Trump promises lower drug prices, but drops populist solutions

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Initial reactions to Trump's speech last week rightly pointed out that the administration's plan for lowering drug prices wouldn't take particularly bold or immediate actions to lower drug prices and would leave PBMs and pharmaceutical drug companies basically unscathed.

Trump mentioned this action as one way his administration has already moved to lower drug prices. In reality, it is entirely in line with the financial interests of the drug companies and health insurers and will do virtually nothing to stop their profit-gouging.

Trump directed US Trade Representative Robert Lighthizer to take up with all countries on the fixing of prices of American pharmaceuticals and medical devices.

"Today, I am calling on America's pharmaceutical manufacturers to level with the American public - be honest about what you're trying to charge us, put your list price in your ads". "We also have to get after pharma companies that engage in anticompetitive practices and try to block the entry of generics or biosimilar products to market", he said. He added that Trump's speech was "very, very positive to pharma". In fact, stock prices for PBMs and pharmaceutical companies generally rose after the announcement. Drug maker Pfizer's shares rose 1.3 percent, while Merck's stock increased 2.8 percent.

One of these suggestions is to require that plans under Medicare Part D share savings from drug rebates with patients directly.

A potential requirement for drugmakers to disclose the cost of their medicines in television advertisements.

In all, Trump spared pharma, instead focusing his criticism on "middle-men", or pharmacy benefit managers, and drug lobbyists. As it stands, Medicare Part D entails significant discounts from pharmaceutical companies, but it is rare that these discounts end up back in the pockets of patients. All the sequester cut to Medicare drug payments for cancer drugs has produced is less access to cancer treatment, higher costs for patients and Medicare, and increased drug prices. This is the vital core of the program, keeping Washington out of pharmacies and maintaining affordable drug prices for patients, and must be protected even as the program grows and changes.

On Friday, Democrats leaped on the lack of Medicare negotiation as an example of a broken promise on drug prices and called the plan a win for drug companies.

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"India needs to encourage its own indigenous manufacturing of Medical Devices to reduce dependency and withstand monopolistic threats by US industry lobbying via US Government as a long term strategy but now on war footing and PM Modi needs to convince President Trump of dire needs of Indians to affordable healthcare and steps needed to ensure this", Nath added.

Newspaper reports recently revealed that Swiss drug maker Novartis paid Trump's former attorney Michael Cohen $1.2 million in "consulting" fees previous year, despite the fact that Cohen lacked any qualifications to provide such services. But current rules prohibit pharmacists from telling a patient about this. "It makes sense that proposals we see coming out of the administration would be somewhat limited". That gives them an enormous amount of leverage over what drugs consumers get access to and the prices they pay. Moreover, the price controls and regulations in other countries have not made it unprofitable to sell drugs there.

Trump has long promised to bring down the cost of drugs and has blasted drugmakers, but Friday's speech was the first time he addressed it at length.

The move includes an FDA evaluation of whether drug manufacturers should be required to list prices in their advertising, as well as longer-term efforts to change the imbalance between what USA consumers pay for drugs developed in the United States versus what foreigners pay in their own countries, where drug prices are often substantially lower. "When foreign governments extort unreasonably low prices from United States drug makers, Americans have to pay more to subsidise the enormous cost of research and development", Trump said. As things are, Medicare pays the standard price, plus a 6 percent markup, for Part B drugs as soon as they're approved, whereas Part D sponsors can require a cheaper alternative - for nonprotected drugs, that is.

And unsafe drugs from unreliable manufacturers could be used to plug the gap. Fourteen of the 20 best-selling drugs saw such double-digit price hikes.

Last year, pharmaceutical companies spent almost $280 million on lobbyists - which is more than tobacco, oil and defence contractors combined, according to Trump. Drugmakers argue that list prices do not reflect actual cost after discounts and rebates.

"You heard President Trump make it clear on Friday how important tougher negotiation is". The president's plan announced the next day did not do so.

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