WASHINGTON — President Donald Trump pledged during the campaign that he would combat high drug prices by allowing Americans to buy cheaper drug from other countries. He hasn’t brought up the idea since - even after meeting with pharmaceutical companies last week.

Trump is about to get a nudge from Vermont Sen. Bernie Sanders, and two Democrats who took heat for voting against the idea last month.

Sens. Cory Booker, of New Jersey, and Bob Casey, of Pennsylvania, are working on a proposal with Sanders to allow Americans to buy cheaper drugs from Canada. Sanders' bill could be introduced in the next several days.

Booker and Casey took heat from progressives for breaking ranks with Democrats to oppose allowing imported drugs. Both said they were troubled the measure by Sanders and Sen. Amy Klobuchar, D-Minn., didn’t deal with drug safety.

A draft of Sanders’ bill - which bears Booker's and Casey’s names - allows the purchase of drugs only from “certified foreign sellers” approved by the Department of Health and Human Services as meeting Canada's safety standards, as well as other requirements.

The bill will renew the debate over how to address high-priced prescriptions and the outrage over astronomical increases for some life-saving medicines, such as EpiPen.

A 2014 survey by the Commonwealth Fund found that a fifth of insured, low-income Americans -- making more than about $47,000 for a family of four -- put off medical care or did not fill prescriptions because of the cost of co-payments.

The impact was greater for people making less than that amount, nearly half of whom said they'd not filled prescriptions or put off care despite their insurance coverage.

Drug imports are opposed by the pharmaceutical industry, which spent $19.6 million last year to influence the federal elections, according to the Center for Responsive Politics. Drug companies also spent $148 million in 2015 on lobbying, according to the money-in-politics group.

A report on high drug costs by the bipartisan Senate Special Committee on Aging, though, recommended only allowing temporary imports of Canadian drugs to compete with drugs with extremely high prices. A broader, longer term plan could reduce the ability of American companies to come up with new drugs, it said.

Still, allowing imports of cheaper drugs is popular. A poll by the Kaiser Family Foundation last September found 71 percent of Americans support allowing people to buy drugs from Canada.

In riding a populist wave to the White House, Trump endorsed the idea during his campaign. He said in his health care platform: “Congress will need the courage to step away from the special interests and do what is right for Americans. … Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.”

But he has been silent on the idea since the election. His comments at a Jan. 11 press conference that drug companies are “getting away with murder" referred to Medicare not being allowed to negotiate prices with drug companies.

Gabriel Levitt, president of the Prescription Justice Action Group, a nonprofit that supports drug imports, said Trump was also silent on the idea after meeting last week with drug company executives and a trade group, the Pharmaceutical Research and Manufacturers of America.

Trump also appeared to step away from the Medicare idea, saying “I'll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market. That includes price-fixing by the biggest dog in the market, Medicare.”

White House spokespeople on Monday did not return a request for comment.

Levitt said he’s hopeful Trump follows through on his campaign pledge, saying “It may well be the only stance he’s taken that all Americans support. … To date, he hasn’t taken it back.”

A Sanders spokesman did not return a press inquiry, and Booker's and Casey's spokespeople declined comment.

But in an op-ed in the Washington Post last week questioning Trump’s commitment to lowering drug prices, Sanders noted that 50 miles from his Vermont home, drugs such as the diabetes medication Januvia, the asthma inhaler Advair and the prostate cancer treatment Xtandi are less than half the price as in the U.S.

The pharmaceutical industry group did not return a call seeking comment Monday. In a 2015 fact sheet, it warned that Canadian officials cannot guarantee the safety of all drugs shipped from the country that had not been cleared for sale there.

But unlike prior proposals - including one introduced by Sanders and Sen. Al Franken, D-Minn., in 2015 - Sanders' latest proposal would restrict imports only to drugs that meet Canadian standards.

A staff memo pointed to the Committee on Aging's report that “some countries’ pharmaceutical manufacturing standards are lax. (But) others, particularly in Canada and the European Union, are stringent and comparable to U.S. standards.”

Kery Murakami is the Washington, D.C. reporter for CNHI’s newspapers and websites. Contact him at kmurakami@cnhi.com.

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