Republicans divided on controversial drug importation championed by Trump and now Biden

By | July 14, 2021

The Republican Party has long been divided in allowing the importation of cheaper prescription drugs from Canada, a policy proposal President Joe Biden revived in a sweeping executive order after the Trump administration’s similar efforts fizzled in 2020.


Biden directed the Food and Drug Administration “to work with states and tribes to safely import prescription drugs from Canada” last week, a scheme former President Donald Trump championed in 2019, but that never came to fruition.

The Trump administration’s vision for legal prescription drug importation from Canada did not materialize, despite enthusiasm from Trump and his ally, Florida Gov. Ron DeSantis, who has pushed for prescription drug importation as a fix to high drug costs for years.

In 2019, the Trump administration first proposed to import inexpensive drugs from Canada, where prescription drugs are cheaper because the government regulates the prices. Trump’s proposal, the Safe Importation Action Plan, called for federal rule-making to authorize state, wholesaler, or pharmacy plans to set up drug importation programs that abide by FDA safety standards and regulations to be sold in the United States.

While Florida and New Mexico have submitted plans for prescription drug importation to the Department of Health and Human Services under Trump last year for approval, neither plan has been finalized.

Still, not all Republicans support drug importation as a fix for high costs to patients. In fact, just 12 Republicans sided with Democrats in a 2017 nonbinding vote to support an importation scheme put forward by Democrat Amy Klobuchar.

Conservatives such as Utah Sen. Mike Lee, Texas Sen. Ted Cruz, and Kentucky Sen. Rand Paul sided with Vermont socialist Bernie Sanders in support of the drug importation measure.

“Why is the party of limited government not rallying around patients and protecting their rights? The reason appears to be that a lot of Republicans buy into the drug industry line that in order to maximize innovation, we have to take away people’s rights to buy medications from [their seller of choice],” said Michael Cannon, director of health policy studies at the libertarian Cato Institute.

Republicans have historically been friendlier with the pharmaceutical industry than their Democratic counterparts and have argued that cutting into U.S. drug profits could harm the innovation of new medicines and cures. Lawmakers would not want to risk losing campaign contributions from the pharmaceutical industry, either, according to Joe Antos, a health policy expert at the conservative American Enterprise Institute.

“To support something like this, given the technical challenges of actually making it become real, kind of says that it’s potentially a meaningless slap at the pharmaceutical industry. It’s not at all clear that giving people some sort of right to import drugs is necessarily going to happen in a way that will benefit consumers,” Antos said.

Some GOP members have also raised concerns that bad actors from other countries could sneak unsafe prescriptions into the U.S. too easily under the guise of a legal importation agreement. For instance, former Wyoming Republican Sen. Mike Enzi argued against Klobuchar’s 2017 amendment, saying, “We can specify Canada, but it may be from another country altogether, particularly the Middle East … being able to get it online from even Canada doesn’t have the kind of assurance we need.”


Iowa Republican Chuck Grassley has been a longtime proponent of prescription drug imports. Earlier this year, he and Klobuchar reintroduced the Safe and Affordable Drugs from Canada Act, which would allow individuals to safely import prescription drugs from Canada through verified contractors who can certify the drug’s safety, according to FDA regulations.

The bill did not offer a blueprint for state governments to follow when designing their state importation plans to be reviewed by the federal government. The federal government also has not struck up a deal to import certain medications with the Canadian government, which has objected to drug import proposals in the past out of concern for depriving its own citizens of medications.

“Creating a whole new supply chain … is really incredibly complicated and unlikely to work,” Antos said. “It would need to be thought through, and I’m sure [Grassley is] aware that it isn’t a wave of a magic legislative wand that’s going to make any of this happen.”