March Drug Importation Madness
March 17, 2026
For a pretty dead policy idea, bulk drug importation has had a lot of news lately.
Texas Health and Human Services published its annual wholesale prescription drug importation report as required by law. The program was created in 2023 without funding, and continues to not operate because of a lack of funding. Shortest report ever.
The U.S. Food and Drug Administration (FDA) held a meeting with the National Alliance of State Health Policy and “several states” to talk about Section 804 Canadian bulk drug importation programs.
For context, only two states have applied (Colorado and Florida), and only Florida’s application has been approved. Florida has committed over $120 million to the program and never imported a single unit of medicine. Additionally, the extension FDA granted them to operate runs out soon, as does funding from the Florida legislature.
Review HHS's new guidance on projecting cost savings.
At the meeting, FDA staff presented some techniques for assembling a Section 804 application, unveiled a new tool to make the required savings analysis easier to produce, and explained how to get an informal meeting to review proposals.
None of this fixes the fact that Canadians won’t cooperate with this plan. Their commitment to block exports has held firm over several years, as Florida has attempted and failed to secure medicine exported from Canada for their state.
The Congressional Research Service quietly dropped a drug importation update with a few bombshells.
First, they reiterated that if you think that ordering medicine online cheaper than what you can get here in the U.S. and having it mailed here is legal, it’s not. Alternative Funding Program vendors cheaply importing medicine for self-funded plans are breaking the law.
Second, they mentioned the “Safe Importation Action Plan” from the first Trump administration. It authorized federally-approved state bulk programs, but also a pathway for manufacturers to import their own products. The update suggests that there is no evidence that medicine has been imported under either pathway to date, and that future importation is unlikely.
At PSM we dropped our twice-a-year update on drug importation, which is divided between bulk importation and Alternative Funding Program importation programs. It also includes a map of pending importation legislation in the states which we also track on our website.
