Here’s a peek at the White House’s unreleased drug-pricing order – that probably won’t work !

This probably will not work as the President believes because there are several middlemen between the manufacturer and the pt who gets/needs the medications.  Two of those middlemen are insurance companies and PBM (Prescription Benefit Managers). They – sometime arbitrarily decide which medications they will pay for and/or demand kickeback/rebates/discounts from the pharma in order for the pharma’s meds to be on their approved formulary. So if Trump tries to implement a “favored nation status” to determine prices..  All of those Medicare Advantage and Part D programs are your basic for profit companies.  If the pharmas are required to cut their price to these entities… and won’t be in the position to pay those kickback, discount, rebates to those middlemen… the middlemen will just raise the premiums that pts pay, increase deductibles, increase copays.

Remember what happened when President Obama got his ACA (Affordable Care Act) with promises of everyone saving $2500/yr in premiums and being able to keep your doctor. Most people who were not “poor enough” to qualify for financial assistance on ACA’s premiums… they saw their premiums DOUBLE OR TRIPLE and their annual deductibles being upwards of approaching $10,000/per/yr.  Pts were unlikely to use be able to use their favorite doc or hospital and or other healthcare providers that they had used in the past or prefer to use.  The insurance companies – those who provided care under the ACA just shifted costs to people they insured.

The other option is as contracts with other country’s national insurance programs… the pharma just raise their prices over there … so that the “favored nation price” in other countries will start to rise… So in the end…. people in other countries will end up paying more for the meds and so will Americans… may be less than they were first raised to, but still more than they use to pay…  The for profit insurance/pbm industry will get their monies and profits.

Here’s a peek at the White House’s unreleased drug-pricing order

Partial text of an executive order the White House has refused to make public indicates the White House is using a more aggressive version of a payment demonstration for outpatient drugs to try to pressure drugmakers to the negotiating table.

President Donald Trump signed four drug-pricing executive orders on Friday, but the White House has refused to release the text of the most controversial order that aims to reduce the amount Medicare pays for some high-cost outpatient drugs. Trump said during the White House event that the order would go into effect a month after signing.

“But the fourth order, we’re going to hold that until Aug. 24, hoping that the pharmaceutical companies will come up with something that will substantially reduce drug prices,” Trump said Friday.

Trump held up the order for a photo op after signing it, and the text of two out of the order’s three pages was visible in a photo taken by Associated Press photographer Alex Brandon and reviewed by Modern Healthcare.

The visible text of the order details that presumably the HHS secretary would be directed to “implement his rule making plan to test a payment model pursuant to which Medicare would pay, for certain high-cost prescription drugs and biological products covered by Medicare Part B, no more than the most favored-nation price.”

The text of the order indicates the White House may pursue a more aggressive version of international reference pricing than it first proposed in October 2018.

The 2018 policy would in part tie Medicare Part B payment to the average price of a market basket of developed countries, while a most-favored nation approach could give the United States the lowest price out of a selected marketbasket.

The order text seems to line up with prior comments by HHS Secretary Alex Azar, who said in November 2019 that Trump was “not satisfied” with the average international price approach, and instead wanted the United States to get “the best deal.”

The text said the purpose of the demonstration would be to see if a most favored-nation pricing demonstration would “mitigate poor clinical outcomes and expenditures associated with high drug prices.”

So far, HHS has only proposed an advance notice of proposed rulemaking on its international reference pricing plan, and would have to propose a rule and finalize it before the policy could take effect. The proposed rule has languished under review at the White House budget office since June 2019. The rulemaking timeline makes it highly unlikely that it could be finalized by the end of Trump’s first term.

The visible text does not detail how a “most-favored nation price” would be calculated, and does not indicate any deadline for implementation. It is possible that details or a deadline were listed on the obscured page of the order.

The White House declined to comment on the partial text.

Trump said he planned to meet with drugmakers this week, but a meeting has not occurred. Pfizer Chairman and CEO Albert Bourla told investors on Tuesday that he was not interested in meeting with the White House to discuss the order.

“I don’t think there is a need for, right now, for White House meetings,” Bourla said.

Pharmaceutical Research and Manufacturers of America said the group remains willing to speak with the administration and discuss ways to lower costs for patients at the pharmacy counter.

“However, we remain steadfastly opposed to policies that would allow foreign governments to set prices for medicines in the United States,” said PhRMA spokesperson Nicole Longo.

The drug-pricing orders were released shortly after former Rep. Mark Meadows took over as White House chief of staff. Meadows criticized the Trump administration’s international reference pricing proposal while he was in Congress.


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