BISMARCK — A suite of North Dakota proposals targeting the high costs of prescription drugs were either tossed out or substantially watered down this legislative session, but advocates of the programs say new conversations on the topic laid groundwork for future state action.

Three bills introduced by Republican Sen. Howard Anderson, of Turtle Lake, each looked north to Canada for possible solutions to runaway costs for prescription drugs. Prices on many medications have skyrocketed in the United States since the 1990s, and the trend has lately become an issue of bipartisan consensus in other states and on Capitol Hill.

One of Anderson's bills would have used Canada's comparatively lower drug prices as a benchmark for setting prices in North Dakota, while the other two proposals were variations on an ambitious plan for a wholesale importation program to ship in lower-cost Canadian drugs to North Dakota buyers.

"I've seen over the years that drug companies really have carte blanche to raise their prices," said Anderson, a longtime pharmacist and former executive director for the North Dakota State Board of Pharmacy.

Prescription drug spending in the United States more than doubled between 2000 and 2015, according to the Commonwealth Fund, outpacing the trends in many other high-income countries. A 2020 AARP study found that a quarter of North Dakota adults opted not to fill a prescription they had received in the last two years, with 44% of respondents citing the cost burden for their decision. And with more affordable drugs available just across the northern border, some North Dakota buyers have already turned to Canada to independently source their medications.

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"And here the drug companies would say, they don't have everything available," Anderson said of the more manageably-priced markets in other countries. "Well, I don't hear any Canadians complaining that they don't have drugs available, but yet their prices are sometimes 30% lower than ours. So, that rings hollow sometimes."

Though the bills picked up traction in the Senate this session, proposals for the reference pricing program and importation program both failed on the House side.

The only one of Anderson's trio still alive, Senate Bill 2212, was gutted from the initial drug importation idea into a legislative study. Should the bill pass into law, that study would be conducted over the next two years and examine prescription drug pricing and the possibility of a reference pricing or wholesale importation program in the future. It could pair with a fourth prescription drug bill, still alive this session, that would require pharmaceutical companies to report increases in their prices to the state, a provision that advocacy groups like the AARP of North Dakota hope will inform more direct future action against these climbing prices.

One of Anderson's importation proposals, Senate Bill 2209, cleared the Senate by more than 20 votes earlier this session but failed in a House vote on Monday, April 12. The bill would have allowed the North Dakota health department to contract with another state to ship in lower cost Canadian drugs.

Rep. Kathy Skroch, R-Lidgerwood, said Canada has opposed the North Dakota proposal, a factor she argued would impede the success of any partnership. She also noted lawmakers' concerns over the possibility for counterfeit drugs and argued that savings would only be short term if the proposal did succeed.

North Dakota's proposals mirrored legislation in several other states that have also looked to Canada as a resource to push down pharmaceutical prices. At least six states have considered proposals this year to use Canadian drug prices as a negotiating benchmark, according to a February report from Kaiser Health News.

But even as the issue has picked up momentum, Anderson said he never expected his proposals to pass this time around, in part because the legislation was introduced too late for the state agencies to come up with a realistic plan. Instead, he said he had a longer view in mind, aiming to start a conversation and gather data for the possible initiation of a reference pricing or importation program down the line.

With a population of roughly 762,000 people — a marginal player in the massive market for prescription drugs — Anderson said North Dakota wouldn't be able to move the needle on its own.

"But if we can get together with some others, we might be able to put a dent in it," he said.

Readers can reach Forum reporter Adam Willis, a Report for America corps member, at