Proposed rule allowing states to import certain drugs from Canada would require tight supply chain, extensive security and reporting responsibilities. The potential costs and rigor involved in implementing the program could impede its uptake. 

Upcoming proposed rule will create a process for third parties (notably including the state of Florida) to begin importing drugs wholesale from Canada. It will be an FDA rule – though FDA has had very little input in it.

Former US FDA commissioner Scott Gottlieb doesn't "want to give too much away," but expresses skepticism about Trump administration's ability to implement its international price index proposal, noting there are ways for brand companies to game the system.