Nov 15, 2022 - Health

Get ready for a drug importation revival

Illustration of earth as a pill.

Illustration: Shoshana Gordon/Axios

Sens. Bernie Sanders and Rand Paul’s shared interest in expanding drug importation could emerge as a populist sequel to Democrats’ drug pricing bill next year — and rekindle friction between the hill, pharma and the Food and Drug Administration.

The big picture: The lawmakers are in line to be chair and ranking member of the Senate health committee in a session likely to be consumed with investigations and messaging bills.

  • A coordinated effort between the socialist and libertarian on importing prescription drugs could tap into broader inflationary and economic concerns, even though experts still view the policy as having limited impact.

Why it matters: The real risk to the drug industry isn't really from importation, an idea that's been discussed for nearly two decades. It's Sanders and Paul teaming up on the bully pulpit to question industry practices or the appearance of coziness with regulators.

Flashback: The duo in June unsuccessfully tried to expand importation during debate on a must-pass bill reauthorizing FDA user fees. "This will be a disruptor. The market needs some disruption," Paul said.

  • The Biden and Trump administrations already embraced limited importation from Canada as a way to bring prices down. States including Colorado and Florida have laws allowing for a state importation program.
  • But Canadian drug suppliers have said they won't participate, and the Biden administration itself has argued in court filings that the idea may not work, citing possible safety concerns over imported products and the potential for consumers not seeing significant savings.

The other side: The drug industry argues importation is a dangerous policy that could put consumers in harm's way.

  • "Rather than rehashing old, flawed ideas that expose Americans to unapproved and potentially dangerous medicines, the next Congress should consider policies that support medical innovation and ensure Americans have access to the best and safest treatments available,” said Gabby Migliara, a spokesperson for PhRMA, the big Washington industry trade group.

The intrigue: It's not clear how a Sanders-Paul combination would actually reduce costs, since existing laws already allow some drug importation but have largely not been used for the purpose of lowering prices, said Rachel Sachs, a law professor at Washington University in St. Louis.

  • There's also skepticism about whether importing drugs from countries with price controls would, in essence, import those price controls.

Yes, but: Sanders and Paul could use importation to press broader concerns about the drug industry and its influence over the FDA, said Cowen analyst Rick Weissenstein.

  • Both lawmakers relish their roles as renegades and are more adept at moving the political conversation than moving legislation, he said.
  • Sanders and Paul both voted against confirming FDA Commissioner Robert Califf, with Sanders raising concerns about Califf's drug industry ties.
  • "The dynamic between Sanders and Paul is likely to make things harder for FDA and brand [drug] companies" and possibly make confirmations more difficult if leadership at the agency or the Department of Health and Human Services turns over, Weissenstein said.

Go deeper