It is a state with 21 million people, a huge concentration of medicine-consuming senior citizens and massive influence in the next U.S. election. And now, with President Donald Trump’s support, Florida is coming for Canada’s prescription drugs.

New legislation that Florida Gov. Ron DeSantis signed into law last week will set up a formal, government-run system for importing cheaper medicines to the state from north of the border, a project Trump has urged his administration to help bring to fruition.

Individual Americans have been importing drugs from this country for two decades, the demand ebbing and flowing, the impact here rarely noticeable.

But Florida’s initiative would seem to take the phenomenon to a new level, involving wholesale importation by America’s third-largest state, backed by the White House in a U.S. election cycle where high drug prices are front and centre.

Colorado just passed a similar bill, and that state’s governor, Jared Polis, says Trump has also pledged his backing for that law. Canadian pharmacists say there are two dozen other such laws in the works at state and federal levels.

Though Health Canada has said little about the trend, some Canadian experts and lobby groups are concerned, raising the spectre of a much larger market siphoning away drugs from Canadian patients.

“If they start avidly tapping our medicine supply, what does that mean?” asked Amir Attaran, a University of Ottawa law professor and health-policy expert. “What does it mean when the parasite is ten times bigger than the host? It could lead to the greatest drug shortage we have ever seen.”

Attaran is urging Ottawa to protect Canadians against such laws by bringing in its own legislation that would restrict medicine exports to other countries.

The Canadian Pharmacists Association says it has also been urging the federal government to take action, worried that wholesale U.S. importation could worsen already serious shortages.

“This is a new kind of development, and different political times as well,” said Joelle Walker, an association spokeswoman. “Our market is less than two per cent of the global market. It’s not designed to serve a market that is ten times our size.”

Health Canada is aware of the situation and is monitoring it, said Theirry Belair, Health Minister Ginette Petitpas Taylor’s press secretary.

“Our government continues its work to lower drug prices for Canadians,” he added.

The notion of Americans buying drugs from Canada, where regulations keep prices in some cases multiple times lower, is nothing new. Patients have ordered from online pharmacies and come in person to Canada since the early 2000s, with about a million Americans currently getting medicines by mail order from here, according to the Canadian International Pharmacy Assocaition.

But a number of developments have opened the door to potential large-scale importation, something that has never happened before.

The U.S. federal government had always deemed the practice illegal, but a law passed by Congress in 2003 said states could import foreign drugs after receiving Washington’s consent.

And now there is a president who appears willing to grant that approval.

During a meeting last month with DeSantis and fellow Republican Rep. Matt Gaetz of Florida, Trump told Health Secretary Alex Azar to “work with Florida to get a plan approved,” Gaetz told CNN. And later Trump said publicly the administration would allow states to import drugs from other countries “if they can buy them for 40, 50, 60 per cent less.”

Colorado’s Polis, a Democrat, said in a statement last month that Trump told him in a phone call he would ensure that state’s law would also be approved.

“President Trump and Secretary Azar are firmly committed to getting drug prices down,” U.S. Health and Human Services spokeswoman Caitlin Oakley said in a statement to the National Post. “They are both very open to the importation of prescription drugs as long as it can be done safely and can deliver real results for American patients.”

Then there is the politics. Drug prices are a major issue for both Republicans and Democrats, importation is the only solution that could be implemented by the 2020 election – and winning Florida is crucial to Trump’s re-election, noted Attaran.

“That leaves us in the middle without drugs,” he said. “It could be catastrophic.”

Yet the administration’s embrace of the idea appears at the same time contradictory. In the face of a powerful pharmaceutical lobby, the White House has shown no inclination to bring in the kind of regulations that make those lower Canadian costs possible. In fact, Trump has blasted countries like Canada for relying on higher prices in the U.S. to effectively subsidize drug research and development.

Regardless, whether an importation scheme like Florida’s would actually work, and how exactly, is unclear.

It’s unlikely pharmaceutical companies would increase their supply to the Canadian market to fuel large-scale exports — and undercut their U.S. profits. When the cross-border sale of prescription drugs reached a peak in the early 2000s, major manufacturers refused to sell to Canadian online pharmacies serving the U.S. market, and told wholesalers to do the same.

“Canada cannot supply medicines and vaccines to a market ten times larger than its own population without jeopardizing Canadian supplies and causing shortages,” Sarah Dion-Marquis of Innovative Medicines Canada, the industry trade group, told the Post.

But Tim Smith of the international pharmacy association said it’s “way too early” to tell what sort of impact, if any, the Florida law could have on this country. Meanwhile, Smith said his members cater to one million individual Americans, not wholesale importers, and have always followed a “Canada first” policy that means they don’t sell to other countries if a drug is in shortage at home.

(Modified 12:50 pm June 20 to add detail on current drug sales to U.S., at 1 p.m to add Health Canada comment.)

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