TORONTO — President Trump drew the ire of Canadians during his campaign when he lambasted the country’s health-care system — a point of national pride — as “slow” and “catastrophic.”
But it appears there’s at least one aspect of the Canadian system that he admires. On Wednesday, his administration said it was weighing plans to allow for the legal importation of prescription drugs from Canada to help Americans coping with skyrocketing drug prices in the United States.
The response from Canadians? Sorry, but back off.
Pharmacists, patient groups, doctors and some lawmakers here worry that the large-scale importation of pharmaceuticals could deplete the drug supply for the country’s 37 million residents.
“This is going to exacerbate some of the drug shortages that we’re already seeing in Canada,” said Joelle Walker, the vice president of public affairs for the Canadian Pharmacists Association. “We aren’t equipped to deal with a country that is ten times our size.”
She said such measures could also increase the prices of drugs for Canadians.
Health Canada, the federal public-health ministry, reports there are 1,846 drug shortages and 65 anticipated shortages in the country. Causes include increased demand, shortages of ingredients and delays in shipping.
“The Canadian federal government needs to start developing a strategy to deal with this issue,” said Joel Lexchin, a professor of pharmaceutical policy at the University of Toronto and an emergency room doctor at Toronto General Hospital.
Prime Minister Justin Trudeau told reporters Thursday that Health Canada would continue to ensure that “Canadians have access to the medications they need at affordable prices.”
Trump’s “safe importation action plan” would allow state governments, pharmacies and drug manufacturers to submit proposals for importing prescription drugs from Canada for federal approval.
Importing medicine from Canada has long drawn opposition in the United States over concerns about unsafe and counterfeit drugs. But as drug prices in the United States have risen, the idea has gained support. States including Florida, Maine and Vermont have passed laws to allow the imports, subject to the approval of the federal Department of Health and Human Services.
The administration announcement Wednesday came days after Sen. Bernie Sanders traveled to Windsor, Ontario, with a caravan of Type 1 diabetes patients to buy insulin at a fraction of the price at which it’s sold in the United States.
“How does it happen 10 minutes away from the American border in Michigan, people here are paying one-tenth of the price for the vitally important drug they need to stay alive?” asked the Vermont independent who is seeking the Democratic nomination for president.
The answer, in part, is that Canada has a system to control drug prices.
The country imports most of its prescription drugs from other countries. A federal body sets a price ceiling for each brand-name medicine to ensure that prices are not “excessive,” in part by looking at the prices for that drug in seven countries similar to Canada.
Provinces and territories run their own drug plans that vary by population and portion of cost covered.
The prices of generic drugs are not set by the federal body. Lexchin said Canadians often end up paying more for them than Americans do.
Michael Law is a professor of health policy at the University of British Columbia.
“If the U.S. was going to import anything from Canada,” he said, “it should import some controls over the prices of prescription drugs.”
Lexchin called the Trump proposal a “sham” and said multinational pharmaceutical companies are unlikely to play ball.
“If there is widespread export from Canada to the U.S., the companies may limit what they ship to Canada to cover what they estimate the Canadian market is and not send any extras that might be sent back to the U.S.,” he said.
Canadian critics of the Trump plan make a distinction between importing prescription drugs for personal use — crossing the border for insulin, for instance — and bulk imports.
“The kinds of caravans that Bernie Sanders or anyone else leads to Canada to buy drugs is not an issue,” Lexchin said. “What’s concerning for Canada is if U.S. states with large populations start to import drugs.”
Even before Wednesday’s announcement, the flurry of state legislation had some Canadians nervous.
“The Canadian medicine supply is not sufficient to support both Canadian and U.S. consumers,” the Canadian Medical Association and 14 other groups representing patients, health-care professionals, pharmacists and hospitals wrote last week to Health Minister Ginette Petitpas Taylor. “The supply simply does not, and will not, exist within Canada to meet such demands.”
Sarah Dion-Marquis, a spokeswoman for Innovative Medicines Canada, said the drugmaker lobbying group would “welcome a public statement from the Canadian government confirming that it will take appropriate action to help protect Canadian supplies in the event of a potential shortage.”
Alexander Cohen, a communications adviser for Health Canada, said Canadian and U.S. officials have held “high-level conversations” in recent months about the state plans.
“Ensuring that Canadians have access to the medicines they need is one of our top priorities,” he said in a statement. He said Health Canada “will be working closely with health experts to better understand the implications for Canadians and will ensure there are no adverse effects on the supply or cost of prescription drugs in Canada.”
John Adams, the chair of the Best Medicines Coalition, an advocacy group for access to drugs that signed the letter last week to the health minister, said he’s not encouraged by the Canadian government’s “nonspecific” response to Trump’s proposal.
He called it “a clear and present danger” to the health of Canadians.
“This is not the sort of thing that good neighbors do to each other.”