What does this actually mean?
Means you can no longer legally^W practically buy far cheaper prescription medicines from Canada, Mexico, India, China etc and ship them to the US.
Their own primer on the topic: https://www.personalimportation.org/understand-the-issue
The people in charge betting they only need to count the "red" ballots this time?
Various pharmacies in Canada will accept a US prescription and send you the medication via mail, usually at far cheaper than what you would pay for the same in the US.
This prevents it.