State importation programs promise lower prescription prices, but the FDA permission is a starting gun, not a delivery. Florida won the same approval in 2024 and has yet to import a single drug.
The Food and Drug Administration on Monday authorized Colorado to import certain prescription drugs from Canada, making it the second U.S. state to receive that permission and the latest test of a state-level experiment in reining in prescription prices (STAT reports). The approval is a regulatory green light, not a shipment. The first state to win the same green light, Florida, has been cleared to import Canadian drugs since January 2024 and has not yet moved a single pill to a patient.
That gap is now the central question for Colorado's program. The FDA's June 15 authorization letter gives the state permission to source specific prescription drugs from Canadian suppliers, but the letter is a starting pistol, not a delivery receipt. Each drug Colorado wants to import still needs its own FDA safety review, its own lab work, and its own arrangement with a Canadian exporter willing to take the political heat. The state's Department of Health Care Policy & Financing, the sponsor named in the FDA letter, has not yet named a launch date or a first drug.
Florida's experience is the most direct test of how that process works in practice. The FDA cleared Florida's importation program in January 2024, and state officials at the time projected savings that could run into the billions over several years (STAT reported at the time). More than two years later, the program has yet to import anything, according to Politico's February 2026 follow-up. The FDA in May 2026 extended Florida's authorization by six months so the program would not lapse while Florida worked through those obstacles.
The obstacles are structural, not partisan. Drug manufacturers, who set the prices Colorado and Florida want to bypass, have contractual and regulatory leverage to limit Canadian supply. The Canadian government, for its part, regulates distribution of drugs intended for the Canadian market and bars their export outside Canada when doing so would worsen shortages at home. Both Florida and Colorado have named the Canadian supply side, not the FDA, as the binding constraint.
The legal pathway for state importation programs traces back to a 2020 final rule from the Department of Health and Human Services published under the first Trump administration, which for the first time allowed states and Indian tribes to submit proposals. The Biden administration affirmed the rule through a 2021 executive order, and the FDA has now used that framework to clear Florida and Colorado. Other states, including New Mexico, Texas, and Wisconsin, have been exploring similar proposals, though none has reached the FDA approval stage.
For Colorado, the question is whether its program can clear the bottlenecks that have stalled Florida's. The FDA's June 15 letter confirms the framework is in place. The next test is whether Colorado can name a Canadian exporter, a drug, and a patient, in that order, before the political and supply-side pressure of the same kind Florida ran into reaches it.