The debate over the reimportation of pharmaceuticals has reemerged with the state of Florida being granted approval by the FDA to import prescription drugs from Canada. This is an extremely old Idea which I wrote about in my first Lexington Herald Leader Op Ed almost 20 years ago. The only difference is back then the idea was advocated by the left and anyone in opposition was obviously in the pockets of big pharma. Today, the political winds have reversed, and it is now being championed by the right.
In 2004, insurance companies were leaving Kentucky and competition to hold down prices was decreasing through consolidation, a sugar-coated term for legalized oligopolies. A major factor for unaffordable healthcare costs has been skyrocketing drug prices, unchecked by a lack of competition.
In Kentucky, three factors were present in 2004: Large numbers of prescriptions were written per Kentuckian. Expensive drugs were too often prescribed when less expensive alternatives existed. And the cost of prescriptions in our country was several fold more than found in other industrialized nations.
All of these factors still exist today. Kentuckians have a long history of overuse of prescription drugs, with the mind-boggling exception of vaccines and Paxlovid. Kentucky has the fifth highest antibiotic usage in the nation, more than double that of California. And Kentucky’s unhealthy lifestyles lead to heart disease, diabetes and cancer, exacerbating the usage of prescription drugs.
Kentucky pharmacists are required by law to substitute a less expensive generic drug, as long as the prescription did not specify ‘do not substitute’. But prescribing a more expensive newly developed drug, which will not have a generic option, happens all too often. Nationally, we currently pay about three times more for name brand prescription medications than does Canada.
A proposed solution to this problem is for states, similar to Florida, to obtain an FDA waiver to purchase medications from Canada. However, as was pointed out in 2004, this may be a good solution for the individual but not for the United States, as a whole. Canada is too small of a country to serve as a reliable source of medications. In 2004 its population was 10.9% the size of the United States, as of July 2024 its size is projected to be 11.5% of the United States. Since Canadians also become sick, and need medications, there has never been a large surplus.
In 2004, I speculated that even with a 20% surplus, this strategy would only be expected to fill about 2% of the United States’ needs. In today’s post-pandemic environment with drug shortages and dependence on China for drug precursors, there is little hope of reimporting Canadian drugs. And why should Canada give their drugs to the United States when they have the political backbone to negotiate prices, and the strongest country in the world is trying to take the easy way out? And why would drug companies let this happen? Wouldn’t they place export prohibitions in their contracts and limit sales commensurate with the country’s needs?
Little has changed since 2004, with the exception that the population of Canada appears to be growing faster than the United States’. But then this may be related to Canada’s sound leadership taking decisive steps, such as negotiating drug prices for their citizens, rather than playing politics with their citizen’s health and safety.
Kevin Kavanagh is a physician and the founder of HealthWatch USA.