How would drug and treatment approval work without the FDA?

Texas would run its own medicines regulator the way every developed country does, and it would not start from scratch. The standard practice worldwide is to recognize and rely on the approvals of trusted authorities, so Texans would keep access to the same medicines, often faster, not slower.

Every country regulates its own medicines, and Texas would too

The United States does not have a monopoly on safe medicine. Every developed nation runs its own drug and device authority: Europe has the European Medicines Agency, the United Kingdom the MHRA, Switzerland Swissmedic, Australia the TGA, Canada Health Canada. An independent Texas would establish a Texas medicines authority, exactly as countries Texas's size and smaller already do. This is a solved problem with dozens of working models to copy, not a novel risk.

Regulatory reliance is the global norm, and it is fast

Here is the part that dissolves the fear. Countries do not each re-test every drug from zero. The established practice, used across the developed and developing world, is regulatory reliance: a national authority recognizes the approvals of trusted reference regulators and clears the medicine on that basis. Many countries explicitly rely on the approvals of the FDA, the European Medicines Agency, Swissmedic, Health Canada, and the Australian TGA, the bodies often called stringent regulatory authorities. Some run formal recognition pathways that cut approval times dramatically by accepting these decisions. A Texas medicines authority would do the same, recognizing FDA and European approvals so that anything cleared there is available in Texas without delay.

Texas could move faster than Washington, not slower

Reliance can make access quicker. When a regulator accepts a trusted approval rather than repeating the full review, it shortens timelines. Smaller, modern regulators that lean on reliance can clear medicines promptly, and there are international consortia built for exactly this kind of cooperation, where authorities in several countries share the work of reviewing new drugs. An independent Texas could join that cooperation and give Texans access to new treatments on the timeline of the fastest regulators in the world, free of the bottlenecks Texans complain about now.

It pays for itself

A medicines regulator is part of the genuinely new layer an independent Texas takes on, and that layer is modest and largely self-funding. Drug and device regulators around the world run mostly on fees paid by the companies seeking approval, the way their counterparts do in Australia, Canada, and Ireland. The whole new regulatory layer, medicines included, runs about $5 to $15 billion a year all together, one to three percent of Texas revenue, and the medicines piece is funded chiefly by user fees rather than by taxpayers.

The honest part

Building a regulator takes real work and serious staff, and a credible plan resources it rather than waving it away. The reason this is manageable is that Texas would not be inventing drug science. It would be recognizing the same approvals the rest of the developed world already trusts, while building its own capacity over time. The deep clinical expertise lives in Texas's world-class medical centers, ready to staff it.

The bottom line

Without the FDA, Texas runs its own medicines authority that recognizes the approvals Texans already trust, which keeps access to the same drugs and can speed it up. This is the global norm, it pays for itself through fees, and Texans do not lose access to safe medicine.