In the United States, about 160billionisspentonprescriptionmedicineseachyear,withMinnesotansspendingabout3 billion. The costs of prescription medicines receive so much attention in large part because, although prescription medicine costs constitute only 10.5% of total health care spending, they account for 23% of the total out-of-pocket costs that people incur when purchasing health care. Minnesota has been a leader in controlling prescription medicine costs. It has aggressively used purchasing pools when possible, and encouraged the use of lower cost, generic prescription medicines when appropriate. Even with these efforts to control costs, prescription medicines were still becoming too costly for many Minnesotans to afford. Busloads of senior citizens headed north for Canada. Others used Internet pharmacies, some of which were unsafe. The need for lower cost prescription medicine alternatives and a desire to protect the safety of Minnesotans who seek them caused Governor Pawlenty, in September of 2003, to direct the Minnesota Department of Human Services to examine the feasibility of importing prescription medicines from Canada and other international sources. He directed the Commissioner of Human Services to examine methods to address the needs of Minnesota state employees, the citizens served through the state’s public assistance programs, and the state’s citizens at large. In response to this directive, a three-phase plan was developed. The plan called for the development of a website to empower Minnesota consumers to purchase mail-order prescription medicines for personal use from approved Canadian pharmacies; the option for Minnesota state employees to voluntarily obtain prescriptions for maintenance medications from Canadian pharmacies; and the establishment of a pilot project that allows Minnesotans to purchase Canadian prescription medicines from their local pharmacies