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.

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:

Challenges to importation:

Coverage:

 

Op-eds from the Experts

Former Assemblyman Reminds Everyone That Drug Importation Is Bad For Alaska

October 2, 2017

Paul Honeman is a former Anchorage Assemblyman representing East Anchorage. He also is a retired Anchorage Police Department Lieutenant. In this September 28, 2017 editorial in The Bristol Bay Times, he highlights the dangers posed by drug importation and reminds everyone why it is currently banned…

Dr. Shepherd at the Interchange

Separating fact from fiction about drug importation at CNN’s recent Healthcare Town Hall

September 29, 2017

CNN’s September 25, 2017 Healthcare Town Hall was an opportunity for prominent senators to share important ideas about ways to improve Americans’ lives, but it also included some erroneous statements about drug importation. PSM’s Board President, Dr. Marv Shepherd, sent this letter on September 29 to clarify those issues.

NV Sheriffs’ and Chiefs’ Association Tells Sen. Heller They Oppose Allowing Drug Importation

September 23, 2017

The Nevada Sheriffs’ and Chiefs’ Association sent a letter to Senator Heller explaining their reasons for opposing S. 469, the bill that would allow drug importation…

Texas Policy Analyst Questions Economic Impact and Safety of Drug Importation

September 22, 2017

Russell Withers, general counsel at the Texas Conservative Coalition Research Institute in Austin, believes that drug importation is “neither affordable nor safe.” In a September 20, 2017 editorial in the Austin-American Statesman , he argues that “it would hurt U.S. and Texas businesses, workers and patients’ and urges Texan congress members to oppose it.

Former FBI agent warns that drug importation risks “counterfeiting, fraud and powerful narcotics in the wrong hands”

September 22, 2017

Former FBI agent Eric O’Neill warned about the dangers of drug importation in Inside Sources on September 20, 2017. “The lull of normalcy,” he writes, “masks very real threats to a relatively well-functioning system, including counterfeiting, fraud and powerful narcotics in the wrong hands…while costs are important, we shouldn’t circumvent the safeguards that keep our medicines safe and reliable.”

US Will Be Exposed to Counterfeits From Weak European Drug Security Warns Expert

August 28, 2017

In early July, European authorities reported that counterfeit versions of Omnitrope, a drug containing human growth hormone, were found in France, Denmark, and Mexico. The counterfeit Omnitrope was designed to look like it was made by a large drug manufacturer, but it contained no active ingredient. Shortly thereafter, German authorities announced that a fake version of a schizophrenia drug, Xeplion, was discovered in Germany. The Xeplion was also a knock-off, mimicking packaging used in Bulgaria and Romania.

These incidents are the latest in a stream of reports about counterfeit drugs throughout Europe. The problem lies in lax security of the supply chain — distributors, middlemen and wholesalers between the drug maker and the consumer. Despite ongoing problems with the EU drug supply chain, Congress is currently considering a bill that would open the U.S. to imports from the EU and elsewhere. We can’t have a serious debate about drug importation without understanding what is going on in Europe.

DEA Agent Warns That a Single Fake Pill Containing Fentanyl Can Be a Death Sentence

August 25, 2017

Daniel R. Salter is a 30-year veteran of the U.S. Drug Enforcement Agency who has witnessed firsthand the devastation that fentanyl is causing to communities and the strain it is putting on law enforcement resources in Georgia…

Health Policy Expert: “Why Cheaper Drugs Can Kill”

August 24, 2017

Health policy expert Kenneth Thorpe weighs in on the dangers of drug importation in this August 23, 2017 editorial in U.S. News & World Report:

“…these savings could come at the cost of Americans’ lives. Legalizing drug importation would make it far easier for harmful counterfeit and contaminated medicines to enter the U.S. drug supply. At a time when illegal, counterfeit drugs already cause hundreds of American deaths every year, importation represents a reckless way to cut health care costs.”

Bioworld: Importation a cliché, not a CAPA

August 21, 2017

Mari Serebrov, the regulatory editor for biotechnology news site BioWorld, offered this opinion about drug importation on August 4, 2017.  

“On the surface, importing drugs from Canada seems like a no-brainer,” she writes, “especially when the Canadian version is virtually the same drug as the one approved by the FDA for the U.S. market – except a whole lot cheaper. But there’s the rub. How can Congress ensure that drugs imported from Canada are all that they claim to be?

While more than 40 countries have or are implementing security measures to protect their drug supply chain, Canada’s not one of them, Brian Daleiden, vice president of industry marketing at Tracelink Inc., told BioWorld. That puts importation – from Canada, at least – on a collision course with the U.S. Drug Supply Chain Security Act (DSCSA), which Congress passed in 2013 as part of the Drug Quality and Security Act.”

Physician: Sanders’ drug proposal comes with serious costs

August 21, 2017

The Daily Herald published this editorial by Dr. Terry Sellers about the shortcomings of drug importation as policy on July 25th, 2017. Sellers is a Utah-based physician specializing in addiction.

“… price is not the same as cost,” he writes, “In this case, cheaper prices will impose tremendous costs that would adversely affect the future of medicine for generations to come.”