Trump order on drug prices faces long road to finish line

President Trump is seeking a preelection boost on a top issue for voters — lowering drug prices — but there are doubts about when and if his latest move will bring down costs for patients.

Trump signed a long-awaited executive order Sunday that aims to lower the amount Medicare pays for many drugs by tying the cost to the price tag in other developed countries.

While the move could significantly cut the price for certain drugs, the timing of Trump’s action means implementation is unlikely before Election Day.

The Department of Health and Human Services (HHS) still needs to issue regulations for the order, a process that can sometimes take several months. After that, establishing an entirely new system of Medicare purchasing will require even more time.

The White House has not always exhibited a sense of urgency on the issue, one that Trump talked about on the 2016 campaign trail. Trump announced an earlier version of the same policy just weeks before the 2018 elections, but the proposal was stalled for almost two years before being revived on Sunday.

“It would be extremely difficult and hard to imagine this getting implemented before the election,” said Tricia Neuman, a Medicare expert at the Kaiser Family Foundation.

“It would have been a different ballgame had the administration put these proposals out and moved them forward earlier in his term,” she added.

The pharmaceutical industry, which strongly opposes the price restructuring, arguing it would lead to painful payment cuts that would harm innovation, quickly said it could sue to try to stop Trump’s order, adding the possibility for further implementation delays.

But if it eventually goes through, Trump’s order could dramatically cut the prices for some high-cost drugs.

In the meantime, Trump’s intentions put congressional Republicans in an awkward position. Most of them oppose the move as an embrace of “price controls,” but they are also hesitant to publicly criticize Trump, particularly in an election year.

Democrats, meanwhile, are also in the odd position of having proposed something similar to Trump’s order, which they largely attacked as purely symbolic and a preelection stunt.

Rep. Lloyd Doggett of Texas, a leading Democratic advocate for action on drug prices, called it “empty election-eve magic” after “failing to lower any prices during almost four years.”

“Trump aims to make a misleading headline for his failing campaign, not a genuine difference for victims of price gouging,” Doggett said.

David Mitchell, founder of the advocacy group Patients for Affordable Drugs Now, tweeted that the move is “good” and can remedy Americans paying two to three times what people pay for drugs in other wealthy countries.

But he added: “None of us should expect to see lower prices for months or years or maybe never. Many critical questions remain unanswered. A similar proposal has been sitting within the Admin for two years.”

Avik Roy, a right-leaning health policy expert, pushed back on the idea that the move is merely “symbolic” but also acknowledged in an op-ed in Forbes that it will likely take “another year” for the new payment system to be set up, once the regulations are issued.

Roy pointed to the similarities between what Trump has proposed and drug pricing proposals from Democratic presidential nominee Joe Biden, raising the question of whether Biden would allow Trump’s order to move forward if he is elected.

The Biden campaign did not respond to a request for comment.

House Democrats, in their signature drug pricing bill passed in December, proposed a similar system of capping drug prices based on prices paid in other countries, while allowing the HHS secretary to negotiate prices down even further.

The Democratic bill is significantly broader, though, in that it would apply to people with private insurance plans as well, not just those on Medicare.

After months of talks between the White House and Speaker Nancy Pelosi’s (D-Calif.) staff last year on a possible agreement on drug pricing, discussions broke down and Trump officials threatened to veto the House bill, echoing the industry argument by warning it would harm innovation.

The White House backed a more modest measure in the Senate, from Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), but Trump never put political muscle into persuading Senate Majority Leader Mitch McConnell (R-Ky.) to schedule a vote. Efforts to advance that bill have similarly stalled.

Congressional Republicans reacted carefully to Trump’s latest order.

Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, did not take a firm position but said he’s “confident [HHS] will consider the impact any action taken could have on the innovation our country is counting on to end the COVID-19 pandemic and to develop cures and treatments for other diseases.”

Rep. Kevin Brady, the top Republican on the House Ways and Means Committee, was more explicit in raising concerns about the impact on innovation. Brady and Walden both pointed to more modest drug pricing legislation that their party has proposed.

“We believe a lasting legislative solution will achieve the President’s goal without the downside of importing foreign price controls that slow down the development of new medical cures,” Brady said in a statement.

Rachel Sachs, a health law expert at Washington University in St. Louis, said there are a range of administrative steps and lingering policy questions that would delay the move from taking effect.

Those obstacles, coupled with the fact that the previous version sat on the shelf for almost two years, make the likelihood of final implementation before the election slim at best.

“The administration hasn’t displayed a sense of urgency about this before,” Sachs said.