Trump taking aim at drug pricing

Greg Nash

The Trump administration is working on actions it can take without Congress to fight high drug prices, according to people who have attended listening sessions that officials are holding on the issue.

It is unclear what exactly the administration will do or how consequential the measures will actually be. But the prospect of changes has the pharmaceutical industry, a powerful lobbying force in Washington, facing some unpredictability.

{mosads}It’s a new circumstance for an industry that has traditionally been aligned with GOP administrations and members of Congress.

It’s now facing a Republican president who is on record as being critical of the way they set prices.

During the 2016 campaign, President Trump railed against the pharmaceutical industry and its prices, saying in January they are “getting away with murder.”

The listening sessions held by Secretary of Health and Human Services (HHS) Tom Price appear to be a step toward policymaking on drug pricing by the new administration.

Price has been holding the sessions with a range of industry groups and advocates.

Those who have attended the meetings say they came away with the impression that the administration is serious about taking action on drug prices, though the details remain unclear.

One lobbyist said some attendees went in expecting a “dog and pony show” but instead found a meeting that was “more substantive than expected,” with Price and other top officials engaged and asking questions, though they did not tip their hand on what they are planning.

One attendee said HHS officials invited the group back at some point in the future to provide feedback once there is a set of proposals.

A major question is whether the administration will stick with safely Republican solutions or break with much of the party and opt for more sweeping ideas usually associated with Democrats.

Trump broke with his party during the campaign, calling on Congress to allow Medicare to negotiate drug prices.   

White House Office of Management and Budget Director Mick Mulvaney caused a stir in health policy circles last week when he said on a panel at Stanford University that the administration was considering proposing that drug companies give discounts through rebates in Medicare the same way they do in Medicaid. That would be a striking break from Republican orthodoxy on drug prices if the administration ended up proposing it, though that could require action from Congress.

Mulvaney said that in addition to items to propose to Congress, “we are looking at things that we can do internally … without Congress.”

“The president keeps telling me again and again and again: ‘What are we doing to fix this?’ ” Mulvaney said.

Price, though, was resistant to government action on drug prices when he was a lawmaker and could lead the process down a more traditionally Republican path of restrained action, some observers think.

“I think it’s safe to say they’re looking at market-based mechanisms,” said Joel White, president of the Council for Affordable Health Coverage, a coalition of industry groups and other health interests.

White, who recently attended a listening session with Price, mentioned ways to speed up the Food and Drug Administration’s approval of new drugs in order to increase competition and bring down prices. That idea has been welcomed by Republicans.  

Still, White noted, “the president has been a little unpredictable” on the issue, so “who knows what happens.”

One lobbyist said that other possibilities for action being floated include allowing Medicaid to exclude coverage of high-priced drugs. Another option, according to the lobbyist, is changing how Medicare Part B pays for drugs. That move could prove ironic given that the Obama administration faced intense blowback for proposing changes in Part B drug spending.

Many of those involved in the HHS meetings said they did not expect actions to be announced until the fall, though some said they thought moves could come earlier — and as soon as June.

An HHS spokeswoman referred back to readouts the department has given of the various listening sessions. Those readouts did not provide details of the administration’s plans but did note that during the meetings, “the Secretary reaffirmed President Trump and the administration’s commitment to address rising prescription drug costs.”


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