Trump gambles in push for drug import proposal

President Trump is breaking with fellow Republicans by opening the door to approving Florida’s proposal to import prescription drugs from Canada, a potentially major shake-up of how Americans pay for drugs.

Trump’s own secretary of Health and Human Services, Alex Azar, expressed concerns with the idea in a meeting at the White House on Monday, and Sen. Lamar Alexander (R-Tenn.), who chairs the Senate committee overseeing the issue, questioned whether the imported drugs would be safe.

{mosads}But Trump appears eager to push forward in his pursuit of lowering drug prices, embracing an idea that is one of the signature proposals of progressives like 2020 Democratic presidential contender Sen. Bernie Sanders (I-Vt.).

“It was very clear that the president wants to see an actionable plan that he can approve for drug importation,” said Rep. Matt Gaetz (R-Fla.), who attended the meeting Monday with Trump, Azar and Florida Gov. Ron DeSantis (R) to discuss the plan.

There are major obstacles to the idea becoming reality, though. Chief among them is the question of safety. For Florida’s proposal to go into effect, the federal secretary of Health and Human Services has to certify that the imported drugs would be safe. No secretary has ever done that before, and the current secretary, Azar, a former pharmaceutical company executive, has voiced reservations over the idea.

“No secretary of Health and Human Services yet has said it’s safe to get away from the FDA’s gold standard,” said Alexander, the chairman of the Senate Health Committee, when asked about the plan.

{mossecondads}And the plan faces strong skepticism from Trump’s own party.

Florida Sen. Rick Scott (R), who was DeSantis’s predecessor as governor, declined to say whether he supported Trump and DeSantis’s idea on Tuesday, saying only that he’s “glad that people are focused on reducing the cost of drugs.”

“I just think all the conversation is a good idea,” he said when pressed.

It is not the first time that Trump has bucked the traditional GOP position on drug pricing. Last year, he proposed basing certain Medicare drug prices off of lower prices paid in Europe, something that has drawn criticism from many GOP lawmakers.

Democrats, though, have long complained that Trump does not back up his words with action and are skeptical he will follow through with his various plans.

Walid Gellad, a drug pricing expert at the University of Pittsburgh, said “the key obstacle is if the secretary is able to confirm it can be done safely.”

But he added that drugs in Canada are already safe. Gellad said he is “very confident” they could be imported safely “if the will existed.”

Asked about drug importation on Wednesday, Azar struck a positive tone.

“We support importation if it can be done safely,” he told reporters on a press call. 

Still, he indicated that developing the details on the proposal is important.

“We’ll have to see what plan Florida comes up with,” Azar added.

Trump’s interest, nevertheless, is giving a boost of momentum to the proposal.

After Trump’s embrace of the idea, Azar’s comments were far more positive than they were last year, when he called the idea a “gimmick” that would not work.

“I don’t think we’ve seen before the secretary of HHS say they’re supportive of this,” Gellad said. “And to have the vocal backing of the president [is key].”

A handful of other Republicans also support importation, including Senate Finance Committee Chairman Chuck Grassley (R-Iowa), who could help build support for the idea after taking over the committee this year for former Sen. Orrin Hatch (R-Utah). Hatch was seen as a staunch defender of the pharmaceutical industry, which strongly opposes the plan.

The president has also made it clear that he is eager to push forward.

In the White House meeting on Monday, he initially proposed having Florida submit a proposal in just two days, according to Gaetz, before DeSantis cautioned that more time would be needed.

And Trump personally directed Azar not to slow down the process.

“He cautioned Secretary Azar against taking any steps that would unnecessarily delay the implementation,” Gaetz said.

Whether drug importation, if implemented, would actually cut drug prices in a significant way is also an open question.

Rachel Sachs, a drug pricing expert at Washington University in St. Louis, said it is possible that drug companies or foreign governments could throw up obstacles to Americans buying drugs at cheaper prices abroad. Or that there simply might not be enough Canadian drugs to adequately serve a state as big as Florida.

But the proposal certainly has the potential to bring lower drug prices. And it’s a sign of the calls for change on drug pricing, which are unlikely to subside with Trump in the debate.

Sachs called the burst of discussion “a continuing sign that the drug pricing issue continues to be a real problem.”

“It continues to be one that the states are searching for ways to address,” she said.