Trump promised to loosen regulations back on the campaign trail to open the door for cheaper options. Its plan to make drugmakers disclose list prices in TV ads had to be scrapped after the companies won a legal challenge, and it abandoned efforts to force pharmacy benefit managers to pass discounts onto Medicare recipients.
The administration's move comes as the industry is facing a crescendo of consumer complaints over prices, as well as legislation from both parties in Congress to rein in costs.
The U.S. Department of Health and Human Services announced Wednesday a preliminary plan to allow the importation of certain, less costly prescription drugs from overseas. That's in large part due to government control - unlike other countries, the United States does not directly or indirectly control drug prices.
But lowering drug prices has been a key promise of President Donald Trump, and a few months later, Azar said he was forming a work group that would explore allowing certain drugs that had seen major price hikes to be imported.
Most patients take affordable generic drugs to manage conditions such as high blood pressure or elevated blood sugar.
But polls show concern about the prices of breakthrough medications for intractable illnesses like cancer or hepatitis C infection, whose annual costs can run to $100,000 or much more.
The proposal, however, will exclude the insulin that diabetes patients need.
In May a year ago, Azar said: "On top of that, the last four FDA commissioners have said there is no effective way to ensure drugs coming from Canada really are coming from Canada, rather than being routed from, say, a counterfeit factory in China ..."
Under the new plan, Americans would be allowed to import FDA-approved prescription drugs from Canada at a lower price than those sold in the U.S.
Another part would allow drugmakers to seek approval for re-importation of their own drugs.
Azar did not offer any time frame on when a system to import drugs from Canada could be in place in any states.
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"The FDA has the resources to do this", said acting FDA Commissioner Ned Sharpless. "The agency is interested in considering any reasonable proposal that maintains the bedrock of safety and efficacy for the American consumer".
The importation idea still needs to be proposed and then finalized by Health and Human Services.
President Donald Trump is the first US president to offer his support for drug importation, and Azar acknowledged that Trump's influence has shaped the path HHS has chosen.
ALEX AZAR: So that they could start thinking about how they would plan for this because we want to see those plans right away as soon as the regs are ready.
Senator Bernie Sanders, Vermont Independent, noted the disparity in USA and Canadian prices.
It's still very hard to guarantee that medication mail order companies based overseas are reputable and would provide the right drugs to Americans, Anderson said. But opponents of importation say sending drugs over the border will increase the chances Americans get counterfeit medications, a claim often boosted by the drug industry.
Canadians will continue to have access to the medications they need, Prime Minister Justin Trudeau promised Thursday in the face of escalating worry about a Trump administration decision to allow prescription drug imports from Canada. That idea was incorporated in Wednesday's plan. PhRMA president and CEO Stephen Ubl warned against importing drugs from Canada that "could have originated from anywhere in the world and may not have undergone stringent review by the FDA". Canadian health officials have said they would be unable to meet USA demand.
"We request that Health Canada provide clarity and assurances to Canadians that USA legislation will not inadvertently disrupt Canada's pharmaceutical supply and negatively impact patient care through greater drug shortages", the group wrote in a July 25 letter to Health Minister Ginette Petitpas Taylor.
The second pathway would let drug manufacturers to import versions of drugs they sell overseas.
However, the pharmaceutical industry swiftly attacked the plan, citing Azar's own words from just previous year, when he called drug importation a "gimmick".