Trump's first-term FDA finalized a rule in October 2020 creating a pathway for states, tribes, pharmacists, and wholesalers to import lower-cost prescription drugs from Canada, and generic drug approvals rose to records of 971 (FY2018) and 1,171 (FY2019), both genuine reductions in barriers to entry for cheaper drug providers. However, no drugs have ever actually been imported under that pathway: the FDA authorized Florida's Section 804 importation program in January 2024 and has granted it repeated extensions (most recently reported through May 2026), but as of mid-2026 the program has shipped zero drugs due to manufacturer resistance and Canadian export restrictions, despite Florida building an importation warehouse. Barriers were measurably lowered on paper and through faster generic approvals, but the flagship new-entrant channel the promise pointed to has not yet produced any actual market entry.