The White House and Florida’s state government are promoting the importation of Canadian medication as a way to lower drug costs, just a day after the United States began a process that could lead to tariffs on pharmaceuticals.

Late Tuesday, U.S. President Donald Trump signed an executive order outlining various strategies to lower drug costs. One of those items directs the Secretary of Health and Human Services, Robert Kennedy Jr., to “streamline and improve” within 90 days a section of the Federal Food, Drug, and Cosmetic Act that allows states to import pharmaceuticals from Canada, with the approval of the Food and Drug Administration.

That program was started during the first Trump administration. A few states have applied but so far only Florida has received FDA approval, in 2024. At the time, Governor Ron DeSantis said that importing cheaper Canadian drugs could save the state US$180-million that year.

On Wednesday, Florida said it had not yet imported any drugs from Canada because of “significant roadblocks put up by pharmaceutical companies and the Biden Administration,” but planned to do so soon.

“We appreciate the new Administration’s focus on prescription drug prices and look forward to working with them to finally get Florida’s Canadian drug importation program off the ground so that Floridians will be able to take advantage of these cost-saving measures,” Mallory McManus, deputy chief of staff at the Florida Agency for Health Care Administration, told The Globe and Mail in a statement.

Health Canada said at the time that it was concerned that large drug exports to the U.S. could lead to domestic shortages. Florida’s population is about half of all of Canada’s. Health Canada also said it had regulatory power to block exports of drugs in the case of a shortage. The department did not respond to questions by deadline Wednesday.

Joelle Walker, vice-president of public and professional affairs at the Canadian Pharmacists Association, said the whole scheme made little sense because Canada and the U.S. mostly source their medications from the same places.

“If you’re talking about the same manufacturers and companies, why would they sell to Canada to then be exported to the United States at a cheaper price, when they’re trying to sell it at the higher price in the United States?” she asked.

But she also noted that importing more drugs from Canada would also seem to run counter to other actions from the White House.

On Monday, the Trump administration kicked off a national-security investigation of pharmaceutical and pharmaceutical ingredient imports that could lead to tariffs in the sector. Tariffs would likely lead to importers raising drug prices, particularly for generic medicines, which are usually produced on slim profit margins.

The notice of the investigation did not name any particular countries of concern. Around 90 per cent of pharmaceuticals prescribed in the U.S. are generics, the bulk of which are made in India and China.

Canada currently exports more than $7-billion worth of pharmaceutical products to the U.S. annually, including finished products and key inputs, and imports about the same amount from the U.S.

Innovative Medicines Canada, a group that advocates for producers of patented medicines, said it expected the investigation given Mr. Trump’s repeated comments about imposing pharmaceutical tariffs.

Erin Polka, spokesperson for the group, said they were urging Canada to exclude pharmaceuticals and related inputs from any retaliatory actions.

The U.S. has by far the highest average drug prices in the world. Data from a Canadian regulator, the Patented Medicine Prices Review Board, showed U.S. list prices were about 3.6 times higher than those in Canada in 2023. (Canada had the fourth-highest prices in the world, behind the U.S., Mexico and Switzerland.)

High drug prices have been a growing political issue in the U.S. While multiple factors are driving the high prices, in recent months the focus has shifted to the role of a type of industry middleman called a pharmacy benefit manager (PBM), which negotiates costs between pharmacies and insurance companies.

The U.S. Federal Trade Commission filed a lawsuit against a group of PBMs last year that it alleged had dramatically inflated the prices of some drugs to extract lucrative rebates. Canada’s Competition Bureau disclosed last week that it was investigating a PBM called Express Scripts Canada over fees charged to pharmacies.

Regulatory and legal pressure on PBMs has been a rare source of bipartisan agreement. This week a group of 39 states – led by Arkansas, Massachusetts, Missouri and Vermont – urged Congress to pass a law prohibiting PBMs from owning pharmacies.

Mr. Trump’s order signed Tuesday also included a directive on PBMs, which told the Secretary of Labour to propose regulations within 180 days to improve transparency on fees paid to PBMs by employer health plans.