Trump often ad libs. What does that mean for his drug pricing speech? | STAT

Letting Medicare negotiate drug prices
This one’s the elephant in the room: allowing Medicare to negotiate the prices it currently pays for a given prescription drug, the way private insurance companies do. Right now, such negotiations are forbidden by law.

Trump pledged his support for that idea on the campaign trail, breaking with years of Republican opposition, saying the government could save $300 billion every year if it implemented cost negotiations.

“We don’t do it. Why? Because of the drug companies,” Trump said in January 2016.

But he hasn’t mentioned that specific idea since assuming the presidency, and his health secretary, Alex Azar, openly opposed the policy in his confirmation hearings.

But there’s already some suggestion that the broad idea of negotiation will come up during the speech. In fact, an HHS spokeswoman told STAT the agency is working on a plan that takes aim at four problems including this one: “seniors and government programs overpaying due to lack of negotiating tools.”

There may be a way for Azar and others to deliver on that promise in a smaller, more targeted fashion. Azar has been signaling, in his confirmation hearing and elsewhere, support for a proposal to shift chemotherapy drugs and others administered in the hospital into a different part of Medicare. That idea would give insurance companies and pharmacy benefit managers new power to negotiate discounts on some of Medicare’s costliest therapies.

It’s an idea pharma still opposes — but not nearly as much as the industry would oppose the idea of far broader negotiations in the program.

Buying drugs from Canada or anywhere else

This is another idea that Trump’s backed — and one that’s pretty simple to talk about, until you get into the nitty-gritty details.

“Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers,” the Trump campaign health care reform proposal said.

He’s talked, too, about how some drugs — even those produced in the U.S. — are available for much lower prices in other countries.

Buying U.S.-made drugs elsewhere and re-importing them is an idea with some bipartisan support, too — Sens. John McCain (R-Ariz.) and Amy Klobuchar (D-Minn.) have co-sponsored legislation on the topic together, and the latest lawmaker to plead for the policy change was libertarian Rand Paul (R-Ky.).

But like negotiation, it’s an idea that Azar, Gottlieb, and other top health officials have long opposed. They have said the policy will likely lead to broader importation than some policymakers envision.

“This thing about importing drugs from Canada is a canard,” Azar said last June. “These drugs are not American-produced drugs sitting in a Canadian retail pharmacy. These are often drugs coming from China or India or elsewhere that are just being trans-shipped through Canada into the U.S. The administration [and] public health officials have repeatedly found these are not safe. There can be no guarantee of safety.”

The easiest way to allow importation — without requiring legislation from Congress, that is — is to empower Azar himself, as health secretary. Medicare rules let the administration bring in drugs from Canada in certain cases, but only if the secretary certifies that the implementation regime is safe and that it would actually save consumers money. Given Azar’s position on the issue, he seems unlikely to engage.

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Trump often ad libs. What does that mean for his drug pricing speech?.