Trump Vows (Again) To Lower Drug Prices But Skeptics Doubt Much Will Change

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Yves here. Mr. Market agreed with this article’s conclusion. Pharma stocks traded up after Trump announced the details of his drug price plan.

By Sarah Jane Tribble, Senior Correspondent for Kaiser Health News who has previously reported for NPR, PBS, the Cleveland Plain Dealer, and the Forth Worth Star-Telegram, and Liz Szabo, Senior Correspondent for Kaiser Health News, who has previously worked for USA Today and the Virginian-Pilot. Originally published at Kaiser Health News

President Donald Trump, armed with the expertise of staff seasoned in the ways of the drug industry, unveiled his blueprint to address sky-high drug prices Friday afternoon, promising that increasing industry competition will help Americans save at the pharmacy counter.

“Under this administration, we are putting American patients first,” Trump said with Secretary of Health and Human Services Alex Azar by his side. Azar, he said, had a mission to “to bring soaring drug prices down to Earth.”

Many of the proposals Trump’s team can accomplish administratively — and some are already in motion — but for others, Trump said, he plans to work with Congress.

The administration’s blueprint proposes 50 actions to reduce what Americans pay for drugs, including giving Medicare more power to negotiate drug prices, Azar said.

Azar said he wants to make drug prices more transparent, as well. For example, he said the Food and Drug Administration should require pharmaceutical companies to disclose drugs’ list prices in their direct-to-consumer television ads.

“It’s material and relevant to know if it’s a $50,000 drug or a $100 drug,” Azar said.

Dr. Jeremy Greene, a professor and health policy expert at Johns Hopkins Medicine, said he was puzzled by how much control the agency would have over requiring drug prices as part of advertising.

“The FDA has had nothing to do with price, especially in advertising,” Greene said. “There have been prominent court cases over whether pharmacies can or cannot advertise based on drug prices.”

Regardless, Trump called the plan “the most sweeping action in history to lower the price of prescription drugs to the American people.”

“We will have tougher negotiations, more competition and much lower prices at the pharmacy counters,” Trump said. “And it will start to take effect very soon.”

On a separate note, Trump told the audience that “right-to-try is happening,” a nod to congressional efforts to expand access to experimental medications for people with life-threatening conditions.

Trump’s proposals target reducing the out-of-pocket costs for older Americans enrolled in Medicare — but experts say that amounts to more show than substance.

“There’s a difference between reducing the pain people feel associated with out-of-pocket costs at the pharmacy counter and reducing the actual national spend on prescription drugs,” said Allan Coukell, senior director for health programs at the nonpartisan Pew Charitable Trusts.

While 80 percent of Americans say the cost of drugs is unreasonable, 1 in 4 people report having difficulty paying for drugs, according to Kaiser Family Foundation polling. And the government is paying more, too. Medicare’s drug spending grew nearly 90 percent from 2006 to 2015, with an annual average growth rate of 7.6 percent, according to Pew.

During the campaign and his presidency, Trump has used strong language against the pharmaceutical industry, famously saying the manufacturers are “getting away with murder.” Late Thursday, senior administration officials told reporters on a call that the plan will reduce the price pharmaceutical companies set for drugs.

But when asked about whether Medicare will negotiate drugs — as Democrats have called for and the president has talked about — administration officials said that lever would not be pulled.

Instead, Trump’s blueprint calls for measures such as offering free generics to low-income seniors, passing on to consumers more of the negotiated savings that insurers win, and making sure Medicare enrollees don’t spiral into the so-called catastrophic phase of coverage they hit when they pay thousands of dollars a year for drugs.

Leigh Purvis, director of health services research at AARP Public Policy Institute, said the president’s proposals fail to ultimately address that spending. AARP has long called for Medicare to have the ability to negotiate prices.

“Anything that doesn’t address the list price really is just kind of squeezing the balloon in this world,” Purvis said.

For Medicare patients, though, limiting what they pay out-of-pocket could be especially helpful to those taking cancer drugs or other expensive therapies, said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University School of Medicine.

Today, patients who pay $5,000 out-of-pocket for prescriptions enter the “catastrophic” category of Medicare coverage, and are charged just 5 percent of their drug costs. But given the astronomical cost of cancer drugs, that can leave patients paying $1,000 a month or more, Dusetzina said.

Medicare patients with the deadly cancer multiple myeloma can spend $14,000 a year out-of-pocket for the drug Revlimid, which costs about $20,000 a month, Dusetzina said.

Trump also accused other developed countries of “freeloading” by enjoying the fruits of American innovation — including drugs developed with taxpayer money or by U.S. companies — without paying a fair price. Because national health systems in other countries have authority to negotiate drug costs — and refuse to cover some drugs entirely — their citizens often pay a fraction of the prices charged in the United States.

“In some cases, medicines that cost a few dollars in foreign countries cost hundreds of dollars for the same pill” in the United States, Trump said. “It’s unfair, it’s ridiculous and it’s not going to happen any longer. It’s time to end the global freeloading once and for all.”

A spokesman for Doctors Without Borders said Trump has it backward. Instead of raising drug prices abroad, costs need to come down everywhere, said Leonardo Palumbo, U.S. advocacy adviser for the group’s access campaign.

“Other countries aren’t ‘free-riding,’ and lifesaving medicines aren’t more expensive here because they cost less elsewhere,” Palumbo said.

Today, Medicare has limited power to negotiate drug prices, partly because many of the most expensive treatments — such as those for cancer patients — are in a protected class that must be covered, Dusetzina said.

To really negotiate better prices, Medicare would need the freedom to reject some drugs completely, Dusetzina added.

But excluding certain expensive drugs from the Medicare program could leave patients in a difficult position, said Chris Hansen, president of the American Cancer Society’s Cancer Action Network. Patients who want an expensive drug would either have to skip it or pay for it themselves, he said.

Azar said Medicare could pressure drug companies to keep prices down in other ways.

“In our drug discount program, if you have a drug in a protected class, it’s almost impossible for drug plans to negotiate and get a discount,” Azar said. “What if we said you only get to be in a protected class if you haven’t raised your price in 18 months?”

Some policy experts, though, said Trump’s proposals are mostly old ideas.

“I don’t think anyone is talking seriously about having Medicare negotiate with drugmakers,” said Tom Bulleit, head of the health care practice at the D.C. office of Ropes & Gray.

Rep. Peter Welch (D-Vt.), who along with Rep. Elijah Cummings (D-Md.) met with Trump at the White House a year ago to propose changes on drug prices, said, “If you listen carefully, you can almost hear the champagne popping in the corporate boardrooms of drug companies across the country.”

David Maris, a pharmaceutical industry analyst for Wells Fargo investors, released a note earlier this month pointing out that the increased social and economic tension on the drug industry is building.

“My guess is this is just the beginning,” Maris said.

Trump’s plan includes tackling the rising costs of drugs in Medicare’s Part B program, which pays for drugs delivered in doctor’s offices or hospital outpatient setting — a challenge previous administrations have failed to tackle.

While the details are still vague, Trump has called for the prices paid for certain drugs under Part B — these could include expensive drugs for cancer chemotherapy and rheumatoid arthritis — to be negotiated using the same tactics insurers and pharmacy benefit managers use under Medicare Part D, which is the program that seniors use for their retail prescription drugs.

Azar said the administration plans to release a request for information to gather input on changes to the program.

The Pharmaceutical Research and Manufacturers of America released a statement Friday saying it was looking forward to working with the administration and warning: “While some of these proposals could help make medicines more affordable for patients, others would disrupt coverage and limit patients’ access to innovative treatments.”

KHN’s coverage of prescription drug development, costs and pricing is supported by the Laura and John Arnold Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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7 comments

  1. The Rev Kev

    The fact that big pharma stocks went up after Trump’s announcement tells you all you need to know about how effective he will be. Absolutely clueless he is. I am going to theorize that what the net effect is going to be is to export the American way of selling drugs to the rest of the world. That means sky-high costs for drugs, 12-year ‘ever-greening’ patents and all the rest of this disaster which has probably been the cause of the deaths of tens, if not hundreds of thousands of Americans.
    India’s drug industry would be a main target here. Because of their huge population and very low wages, they have fought to have companies produce low cost drugs for their people. Apparently, about 70 per cent of the world’s branded drug profits come from America alone and big pharma fights any low cost generics being released. Probably this is the model that big pharma wants the rest of the world to adopt in buying American drugs.
    I think that America is the only country that does not put any price controls on drugs which accounts for lower costs. An example that I read of is that in Europe, a bottle of 60 tablets of Vimovo costs roughly $21 while in the US you can pay $2,979 for the same bottle of pills. Also, there have been numerous examples of US drug companies raising the price of the drugs to outrageous levels for absolutely no reason at all.
    If Trump wants to go after free-loaders he should be looking at big pharma itself. Years ago I was reading an article on the drug industry in the US and as an example it said that the US government spent years and millions of dollars of tax-payers money to develop a highly successful drug. The US government then GAVE that drug free to a big pharma company who fiddled with the dosages for the final touches and then made a boat-load of money selling that drug while owning the patent because of its dosage research and I believe that in the US that companies get 20 years initially to market a new drug.

    Reply
  2. agkaiser

    Nationalize, nationalize, nationalize. All of medicine, pharmaceuticals, finance, insurance and real estate shall be operated on a non profit basis of, by and for the people in a sane community that protects the survival of the human race from the threats we face.

    Reply
  3. Frank

    Don’t expect much. The essay linked to below reports how the pharmaceutical industry has about every base covered.

    The Pharmaceutical Industry in Contemporary Capitalism
    by Joel Lexchin who teaches health policy at York University and is an emergency physician with the University Health Network in Toronto.

    https://monthlyreview.org/2018/03/01/the-pharmaceutical-industry-in-contemporary-capitalism/

    From the essay:

    “Controlling Knowledge

    Clinical trials that fail to demonstrate effectiveness or that raise significant safety concerns can dramatically affect the sale of products. In July 2002, the results of a Women’s Health Initiative clinical trial found that the estrogen/progestin combination of hormone replacement therapy (HRT) caused an increased risk of cardiovascular disease and breast cancer in postmenopausal women. By June 2003, prescriptions for Prempro, the most widely sold estrogen/progestin combination, had declined by 66 percent in the United States.

    To avoid these scenarios and continue to expand revenue, corporations have evolved from controlling the development of new drugs to controlling the knowledge about those drugs, ensuring that their message is the one that reaches doctors and patients.39 Pharmaceutical corporations fund almost all pre-market clinical trials, the ones used as the basis for approving a new drug or a new indication for an existing drug. These trials are the foundation of knowledge about a drug and as such their outcome is extremely important. As funders, corporations control all aspects of the trials from their initial design to the way that they are conducted and analyzed, how they are reported to drug regulatory agencies such as the FDA, whether and how they are published, and to a large extent how they are presented to doctors.”

    Reply
  4. Fred

    I pay $75 a month for my drugs plust the premium under Plan D. If I pay cash my local grocery store gives me a discount and I pay $50. Of course Plan D has a penalty if you don’t enroll on time. Like Trump said it’s the middle men that are keeping costs high. And, by middle men I mean the insurance companies.

    Reply
  5. clarky90

    My 78 year-old, very fit neighbor, developed all-over, itchy skin rashes for the previous four years. He couldn’t sleep – drove his wife nuts with his tossing and turning. He spent a lot of money on propriety ointments, visits to the specialist dermatologist, DRUGS and sophisticated investigations/tests; lots of antibiotics, steroids, sleeping pills, anxiety pills and so on. The sunset years of his life were a misery.

    Then, something happened!

    His old doctor retired, and his new doctor took him off of STATINS. The rash disappeared. (true story)

    IMO, extended use of a drug, even aspirin, is wrong. Fix the underlying cause by diet, fasting, sleep hygiene, exposure to extreme hot/cold (Wim Hof), full spectrum lighting, reduce EMF (use ethernet cables not WiFi) and exercise.

    The price of pharmaceuticals can be zero/cheap (here in NZ) or astronomical (USA) and it makes little difference to me.

    Are we “Blessed” because McDonald, KFC and junk-snacks are very cheap and accessible in the USA/NZ as compared to rural China? Or, do we avoid, like the plague, irrespective of the “price we pay”.

    A metaphor; If the one’s toilet stinks to high heaven; roll up your sleeves, unblock the waste pipe and fix the simple problem.

    Do not drench your house with continuous, high-end, air freshener, and close the toilet lid, and hope that raw sewage will not overflow into your house…..It will

    And, yes, allopathic medicine is brilliant for trauma and infections.

    And yes, I am 68 yo, and I do as I advise others to do

    Reply

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