Pharmacists and some health experts are opposing a proposal to permit the bulk importation of drugs from Canada to Maine, arguing that it could result in unsafe drugs being brought into the state and have unintended consequences, such as causing drug shortages in Canada.

Proponents of Senate President Troy Jackson’s bill say those fears are unfounded, and believe it could be one of several proposals that would help to rein in prescription drug prices in Maine. The bill will go before the Legislature’s Health Coverage, Insurance and Financial Services Committee on Wednesday. If approved, the state would designate a wholesale purchaser of drugs from Canadian wholesalers.

Retail prescription costs per capita were $1,100 in the United States versus $669 in Canada in 2016, according to research by The Commonwealth Fund. Prescription drug prices in Canada are regulated by a national board, while no such system of price controls exists in the United States.

Kenneth McCall, past president of the Maine Pharmacy Association, said that trying to use the Canadian health care system to reduce drug prices in Maine is a flawed model.

“We all are looking for strategies to lower prescription drug prices, but let’s fix our own problems rather than relying on a country (Canada) that’s one-tenth the size of the United States,” McCall said. The Canadian Pharmacists Association opposes similar proposals from the U.S. at the federal level, saying it could cause drug shortages in Canada.

UNCHARTED TERRITORY

There is no real-world example of what might happen if Maine lawmakers approved and Democratic Gov. Janet Mills signed into law the wholesale bulk importation bill. Maine would be only the second state to approve such a measure, and the first, Vermont, is still awaiting federal approval before its law goes into effect. The Trump administration hasn’t yet signaled whether it will support Vermont’s efforts.  

McCall contends that it would be difficult to ensure the safety of the drug supply. He said many of the drugs bought and sold in Canada come from overseas countries and are of dubious quality, and the number of unscrupulous sellers has skyrocketed in recent years.

The regulated supply of drugs in Canada is not the issue, McCall said. Instead, issues arise when sellers of prescription drugs in Canada – when advertising to U.S. customers – pretend to be selling Canadian drugs, but are actually peddling drugs of poor quality from other countries. He said many sellers do that now online to individual buyers, pretending to be hawking Canadian drugs.

McCall said to start a wholesale purchasing program from Canada, there would need to be “robust” state oversight in Maine, and he’s not sure that can be done and still provide a cost savings.

Also, McCall said there would be no recourse if Maine patients were harmed by drugs that do not meet U.S. safety standards.

“At the end of the day, we wouldn’t have any jurisdiction over a foreign entity,” McCall said.

BUILT-IN SAFEGUARDS CITED

Trish Riley, executive director of the Portland- and Washington, D.C.-based National Academy for State Health Policy, provided the model legislation for Maine, Vermont and several other states that are considering similar legislation.

Riley said the legislation has several safeguards built in to ensure that the drugs purchased from Canadian wholesalers would meet U.S. Food and Drug Administration standards, including testing for safety and to make sure the drug has the correct amounts of active ingredients.

She said the wholesale purchasing from Canada will only be used on drugs where there is a substantial cost difference between what Canadians pay and what a U.S. customer would pay – so the wholesale purchasing wouldn’t be used on generic drugs. Riley said she’s not worried about supplies in Canada, because wholesalers will work to meet the extra demand to make more money.

“It’s a market-based solution by using the market in Canada, where prices are controlled,” Riley said.

She added that the drug supply chain is already global, even without factoring in purchasing from Canada.

“If you go to Hannaford today to get your prescription filled, 40 percent of the drugs there are manufactured in some other country,” Riley said.

CONSULTANT: DEVIL’S IN THE DETAILS

However, Mitchell Stein, an independent, Maine-based health policy consultant, said drug manufacturers are not going to want to increase the volume of drugs going to Canada in a price-controlled setting when they can make more money selling to the more unregulated U.S. market.

“There is absolutely no reason to think they will increase the volume to provide more drugs than what Canada actually needs,” Stein said. “It sounds like a good idea, but the more you get into the details, the less realistic it sounds.”

Stein said more savings could be found if the United States focused on its own solutions to prescription drug pricing, rather than trying to piggyback off the Canadian system.

Other bills submitted by Senate Democrats that await committee votes would create a prescription drug payment board in Maine, regulate pharmacy benefit managers – the middlemen who can exclude certain medications from insurance plans – require more transparency in drug prices, and permit individuals to import drugs from Canada.

In addition, state Sen. Matt Pouliot, R-Augusta, has also sponsored a bill that would regulate pharmacy benefit managers.