The West Virginia Legislature continues to weigh whether it would be worth the state joining four other states in attempting to get federal permission to import some prescription drugs from Canada, one way states are trying to reduce prescription prices for consumers.
The Legislative Commission on Health and Human Resources Accountability last Monday heard from researchers at the National Academy for State Health Policy on what states are doing to implement wholesale drug importation programs, which would allow states to import drugs from Canada using existing structures to inspect quality.
A bill to create a wholesale program sponsored by Delegate Mick Bates, D-Raleigh, moved through committees during the 2019 session, but delegates chose to study it more in the interim before going any further. A similar bill was introduced in 2018.
“Not only do I think it is a good idea for us to be looking at this, it puts pressure on the pharmaceutical industry and shows them that we are serious and we can’t just take these year-over-year increases on the cost of prescriptions,” Bates said. “It’s just unsustainable. It’s eating up all the resources.”
Vermont was the first state to begin working on a wholesale importation program, with Florida, Colorado and most recently Maine getting on board. The states are working together to blaze a path that leads to federal approval of the program, said Maureen Hensley-Quinn, senior policy director at the NASHP.
The biggest of several hurdles is getting federal approval. Under federal law, the U.S. Secretary of Health and Human Services has the authority to allow wholesale importation from Canada if certain standards are met. The U.S. Food, Drug and Cosmetic Act allows for drug importation if safety and consumer savings can be assured. Opioids, biologics, injectable medications and certain other drugs may not be imported.
Hensley-Quinn said some examples of drugs states are hoping to import are for diabetes, HIV/AIDS, hepatitis C, COPD and blood clot prevention. A Vermont study determined by importing just 17 types of prescription drugs, the state would save $1.5 million a year — a figure that led to some murmurs in the committee room.
To get federal approval, Vermont and other states will have to prove there will be cost savings to the consumer, and researchers said finding a way to prove that has become a challenge. One way may be to show a reduction in copays or deductibles. She said there may also be a way to track a reduction in premium rates.
States are also having trouble accessing data as even local stakeholders, like private insurance companies, push back against the idea. One way to go around this is to start with the state employee insurance program, she said.
Hensley-Quinn said they also anticipate pushback from the pharmaceutical industry itself, probably in the form of lawsuits.
“States are disrupting the pharmacy industry that continues to raise its costs with these laws,” she said.
At the same time, states cannot get a Canadian supplier to explicitly state they would be willing to participate in such a program. Hensley-Quinn said they anticipate there will be companies that come forward once the U.S. government gives its approval.
With the goal of disrupting the pharmaceutical industry status quo in mind, Hensley-Quinn said the creation of wholesale importation programs is not the only avenue being taken to reduce prescription drug prices. She said President Donald Trump’s transparency plan goes much further than any before by looking at the entire supply chain.
While this alone won’t pull down prices, it will allow everyone to see where the issues really are. States are also finding cost savings through legislation regulating pharmacy benefit managers, or PBMs.
Bates said something needs to be done to curb rising drug prices. He said he was encouraged by the additional interest and he plans to reintroduce the bill next session. He is hopeful it can move through the House to the Senate.