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Trump and DeSantis want Florida to import prescription drugs. Does Biden?

The Biden effect in Florida: Biden’s campaign health care plan is unclear, and his transition team isn’t talking.

TALLAHASSEE — Joe Biden and Donald Trump didn’t agree on much, but they did on this: Floridians should be able to import prescription drugs from foreign countries.

Trump, the Republican outgoing president, made driving down the cost of prescription drugs a key campaign promise in Florida, which is home to about 4.5 million seniors. Biden, the Democrat who beat Trump by some seven million votes, made a similar pledge during the 2020 campaign.

“Biden will allow consumers to import prescription drugs from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe,” Biden’s health care plan read.

It’s unclear how Biden will approach drug importation once he’s in the White House. Multiple inquiries to his presidential transition team were not returned.

But according to Donna Shalala, the former congresswoman from Miami who once served as President Bill Clinton’s Health and Human Services Secretary, the second half of that promise — the part about the drugs being safe — could loom large in Florida.

When she served in the Clinton administration, Shalala had the opportunity to approve the importation of prescription drugs. She declined because she wasn’t able to secure a guarantee from the Food and Drug administration that the drugs would be safe for consumers, she said.

“It didn’t have anything to do with whether I was pro-pharma or anti-pharma,” Shalala said. “I’m neither. It had to do with safety.”

Biden’s pick for Health and Human Services Secretary, California Attorney General Xavier Becerra, will have the final authority to approve or nix the federal importation program. But his office didn’t say whether he thinks drug importation is legal.

“The California Department of Justice is unable to provide legal advice or analysis,” a spokesman wrote in a December email to the Times/Herald.

The Biden administration’s decision will have big implications for Florida — at least politically. Under Gov. Ron DeSantis, the Sunshine State has already submitted a plan to allow Floridians to import drugs from Canada. A federal rule change that happened under the Trump administration made that possible.

DeSantis’ administration is selling the importation plan as a game-changer. Acting Agency for Health Care Administration Secretary Shevaun Harris said it was a “crucial step” and “the result of bold leadership from Governor Ron DeSantis.”

Shalala, who lost a re-election bid for her Congressional seat in 2020, isn’t so sure drug importation was ever going to happen. Why would Canada, a country of about 38 million people, agree to expand its drug market by 21 million Floridians, Shalala said. And how exactly would expanding the market to that extent drive down prices for anyone?

“I never thought it was going to happen,” Shalala said. “I thought it was just a price release.”

After this story was published, a spokeswoman for the Agency for Health Care Administration said the state “anticipates working with the incoming Biden administration to ensure Floridians across the state will have increased access to life saving medications.” The spokeswoman, Tiffany Vause, did not say whether state officials expect Biden to continue the importation program. However, Vause said the state’s importation effort could save Florida as much as $150 million per year once fully operational.

Even if the Biden administration allows DeSantis’ plan to go forward, Florida’s drug importation project will have to survive a legal challenge in federal court. In November, an influential pharmaceutical lobbying group led by the Pharmaceutical Research and Manufacturers of America sued to reverse the federal rule change that allowed Florida to submit a plan.

The lawsuit said that under federal law, governments are only allowed to import prescription drugs if officials prove the plan is safe and cost-effective for the consumer. The Trump administration’s rule change meets neither standard, the pharmaceutical group says.

The lawsuit, which is still in its early stages, could take months or even years to shake out. The DeSantis administration previously called it an effort by “big Pharma” to “block the advancement of a program that will help ensure access to more affordable prescription drugs for Americans.”

Another Trump administration proposal aimed at lowering drug prices commonly known as the “most favored nation” rule has also seen a court challenge from the pharmaceutical lobbying group. It’s unclear how the “most favored nation” proposal will fare in a Biden administration.

While the legal challenges make their way through the courts, there are other things Biden could do to try to lower prescription drug prices, Shalala said. For instance, he could let the Health and Human Services Secretary negotiate directly with drug companies on the prices of some prescription drugs covered under Medicare.

Democrats in the House of Representatives passed a bill in late 2019 which would allow the federal government to do just that, but Republican leadership declined to take it up in the Senate.

The Biden effect in Florida is an ongoing series that looks at what the Joe Biden Administration means for Florida.