With a U.S. task report expected any day on importing cheaper prescription drugs from Canada, there's growing speculation on both sides of the border that American officials may reverse course and finally endorse it.
Widespread pressure in Congress, states flouting import restrictions and polls suggesting it's a popular option among Americans who pay some of the highest drug prices in the world are also forcing the issue.
"There's almost a sense of inevitability," said Frances Smith of Consumer Alert, which opposes drug imports.
Smith expects any endorsement by the 13-member task force led by the U.S. Surgeon General would be accompanied by policing requirements to weed out contaminated or counterfeit drugs, perhaps by using tiny radio frequency identification tags that could be read by customs officials.
Canada's Health Minister, Ujjal Dosanjh, warned this week there could be serious consequences to the United States opening the gates to widespread imports, including shortages and higher prices for Canadians.
But many Internet pharmacists in Canada disagree, saying their system is designed to serve Canadians first and price increases would still be kept to inflation levels by a national review board.
"It disappoints me that the health minister is playing that scare card," said Jeff Uhl, whose Winnipeg operation fills 1,200 prescriptions a day for Americans.
Several manufacturers have limited supplies to Canadian firms that do business in the U.S., leaving them to fill the gap with pills from other countries.
The drug regulator issued warnings to states but didn't stop them from developing websites for imports.
But Rx Depot, an import firm based in Oklahoma, was forced earlier this year to shut down after the FDA took it to court.