Cutting through the noise: the handful of pricing proposals the Trump administration or Congress may enact

The prospects of the handful of government price proposals that drug companies need to think about

Scores of proposals for reducing the cost of drugs are swirling around Congress, the White House and the U.S. Department of Health and Human Services, but only a few merit attention outside the beltway.

Eliminating ideas that are unlikely to be put into effect, as well as those that will have minor impacts, yields a list of 10 initiatives that could have substantial impacts on drug companies (see Figure: “Separation of Powers”).

They are a mixed bag, with some having the potential to cut into drug sales and others boosting revenues.

Limits to the executive branch’s jurisdiction, and the political radioactivity of the Affordable Care Act, mean that government drug pricing initiatives will focus almost exclusively on Medicare and Medicaid.

The glide path is smoothest for proposals the administration can implement without legislation.

The administration is, however, sensitive to political pressure from patients and physicians. This is reflected in its decision, announced May 16, to drop its proposal to modify a rule that requires Part D plans to cover all FDA-approved drugs for conditions like cancer, HIV and depression.

The glide path is smoothest for proposals the administration can implement without legislation.

Congress has the power to block or modify executive drug pricing actions. The Republican-controlled Senate, however, has demonstrated no appetite for challenging President Donald Trump, and there’s little reason to believe it would start by overruling HHS to help drug companies.

Getting legislation through a divided Congress is always difficult, but an unusual convergence between congressional Democrats and Trump makes bipartisan drug pricing legislation possible.

Gauging the prospects of implementing drug pricing proposals

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