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importation to determine if the state could become certified to operate a prescription drug importation program . 18 , 19 The Vermont bill is still under consideration , but the Utah bill failed to pass .
Even if these measures passed , Dr . Alvarnas said it is difficult to know if state action alone could lead to any kind of a wholesale change in U . S . drug pricing .
“ If a state like California , which has 40 million people – more than Canada –
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could unify all the elements of the state health-care system and place it under one purchasing authority , then that would be a lot of buying power ,” Dr . Alvarnas said .
“[ The Centers for Medicare & Medicaid Services ( CMS )] is the big dog in the room . If CMS had the authority to negotiate drug pricing with pharmaceutical companies , that would probably have an extraordinary impact ,” he said . “ In general , when it comes to health care ,
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where CMS goes , everybody else eventually follows .” — By Leah Lawrence ●
REFERENCES
1 . Bernie Sanders . “ Affordable and Safe Prescription Drug Importation Act Introduced to Help Lower Skyrocketing Cost of Medicine .” Accessed April 4 , 2018 , from https :// www . sanders . senate . gov / newsroom / press-releases / affordable-and-safeprescription-drug-importation-act-introduced-to-help-lowerskyrocketing-cost-of-medicine .
2 . Congressional Budget Office . “ Preliminary Estimate – S . 469 , the Affordable and Safe Prescription Drug Importation Act ( as
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Print-only content introduced ).” Accessed April 4 , 2018 , from https :// www . cbo . gov / system / files / 115th-congress-2017-2018 / costestimate / s469preliminary . pdf .
3 . John McCain . “ Senators McCain & Klobuchar Reintroduce the Safe & Affordable Drugs from Canada Act .” Accessed April 4 , 2018 , from https :// www . mccain . senate . gov / public / index . cfm / 2017 / 1 / senators-mccain-klobuchar-reintroduce-the-safeaffordable-drugs-from-canada-act .
4 . Howard DH , Bach PB , Berndt ER , et al . Pricing in the market for anticancer drugs . J Econ Perspect . 2015 ; 29:139-62 .
5 . Zafar SY , Peppercorn JM , Schrag D , et al . The financial toxicity of cancer treatment : a pilot study assessing out-of-pocket expenses and the insured cancer patient ’ s experience . Oncologist . 2013 ; 18:381-90 .
6 . Huntington SF , Weiss BM , Vogl DT , et al . Financial toxicity in insured patients with multiple myeloma : a crosssectional pilot study . Lancet Haematol . 2015 ; 2 : e408-16 .
7 . Mansfield C , Masaquel A , Sutphin J , et al . Patients ’ priorities in selecting chronic lymphocytic leukemia treatments . Blood Advances . 2017 ; 1:2176-85 .
8 . International Federation of Health Plans . “ 2015 Comparative Price Report . Variation in Medical and Hospital Prices by Country .” Accessed April 6 , 2018 , from https :// static1 . squarespace . com / static / 518a3cfee4b0a77d03a62c98 / t / 578d34649de4bb15e7a9f2e2 / 1468871781348 / 2015 + Comparative + Price + Report _ Final + 071516 . pdf .
9 . Congress . gov . “ H . R . 1 - Medicare Prescription Drug , Improvement , and Modernization Act of 2003 . 108th Congress ( 2003-2004 ).” Accessed April 9 , 2018 , from https :// www . congress . gov / bill / 108th-congress / housebill / 1 .
10 . National Institute for Health and Care Excellence . “ New deal will give people with kidney cancer another treatment option .” Accessed April 8 , 2018 , from https :// www . nice . org . uk / news / article / new-deal-means-anothertreatment-option-for-people-with-kidney-cancer .
11 . National Institute for Health and Care Excellence . “ Breast cancer patients to have routine access to two life extending drugs after new deal , say NICE in draft guidance .” Accessed April 6 , 2018 , from https :// www . nice . org . uk / news / article / breast-cancer-patients-to-have-routineaccess-to-two-life-extending-drugs-after-new-deal-saynice-in-draft-guidance .
12 . Patented Medicine Prices Review Board . “ Patented Medicine Prices Review Board explores possible changes to how it conducts business .” Accessed April 9 , 2018 , from https :// www . newswire . ca / news-releases / patented-medicineprices-review-board-explores-possible-changes-to-how-itconducts-business-663445143 . html .
13 . The Washington Post . “ Four former FDA commissioners denounce drug importation , citing dangers to consumers .” Accessed April 7 , 2018 , from https :// www . washingtonpost . com / news / to-your-health / wp / 2017 / 03 / 17 / four-former-fda-commissionersdenounce-drug-importation-citing-dangers-toconsumers /? utm _ term =. b5e12e4bb493 .
14 . PharmacyChecker . com . “ FDA understates percentage of foreign-made medication sold in U . S .” Accessed April 7 , 2018 , from https :// www . pharmacychecker . com / news / fda-understates-percentage-of-foreign-mademedication-sold-in-us . asp .
15 . U . S . District Court for the District of Montana Butte Division . “ USA v . CanadaDrugs . com Ltd . Partnership .” Accessed April 7 , 2018 , from http :// www . safemedicines . org / wp-content / uploads / 2015 / 08 / CanadaDrugs- Indictment1 . pdf .
16 . Associated Press News . “ Canadian pharmacy fined $ 34 million for illegal imports .” Accessed April 17 , 2018 , from https :// apnews . com / 7fd1b44d95bc4e4187512b332 3c00495 / Canadian-pharmacy-to-be-fined-millions-forillegal-imports .
17 . U . S . District Court District of Maine . “ Maine Pharmacy Association v . Maine .” Accessed April 10 , 2018 , from http :// www . fdalawblog . net / wp-content / uploads / archives / docs / Maine % 202-23-15 % 20Decision . pdf .
18 . Associated Press . “ Vermont considering drug importation as way to save money .” Accessed April 8 , 2018 , from https :// www . usnews . com / news / best-states / vermont / articles / 2018-01-18 / vermont-considering-drugimportation-as-way-to-save-money .
19 . Utah State Legislature . “ H . B . 420 Prescription Drug Importation Study .” Accessed April 9 , 2018 , from https ://
le . utah . gov /~ 2017 / bills / static / HB0420 . html .
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