HHS's Federal Action Plan for Drug Importation, 2019
Synopsis:
On December 18, 2019, the U.S. Department of Health and Human Services (HHS) released proposed regulations for importation by pharmacists and wholesalers (Pathway #1) or by manufacturers (Pathway #2).
Current status:
HHS's comment period for RIN 0910-AI45 ended on March 9th. Read PSM's summary of the results here.
What you can do now:
Because these programs have never sustainably saved money, and have endangered Americans every time they've been attempted, PSM is taking a number of actions to fight for patient safety. As we develop opportunities to speak up for safety, we'll put these here.
How should we evaluate this program?
Until July 2019, every head of Health and Human Services and the FDA since 2003 has refused to certify the safety of drug importation. Many—including Alex Azar, former FDA Commissioner and Trump appointee Scott Gottlieb, and his four immediate predecessors—have explicitly criticized these proposals as unsafe, unimplementable, and unlikely to save money.
HHS and FDA hasn't implemented its proposals yet so there's no way to evaluate whether they save money or keep patients safe. However previous programs in Maine, Illinois, and Minnesota all shut down because they didn't save the money promised. They all had safety lapses as well.
RIN: 0910-AI45
Official actions and statements
December 23, 2019 - March 9, 2020: HHS solicits comments about RIN 0919-AI45
July 31, 2019:
- HHS Announces New Action Plan to Lay Foundation for Safe Importation of Certain Prescription Drugs
- Remarks on the Safe Importation of Certain Prescription Drugs
August 6, 2019:
August 20, 2019:
- Florida submits a Canadian Prescription Drug Importation Concept Paper to HHS
Fall 2019:
- Office of Information and Regulatory Affairs posts RIN 0910-AI45, a draft of the proposed rule for the importation of prescription drugs.
Planning documents
HHS/FDA announces the Safe Importation Action Plan. July 31, 2019
Section 804 of the Food, Drug and Cosmetic Act which outlines the method by which the Federal government may import medicine from Canada.
Background / resources
Just learning about foreign drug importation proposals? Start with some of these resources that outline the safety issues.
PSM Materials:
- Learn about failures to save money and keep patients safe in previous importations programs in Maine, Illinois, and Minnesota.
- Every head of Health and Human Services and the FDA since 2003 has refused to certify the safety of drug importation
- Importation has been opposed by dozens of groups representing law enforcement, patients, regulators, and healthcare professionals for nearly two decades.
- Drug importation endangers U.S. patients by breaking our closed, secure drug supply
- Common misconceptions about drug importation
Challenges to importation:
- Canadian patient groups, healthcare groups, boards of pharmacy and the Canadian government have not agreed to importation.
- A 2018 study by PSM board member and pharmaco-economist Dr. Marv Shepherd shows that if 20% of U.S. prescriptions were filled using Canadian prescription drug sources, the Canadian drug supply would be exhausted in 183 days.
- Dr. Kristina Acri's analysis shows that importation programs are unlikely to save money because of the costs of testing medication and treating patients who encounter counterfeits.
- Importation breaks Track and Trace systems which have been in-process since 2013, when Congress passed the Drug Supply Chain Security Act.
- State Drug Importation Laws Undermine the Process That Keeps Our Supply Chain Safe (July 11, 2019)
- In February 2017, Alan Coukell, the senior director of health programs for the Pew Charitable Trusts wrote Senator Bernie Sanders, to raise concerns about the effect of importation on the pharmaceutical supply chain security provisions.
- To learn more about Track and Trace, consult the FDA and RXTrace
Coverage:
- Everything (or almost everything) you need to know about importing drugs from Canada, July 31, 2019
- Canada wasn’t consulted on specifics of U.S. plan to import prescription drugs, July 31, 2019
- U.S. demand is threatening Canada's drug supply, groups warn feds, July 26, 2019
- Exclusive: Canada warns U.S. against drug import plans, citing shortage concerns, July 18, 2019
- HHS Secretary Alex Azar dismisses drug importation as a gimmick, May 14, 2018
Op-eds from the Experts
In this editorial, which was published in The Bend Bulletin on May 21, 2019, Canadian law enforcement veteran Don Bell explains why Oregonians can not rely on Canada for safe prescription drugs.
Dozens of the most highly qualified law enforcement officials and former, senior staff at the U.S. Food & Drug Administration have conducted in-depth analyses that show Canadian drug importation will lead to a massive increase in counterfeit drugs entering the U.S.
In this editorial published in The Hill on May 12, 2019, Brooklyn Roberts, the director of the health and human services task force at the American Legislative Exchange Council, discusses the risks of drug importation:
“The safety of our prescription drugs relies on a closed system where drugs can be traced to manufacturers, distributors, pharmacies and patients. Opening that system to foreign drugs would allow the potential for dangerous and potentially deadly medicines to land in the hands of the American public.”
In this editorial published on April 30, 2019, former FBI Director Louis Freeh talks about the safety risks of drug importation: “There are hidden risks and costs associated with the scheme that have not been getting much attention which impact your health and Colorado law enforcement’s ability to keep us safe.”
In this editorial published on April 26, 2019, Douglas Holtz-Eakin, economist and President of American Action Forum, questions economic truths about drug importation:
“Drug reimportation has long been the fool’s gold of health policy, and the Florida bill is no different. It flunks a basic policy analysis. But most amazing, it is drafted to raise hope, but not actually help Floridians.”
In this piece published in the Washington Free Beacon on April 25, 2019, staff writer Charles Fain Lehman explores issues around Florida’s drug importation proposal. “Critics,” he notes, “fear that the actual realities of regulatory oversight—especially in the hand of an as-yet-unnamed private vendor—will simply be too challenging to manage responsibly.”
In this piece, which was published in The Deseret News on April 24, 2019, pharmacist and Utah State Senate Majority Leader Evan Vickers raises serious concerns about importation as a strategy to lower drug prices:
“Anyone who truly understands how drugs are sold and distributed in the U.S. knows that there are very solid technical reasons that such importation is not viable. There are also serious concerns about drug safety, since the CHS cannot guarantee origin and purity on foreign-sourced drugs.”
In this piece, which was published on the ABC affiliate WJLA’s website on April 25, 2019, political analyst Boris Epshteyn explains that “this is a risky plan that will make it difficult to ensure that Floridians are receiving real and safe medicine.”
In this piece, which was published in the Inside Sources on April 22, 2019, Michael Graham reviews the case against drug importation: “As Scott Gottlieb said in 2016 before becoming President Trump’s FDA chief…’There are simply too many channels for fake drugs to enter any importation scheme to forgo some meaningful controls.’”
In this editorial, which was published in the Palm Beach Post on April 22, 2019, Michelle Flowers writes about Florida’s history of black market cancer treatments and the danger importation poses to patients. Flowers is president of the Oncology Managers of Florida.