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Victoria Knight
By Victoria Knight July 13, 2021

Biden's executive order includes push for drug importation, but experts question feasibility

During the 2020 presidential election, one of the policy points of President Joe Biden's health care platform was that he would "stand up to abuse of power" by pharmaceutical companies. Specifically on Biden's campaign website, he promised that he would allow consumers to buy or import prescription drugs from other countries, as long as the Department of Health and Human Services deemed it safe to do so.  

Nearly six months into his term, Biden issued an executive order about promoting economic competition, which included his first move towards accomplishing his drug importation promise. 

The July 9 executive order directed that the Food and Drug Administration commissioner work with states to develop a drug importation program allowing prescription medications to be sent in from other countries, particularly Canada. 

However, multiple drug pricing experts told us that of all the policy ideas aimed at reducing the cost of prescription drugs, importation from other countries seems the most unlikely to happen. 

"Other countries are not interested in facilitating this," said Benedic Ippolito, a senior fellow in economic policy studies at the American Enterprise Institute. 

Matthew Fiedler, a fellow with the University of Southern California-Brookings Schaeffer Initiative for Health Policy, agreed. 

"This policy is unlikely to ever work as intended because Canada is unlikely to allow the export of drugs to the United States," Fiedler wrote in an email. 

That's because drug manufacturers would then probably demand higher prices in Canada, since those would become the de facto prices in the U.S., he said. "That would cause a big increase in prices in Canada that Canada likely wishes to avoid," said Fiedler. 

This is not the first time that a president has suggested importing drugs from other countries, notably Canada. Former President Donald Trump put forward the same idea during his time in office. Democrats and Republicans alike have also supported similar proposals. 

During the Trump administration, a rule was finalized allowing states to seek the FDA's permission to import drugs from other countries. Several states then passed laws to that end, but Florida is the only state to have formally applied to the FDA to request to import drugs from Canada. The agency has yet to make a decision on the request. 

The Pharmaceutical Research and Manufacturers of America, the trade industry group representing major pharmaceutical companies, sued HHS in 2020 in an attempt to get this drug importation rule overturned. The litigation is ongoing, though the Biden administration has asked for the case to be dismissed. 

In a May court filing, the Biden administration argued the case was pointless because it's unclear whether any drug importation plans from states were going to be approved anytime soon. 

Canada has also signaled its concern that enacting such a policy could trigger drug shortages within its borders, and after the Trump-era rule was finalized, the country moved to block the exportation of drugs to the U.S. that may be in short supply. 

Still, Rachel Sachs, a professor of law and drug pricing expert at Washington University in St. Louis, says the idea of Biden proposing a "rehabbed" policy isn't a bad thing.  

"Drug pricing has been a big problem for several years now, and there are many policy ideas on the table. We don't lack for policy ideas — we lack for actual implementation of those ideas," Sachs wrote in an email. "So I don't think it's concerning at all if the administration chooses to advance existing policy ideas rather than developing new ones from scratch." 

It's also important to remember that Biden has just released an executive order requesting for these things to happen. It is just a first step in a long line of steps, including issuing rules and allowing time for public comment. 

That means the details of how this drug importation policy would actually work are not yet available. The executive order calls for a report to be issued 45 days after the order with a plan that outlines the specific efforts that should be implemented to reduce prescription drug prices. 

"I assume we'll know more then," said Sachs. 

So it still remains to be seen whether drug importation under the Biden administration will become a reality or will go the way of other drug importation proposals thus far — all talk and no action. 

We rate this promise In the Works.

Our Sources

Email interview with Benedic Ippolito, senior fellow in economic policy studies at the American Enterprise Institute, July 9, 2021

Email interview with Matthew Fiedler, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy, July 9, 2021

Email interview with Rachel Sachs, Treiman professor of law, Washington University of St. Louis, July 9, 2021 

Kaiser Family Foundation, 10 FAQs on Prescription Drug Importation, Oct. 8, 2021 

Kaiser Health News, Biden Administration Signals It's in No Rush to Allow Canadian Drug Imports, May 28, 2021

U.S. District Court for the District of Columbia, PhRMA vs. HHS Court Filing, May 28, 2021

NPR, Canada Blocks Export Of Medications In Short Supply In Response To Trump Plan, Nov. 29, 2020

The Wayback Machine, Joe - Health Care, accessed July 12, 2021 

The White House, Executive Order on Promoting Competition in the American Economy, July 9, 2021

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