Skepticism reigns as Trump finally details plan to rein in prescription drug costs

Did you hear it? Was that a giant sigh of relief by Big Pharma executives around the globe? Or was it the air deflating from any Americans who still had high expectations that President Trump, as he had promised for more than a year, really would offer a quick, powerful, and effective public policy prescription to slash skyrocketing drug prices?

The stock market made a big bet that Big Pharma would do just fine, sending drug manufacturer stocks higher.

News organizations splashed lots of ink and electrons on the highly promoted presidential statement on prescription drugs, including prominent and detailed coverage from the New York Times, the Washington Post, the Los Angeles Times, the Wall Street Journal, the Associated Press, and online news sites such as Vox and Stat.

How much did the president tackle the problems in drug costs and prices, as described succinctly in the video (above) from Robert Reich, a Democrat, political commentator, and UC Berkeley public policy professor?

Although Trump and other administration officials trumpeted the importance and potential effect of the president’s drug cost-cutting plan, a 44-page blueprint titled, “American Patients First,” the headlines told a different story, including:

  • Trump’s prescription to reduce drug prices takes small steps (AP)
  • Trump’s Plan to Lower Drug Prices Diverges from Campaign Promise (NYT)
  • Trump promises to lower drug prices, but his blueprint is less sweeping than his campaign rhetoric (LAT)
  • Trump’s Plan to Cut Drug Prices Leaves Industry Relieved (WSJ)

Some key things the president didn’t call for in his action plans, though he has suggested before that he might, and that might have had significant effects: As the New York Times described it, Trump opted not to have the federal government directly negotiate lower drug prices for Medicare. And he chose not to allow American consumers to import low-cost medicines from abroad. “

The speech commentary also was notable:

  • Ronny Gal, a securities analyst at Sanford C. Bernstein & Company, told the New York Times that the president’s speech was “very, very positive to pharma,” and he added, “We have not seen anything about that speech which should concern investors” in the pharmaceutical industry. Gal and others noted that Big Pharma stock prices dipped before the speech but soared after.
  • Chuck Schumer, the Democratic leader, was quoted by the New York Times as saying after the speech: “President Trump offered little more than window dressing to combat the rising cost of drugs — a problem that is pinching the pocketbook of far too many Americans.”
  • The president attacked outfits like Pharmacy Benefits Managers, aka PBMs, which are supposed to work with big employers, insurers, and drug makers and suppliers to negotiate most favorable prices: “We’re very much eliminating the middlemen. The middlemen became very, very rich, right? Whoever those middlemen were — a lot of people never even figured it out — they’re rich. They won’t be so rich anymore.”
  • Alex Azar, the head of the federal Health and Human Services agency, commented: “It’s going to be months for the kind of actions that we need to take here. Again, this is — it took decades to erect this very complex, interwoven system. We’re talking about entrenched market players, complex financial arrangements that have — would have to be redesigned.”
  • The Washington Post quoted Rachel Sachs, an associate professor at Washington University School of Law, as saying: “With all the buildup the administration has given it, the president’s speech was deeply underwhelming. There is very little new in the administration’s plan, and little if anything that will make a difference in the near future, as the president has promised.”
  • Lloyd Doggett, a Texas Democrat, dismissed Trump’s plan as “a sugar-coated nothing pill,” the AP reported.
  • Jack Hoadley, of Georgetown University’s Health Policy Institute, expressed skepticism to the AP about Trump’s assertion that the U.S. could pressure foreign governments to pay more for drugs, so Americans might pay less: “It’s hard to know why Germany or France or Australia would agree to something like that.”

To be fair, the AP summarized key Trump’s proposals as including: “A potential requirement for drug makers to disclose the cost of their medicines in television advertisements; banning a pharmacist ‘gag rule,’ which prevents druggists from telling customers when they can save money by paying cash instead of using their insurance;  speeding up the approval process for over-the-counter medications so people can buy more drugs without prescriptions; and reconsidering how Medicare pays for some high-priced drugs administered at doctors’ offices.”

The down-the-middle news service also reported, though: “Those ideas avoid a direct confrontation with the powerful pharmaceutical lobby, but they may also underwhelm Americans seeking relief from escalating prescription costs.”

In my practice, I see not only the  harms that patients suffer while seeking medical services, but also their  struggles to access and afford safe, effective, and quality medical care — and their major and growing nightmares in dealing with bankrupting and all too often dangerous drugs. As the Washington Post reported: “Prescription drug spending grew 1.3 percent in 2016 , to $328.6 billion, according to the Centers for Medicare and Medicaid Services.” And as he AP noted: The U.S. spent $1,162 per person on prescription drugs in 2015, according to the Organization for Economic Cooperation and Development. That’s more than twice the $497 per person spent in the United Kingdom, which has a nationalized health care system.

Translation: Prescription drug prices are soaring out of reach for all too many patients, and this is harmful and unacceptable.

But Big Pharma’s political spending has exploded, with the AP reporting: “The drug industry’s top lobbying arm, Pharmaceutical Research and Manufacturers of America, spent nearly $26 million to sway federal decision makers last year, according to records tallied by Center for Responsive Politics. The annual total was the group’s highest since the 2009 congressional fight that led to Obamacare.”

Further, the Trump administration is rife with onetime Big Pharma executives, as noted by Public Citizen, a consumer advocacy group, and the administration finds itself caught up now in deepening scandals over pay-to-play schemes, including with Big Pharma players, disclosed as part of the widening investigation over the extent of Russian meddling in the 2016 presidential elections.

What chance do ordinary Joes and Janes, in the face of big money interests, in getting affordable medications that can change and save their lives? The midterm elections are rolling on us fast, and they may be more consequential than many we have seen in recent times.

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