President Donald Trump's long-promised plan to bring down drug prices, unveiled Friday, would mostly spare the pharmaceutical industry he previously accused of "getting away with murder." Instead, he focuses on private competition and more openness to reduce America's prescription pain.
Donna Barsky, pharmacist and owner of TexasStar Pharmacy in Plano says it’s possible to lower drug costs, but there’s a long road ahead.
“The problem is this,” said Barsky. “You have so many hands in the pile, everybody want to make a profit, and in some cases that profit has gotten exorbitant.”
In some ways, Texas is paving the way. The President’s plan calls for dropping a "gag rule" that prevents pharmacists from telling customers about lower priced options. Texas started doing that about 6 months ago.
“Previous to that, I would not be able to tell the patient I could take this off of insurance and give you a better price,” Barsky explained. “If they have to take medication, why should we charge them more for something they can get for less.”
The Trump administration will pursue a raft of old and new measures intended to improve competition and transparency in the notoriously complex drug pricing system. But most of the measures could take months or years to implement, and none would directly stop drugmakers from setting sky-high initial prices.
Drugmakers generally can charge as much as the market will bear because the U.S. government doesn't regulate medicine prices, unlike most other developed countries.
The list of 50 proposals includes:
— A potential requirement for drugmakers 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.
— Consider changes to how Medicare pays for some high-priced drugs administered at doctors' offices
Those ideas avoid a direct confrontation with the powerful pharmaceutical lobby, but they may also underwhelm Americans seeking relief from escalating prescription costs.
Several consumer groups and Democrats in Congress criticized Trump for not following through on pursuing direct Medicare price negotiations, as he had long promised.
Perhaps the idea under consideration that would be most threatening to drugmakers is to give the private health insurers who run Medicare plans more negotiating power with them. But administration officials offered few specifics on how that might work.
Pharmaceutical investors and analysts expressed relief after the announcement, and shares of several top drugmakers rose slightly.
"Trump had a choice today: to seek disruptive fundamental reform or to embrace more incremental steps," wrote Terry Haines, a financial analyst, in an investment note. "Trump chose the incremental over the disruptive."
A majority of Americans say passing laws to bring down prescription drug prices should be a top priority for Trump and Congress, according to recent polling by the Kaiser Family Foundation.
Azar and other Trump officials have hinted for weeks that the plan would, in part, "dismantle" the convoluted system of discounts and rebates between drugmakers and the health care middlemen known as pharmacy benefit managers.
Trump called out those companies early in his speech, but gave no details on what new restrictions or penalties they might face.
"We're very much eliminating the middlemen," Trump said.
Public outrage over drug costs has been growing for years as Americans face pricing pressure from multiple sources: New medicines for life-threatening diseases often launch with prices exceeding $100,000 per year. And older drugs for common ailments like diabetes and asthma routinely see price hikes around 10 percent annually. Meanwhile, Americans are paying more at the pharmacy counter due to health insurance plans that require them to shoulder more of their prescription costs.
Experts who study drug pricing are encouraged that the discussion has moved on from angry protests to more sophisticated proposals.
But others warn there is no guarantee that unraveling the current pricing-setting bureaucracy will lead to lower costs because it all starts with drugmakers' initial prices.
America has the highest drug prices in the world.
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.
Medicare is the largest purchaser of prescription drugs in the nation, covering 60 million seniors and Americans with disabilities, but it is barred by law from directly negotiating lower prices with drugmakers.
Allowing Medicare to negotiate prices is unacceptable to the powerful drug lobby, which has spent tens of millions of dollars since Trump's inauguration to influence the Washington conversation around drug prices, including a high-profile TV advertising campaign portraying its scientists as medical trailblazers.