The presidential campaign is reigniting the battle over importing prescription drugs from Canada, with all of the leading Democratic candidates endorsing the idea.



Calls for allowing people to buy directly from Canadian pharmacies are also intensifying from some Republicans in Congress, including Sens. John McCain John Sidney McCainCindy McCain endorses Biden: He's only candidate 'who stands up for our values' Biden says Cindy McCain will endorse him Biden's six best bets in 2016 Trump states MORE (Ariz.) and Chuck Grassley Charles (Chuck) Ernest GrassleyCollins says she will vote 'no' on Supreme Court nominee before election The Hill's Morning Report - Sponsored by Facebook - Trump, GOP allies prepare for SCOTUS nomination this week Gardner signals support for taking up Supreme Court nominee this year MORE (Iowa).



But the drug industry remains dead-set against allowing importation, and it's unclear whether voter support will translate into legislative action.



“Ensuring patients have access to needed medicines is critical, but importing medicines, whether from Canada or elsewhere in the world, is the wrong answer,” the trade group, Pharmaceutical Research & Manufacturers of America or PhRMA, wrote in a fact sheet last month. That position was reiterated in a recent briefing with reporters.



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The main argument from pharmaceutical companies is that allowing imported drugs into the U.S. could bring in unsafe drugs — a risk that the group says is growing over time.“It has become very easy for counterfeiters to make bottles and packages look genuine, but the reality is they are often filled with laced, adulterated or fake pills that are dangerous to patients,” the group warned.Still, public support for the idea is strong among both registered Democrats and Republicans alike. Nearly 75 percent of people believe Americans should be able to import prescriptions from Canada, according to a poll this fall by Kaiser Family Foundation.Drug importation is governed by a complex patchwork of laws and regulations that is fueling a web-driven hunt for prescriptions.While pharmacies are prohibited from importing drugs for resale, patients can purchase online for their own use. The Food and Drug Administration has cracked down on Internet pharmacies over the last three years, though it still has a slim record of enforcing the federal ban.The personal use exception policy was “intended for humanitarian purposes” to allow patients with serious medical conditions to acquire treatments not yet approved in the U.S., according to a recent brief by AARP, which supports drug importation as a way to restrain costs.As the cost of prescription drugs takes a larger focus, more lawmakers are looking to step in to help regulate the developing market.The House has passed multiple bills that would allow the importation of drugs in the last three years, while also making inroads in the Senate thanks to advocates like Sens. Chuck Grassley (R-Iowa), John McCain (R-Ariz.) and(D-Minn.). Still, no changes have been made to the law and GOP leaders have given no indication that any bills will come up for a vote this year.This week, McCain and Grassley sent a letter asking Health and Human Services Secretary Sylvia Mathews Burwell to use her power under existing federal regulations to allow patients to directly purchase certain drugs, particularly those that have been subject to sharp price increases.“Given the priority that voters place on addressing the high cost of prescription drugs, we believe that it is time Congress and the Administration work together to take concrete steps to address pricing abuses,” Grassley wrote in a statement Monday.PhRMA said it did not yet have a comment on the letter.The most-watched policy battle has taken place on the state level.Two years ago, Maine became the first and only state to create a legal way for companies to buy medicines from outside the U.S. for resale. That law was promptly challenged in court by PhRMA, which argued that it violated the FDA’s regulatory authority.This February, a federal judge struck down the law and delivered a major win to the drug industry. In a 19-page decision, Judge Nancy Torresen ruled that the state didn’t have the right to pass a law that is superseded by federal legislation.McCain and Klobuchar, who have led recent efforts to pass legislation in the Senate, said then that the judge’s ruling added urgency.“There is bipartisan support for our bill to allow all Americans to import cheaper prescription drugs from Canada and this ruling only underscores the importance of passing it into law,” Klobuchar said at the time.Advocates of drug importation policies last saw an opening in 2009 as lawmakers helped shape an enormous package of health bills under ObamaCare.During his campaign the year before, President Obama voiced strong support for a change in policy. In 2008, he said all Americans should be able to import medicines "if the drugs are safe and prices are lower outside the U.S."But Obama backed off that position in order to win support from the pharmaceutical industry.Now, Democratic candidates Hillary Clinton, Sen.(I-Vt.) and former Maryland Gov. Martin O’Malley say they will each take on the fight if they are elected.Sanders, who once drove across Canada with a busload of American patients seeking medication, has been one of the fiercest proponents of a policy change.“Americans should not have to pay higher prices for the exact same drugs than our Canadian neighbors simply because Congress is bought and paid for by the powerful pharmaceutical industry,” Sanders writes on this campaign page.