The U.S. Food and Drug Administration recently announced plans to help states and Indian tribes purchase certain prescription drugs from Canada, where brand-name medicines tend to be cheaper because the government caps their price. The new guidance is part of a larger Trump administration effort to cut drug prices.
But states should think twice before opening their borders to foreign drugs. The new importation strategy would leave America’s drug supply vulnerable to dangerous counterfeit medicines from abroad.
Let’s start with the logistical hurdles. Canada is by no means eager to share its medicines with American patients. In response to a drug importation program launched by Florida last year, the Canadian health minister made clear that his government would “do everything in our power to make sure that another country cannot be given the ability to pillage our health system for its own benefit.”
That might help explain why Florida’s importation program — the first of its kind in the nation — has yet to purchase a single Canadian drug since garnering FDA approval over a year ago.
Further, most of the drugs consumed in the United States — more than nine in ten — are generics, which are cheaper here than in our northern neighbor. The relative prices of generics in Canada are 256% of those in the United States, according to research published by economist Tomas Philipson and two colleagues at the University of Chicago.
There’s no point in importing Canada’s more expensive generics.
And it’s far from clear that the brand-name drugs Americans may be looking for will even be available for importation. Of 287 drugs launched in the developed world between 2018 and 2022, just 28% were available in Canada by the end of 2022, according to research from RAND. Nearly three-quarters of them were available in the United States.
Even if Canada couldn’t wait to sell us the medicines it has in stock at lower prices, President Trump’s importation plan would put American lives at immense and needless risk.
Counterfeit medicines are a real and growing global health threat — one that takes roughly 1 million lives every year, according to the World Health Organization.
One might think that medicines shipped in from a country as developed as Canada would carry little risk. But Canada’s drug-safety standards don’t apply to medicines exported to other nations.
The FDA manages to secure America’s drug supply by enforcing a “closed” drug distribution system — one in which medicines are tightly controlled from the moment they’re manufactured to the moment they’re dispensed by a pharmacist.
The FDA doesn’t have the capacity — or the authority — to monitor every drug that enters Canada and may eventually be exported to the United States.
Finally, drug importation would prove disastrous for the research ecosystem that has made America the world’s leader in drug innovation for decades.
Importing Canadian drugs means importing price controls. And that will deprive drug makers of revenue. They’ll cut their investments in research and development in response. And that means fewer new therapies for the next generation of patients.
Importation will not make drugs more affordable for Americans. It puts their safety — and future innovation — at risk. In this case, the best strategy is one that should come naturally to the Trump administration: Buy American.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It (Encounter 2025). Follow her on X @sallypipes. This was originally published in the Orlando Sentinel.
