"There are some things in this set of proposals that can move us in the direction of lower prices for some people", said David Mitchell, founder of Patients for Affordable Drugs.
And finally, we're pushing President Trump to immediately lower the cost of naloxone.
The president also spoke of ending trade practices overseas that lead to unfair prices for Americans. But I don't know even one person who's seen the cost of their prescriptions go down.
As a candidate, Trump railed against the pharmaceutical industry, accusing companies of "getting away with murder". He repeated those words at a Cabinet meeting in October.
It said the administration's immediate actions would include allowing commercial plans that administer Medicare Part D prescription drug benefits for seniors more power to negotiate prices with drug makers. "The drug prices have gone through the roof". He also promised to make it more expensive for "free-riding" foreign countries to produce drugs, arguing that they take advantage of USA manufacturers' research and development. "They're thinking of the price to the patient, or - more cynically - they're thinking about the price to the voter". He also said the pharmaceutical industry is making an "absolute fortune" at the expense of USA taxpayers. It's an approach that could avoid a direct confrontation with the powerful pharmaceutical lobby, but it could also underwhelm Americans seeking relief from escalating prescription costs. Often, companies are rewarded for setting a high retail price because insurers negotiate discounts off that initial price.
It does not include his campaign pledge to use the massive buying power of the government's Medicare program to directly negotiate lower prices for seniors.
Trump also blasted the pharmaceutical and insurance industries for spending hundreds of millions of dollars on lobbying to "protect the status quo". He didn't mention letting Americans import medicines from other countries that carefully control drug quality. That trend, coupled with several high-profile cases where drug manufacturers significantly raised the price for common, decades-old drugs, have thrust the issue into the national spotlight. "I think very expensive champagne will be popping in drug company boardrooms across the country tonight", said Rep. Elijah Cummings, a Maryland Democrat. Health and Human Services Secretary Alex Azar, a leading figure on the issue for the administration, said as much during a briefing with reporters shortly after the president's address. But administration officials offered few specifics on how that might work.
Azar and other Trump officials have described the pricing problem in stark terms and promised bold action. FDA Commissioner Scott Gottlieb - another Trump appointee with industry connections - hinted at a plan to "dismantle" the convoluted system of discounts and rebates between drugmakers and health care middlemen. "Why? Because of the drug companies".
On Thursday, administration officials also vowed to address foreign governments that rely on USA medicines but pay drastically lower prices due to government controls.
"Insurance providers share the savings from negotiations with drug manufacturers by lowering premiums and copays for all consumers", AHIP said in a statement.
One novel proposal in the president's grab bag is meant to actually raise prices - not in the US, but in other developed countries.
Democrats were especially upset Trump's announcement did not call for Medicare to negotiate drug prices, a popular Democratic proposal and one of his signature campaign promises.
One area in the Trump administration's sights is the shadowy world of drug price rebates. "No similar negotiating happens in the U.S".
"Every incentive is toward higher list prices because everyone in the system gets a cut off that list price except the patient", said Azar, speaking on "Fox and Friends" on Friday morning. Critics contend that this lack of transparency limits competition and drives prices higher.
And their job is to stop competition and to keep prices high.
Trump argued that other countries take advantage of the U.S. pharmaceutical industry and its investments in research and development, claiming that bringing downs costs at home would require increasing prices in foreign countries. Those price concessions are nearly never disclosed and it's unclear what portion actually flows back to consumers.
Proposed Part D reforms would allow greater benefit design flexibility; provide free generic drugs to low-income seniors; require such plans to pass on a minimum percentage of drug rebates with patients; disincentivize plans to accelerate beneficiaries into catastrophic coverage through branded drugs by establishing a new out-of-pocket maximum. Another proposal would do away with rebates altogether to encourage more upfront discounts in Medicare. Presciption rices have not been lowered at all. Most drugmakers increase their prices annually during this monopoly period, and until recently double-digit price hikes were the norm.
The administration is considering rules instituting site neutrality that would eliminate or reduce facility fees charged for drugs issued at hospitals and hospital-owned clinics.