles well the drug companies um so basically in order to get drugs from Canada into the United
States you have to be able to secure supply of those drugs in Canada many of the drugs many of the drugs that we use in Canada aren’t made in Canada they’re imported into Canada um or they are sold in Canada by International pharmaceutical companies and many of those pharmaceutical companies have
Already moved to get in front of this sort of thing um and they have actually created contractual agreements uh for their purchasers in Canada to prevent those purchasers from reselling uh drugs from Canada to other markets I.E the United States so there’s so there’s like there’s like Clauses in the contracts
That we can’t sell those drugs to the states then correct yeah so I reached out to a number of of Pharmaceutical companies a couple of them got back to me and confirmed this on the record novaris for example said contractually resale of novaris products outside of Canada are prohibited um GSK and V
Healthcare said our general terms and conditions of Supply include anti- exort Clauses Colorado the state of Colorado put out a report that was documented some of its efforts to kind of prepare the ground for imports from Canada this came out in December basically what the
State said was um what we we’re going to have to do is we’re going to have to get individual drug makers to work with us in order for us to be able to import directly from Canada into Colorado so they started working on that state officials um reached out to 23
Pharmaceutical companies four of them only four agreed to have meetings but at those meetings said that they had no interest in negotiating with Colorado on bringing in drugs from Canada nine of them said nope we’re not meeting you at all um and 10 said we’re didn’t even respond the state made multiple requests
To meet and they didn’t respond so that gives you a real sense of uh what is one of the chief obstacles to States like Colorado and Florida to bringing in drugs from Canada so we’ve talked a little bit about the you know the feelings in in parts of the states and
And the motivation there Nathan but let’s talk about Canada what is the reaction from Canada to to these plans well what what we seen is we’ve seen the current liberal government say that it feels like there are sufficient prote in place to ensure um the security of Canadian Supply there are anti- exort
Provisions related to sufficiency of Supply in Canada already I reached out to uh the minister of Health’s office and spokesman there said Canada has the tools to make sure that Canadians continue to have access to the medications they need uh when they need them but of course you know one of the
Worries has been if you have a state of Florida with 21 million people in it coming to buy from Canada what’s that going to mean in terms of the the drugs that are left for Canadians and and how how much of Canada Supply is is going to
Be purchased by some of these states but the fact remains that um at at this point in time such exports from Canada are difficult and constrained but not illegal and so this is one of the arguments that’s been made by for example ujal desange who was a liberal
Health minister in the Paul Martin Administration and and he’s been a bit outspoken about this I I spoke with him he’s like we can’t be the drugstore for the United States of America he’s worried that someone somewhere is going to find a way through some of these
Obstacles a loophole or some other way through um and that we are going to start seeing shortages of some of these drugs and and by that point it’s going to be difficult to respond he’s saying you know these bulk exports from Canada to the United States should just be made
Illegal there should be a law against it um to forall even the possibility of of this taking place so so this former minister is advocating for you know just a a regulation clearly to state that we you know we can’t do this but he also talked about loopholes so Nathan it
Sounds like there are some regulations in place then to prevent this this from happening there are regulations that are designed to protect the sufficiency of pharmaceutical in supply of Canada so Health Canada prohibits exporting drugs um intended for the marketing Canada if the export of those drugs would sort of
You know create or worsen a shortage of those drugs in Canada so th those are the sorts of regulations and they’re linked to ensuring that there are sufficient supplies for Canadians okay I I’m just curious Nathan why is the US looking to Canada to import drugs instead of you know any other country
Maybe even Europe where where prices are also cheaper why why Canada the quick answer is they are also looking at other uh countries but but you know the requirements uh for bringing in drugs into the United States uh or that they need to come from a place where they have a comparable pharmaceutical
Regulatory environment which sort of simplifies the whole process and you know and and and Canada’s easy from that perspective you know it’s close and and from from the perspective of um achieving drugs that meet the same drug safety standards uh Canada is pretty easy I guess though given the major
Hurdles you know even after this has been approved by the FDA that we’ve been talking about uh what is the point of trying to get drugs from Canada because it sounds like there’s a lot of stuff in place to to make this not actually
Happen so in I mean in a way is this actually possible is this just like a symbolic move well I mean I put that question to to the state senator Sonia heckis Lewis who I spoke and she said no it’s not symbolic you know this this could be uh importing drugs from Canada
She said could be a you know quick kind of part-time solution but she’s also pretty open to the fact that one of the things that they’re hoping to do through this broader campaign to import drugs from Pharmaceuticals from Canada uh is to draw attention to some of these
Differences in prices to to sort of um create the conditions for writing a report such as the one that sort of outlines the differences in drug cost and that sort of thing um and in so doing um to both shine a light on what pharmaceutical manufacturers are doing
In terms of uh pricing in the United States and and to help sort of further pressure on some of these other initiatives to try to negotiate down the price of some of these drugs inside the United States so there is an element of this um that is that is part of a a
Broader pressure campaign um but there’s also an element of it this that’s born of a frustration um that it’s been very difficult to achieve progress in the United States there’s a hope that perhaps Canada and accessing drugs from Canada can form a quicker easier simpler kind of end run around some of that
Stuff but as we’ve discussed it’s it’s not clear how much is going to make it through if anything will make it through that endrum yeah so Nathan just lastly then I mean at the end of the day should Canadians be worried about their access to medications well I mean Colorado is
Saying you know they they have no interest in any drugs that are already in short supply they specifically said you know for example OIC is not on the list or any of these that have made headlines lately but it’s clear that there are States now that are gunning for pharmaceuticals for Canada and
They’re putting uh both itical and bureaucratic Capital into making that happen and that is likely to have implications in some way in the future uh that we may not even yet fully understand at the moment though I mean it it does seem if you look at the incentive structure do pharmaceutical
Companies that Supply Canadians with drugs do they have any incentive to let those drugs go into the United States Market in purely economic terms the answer really does seem to be no Nathan thank you so much for taking the time to speak with me today today thanks for having Me that’s it for today I’m Manar ramman Wilms our producers are meline white Cheryl Sutherland and Rachel Levy McLaughlin David Crosby edits the show Adrien Chong is our senior producer and Angela Penza is our executive editor thanks so much for listening and I’ll talk to you tomorrow
In early January, Florida became the first U.S. state to get approval to import wholesale drugs from Canada. The FDA’s decision overrides decades-long objections from drug companies and could save the state millions of dollars. Now, Colorado is looking to do the same.
The Globe’s international correspondent, Nathan VanderKlippe went to Colorado to learn about their plan to bring in cheap drugs from Canada, why drugs are so much more expensive in the U.S., and whether Canadians could be facing a shortage in their medications.
Read more:
Follow The Globe and Mail
Instagram:
Twitter:
Facebook:
