Drug prices improved under Biden-Harris and Trump − but not for everyone, and not enough

When it comes to drug pricing, both the Trump and Biden-Harris administrations have some very modest victories to boast about.

As a director of Health Outcomes, Policy and Evidence Synthesis Group University of Connecticut School of Pharmacy I teach and study On the ethical nature of prescription drug prices and the complexities of drug pricing nationwide.

A closer look at the successes of the presidential candidates’ numerous drug pricing policies shows progress continuing across administrations, but neither the Trump nor Biden-Harris administrations have done anything to truly lower drug prices for the vast majority of Americans.

Insulin $35

Insulin is a necessity for people with diabetes. But between January 2014 and April 2019, the average price per unit $0.22 to $0.34 It will drop slightly to $0.29 per unit by July 2023. Because dosing is based on weight, the cost of insulin for a person weighing 154 pounds will increase from $231 to $357 per month between 2014 and 2019, then fall to $305 per month by 2023. The rising prices have prompted some patients to space out their doses by taking less than is needed to maintain good blood sugar control. One study found that More than 25% of patients At an urban diabetes center, some patients were underusing insulin.

In July 2020, the Trump administration Insulin cap is $35 The executive order waived the copayments. In effect, companies participating in the Medicare Part D program were required to cap the price of each type of insulin at $35 per pill. For example, if a plan’s approved drug list included six short-acting insulin pills, the insurer had to offer one vial form and one pen form for $35.

These price changes were not implemented during President Trump’s term. By 2022, Approximately 800,000 people – or 11% or more 7.4 million people in the U.S. use insulin The price has been reduced to regulate blood sugar levels.

In August 2022, the Biden-Harris administration Inflation Control Law The law was enacted, which maintained the $35 insulin cap under the same conditions, but made the program mandatory for all Medicare Part D and Medicare Part B enrollees, expanding the number of people eligible to benefit from cheaper insulin to 3.3 million people.

This is still Not helpful for the majority of people with diabetesIf you don’t have Medicare, you don’t get the $35 discount. Additionally, while pharmaceutical companies are not responsible for lowering insulin costs under these policies, health plans are responsible for lowering out-of-pocket costs, and the costs can be passed on to beneficiaries in future Medicare premiums.

Importing Canadian Medicines

Americans pay For prescription drugs, the rate is about 2.6 times higher. Prices are higher than people in other high-income countries, and one way regulators have tried to lower prices is to import drugs at the price that drug companies charge those countries, rather than the price that is charged to U.S. consumers.

In July 2019, the Trump administration Importing medicines from Canada As a way to share Canadians’ lower drug costs with American consumers, he signed an executive order allowing the Food and Drug Administration to write rules allowing states to import drugs. When President Joe Biden took office, he left the executive order in place and the rule-making process continued.

Under the Trump and Biden-Harris administrations, no state has been able to import Canadian medicines. However, in January 2024, the Food and Drug Administration allowed Florida to import Canadian medicines. Plans to import Canadian medicinesColorado is the first state to receive approval, with Colorado, New Hampshire, New Mexico and Texas all pending applications as of September 2024.

Unfortunately, it is unlikely that Canada will allow prescription drugs to be shipped in bulk to American consumers. impose high tariffs As a disincentive, because if drugs are moved to the U.S., pharmaceutical companies could restrict supply to Canada, causing shortages. Also, pharmaceutical companies may be reluctant to negotiate lower prices for Canadians if it hurts U.S. profits.

Negotiations with the pharmaceutical industry

For any sale, whether of prescription drugs or a car, both the buyer and seller must agree on a price for it to be successful. If a potential buyer isn’t willing to walk away from the negotiations, the seller won’t get their best price. One reason drug prices in the U.S. are higher than in other countries is because the government isn’t a smart negotiator.

The negotiations Leading to a significant reduction in drug prices In many cases, this is because the drug company loses access to patients with certain health insurance plans or falls into higher drug tiers that significantly increase patients’ out-of-pocket costs. However, if the buyer rejects the seller’s final offer, its members and citizens will lose access to those drugs. Large private health plans and pharmacy benefit managers can negotiate drug prices directly with pharmaceutical companies, often resulting in significant savings, but Medicare was prevented from doing so. Until recently, it was prohibited by federal law.

In May 2018, the Trump administration launched the so-called Blueprint for Lowering Prescription Drug Prices This included negotiating with the pharmaceutical industry over Medicare prescription drug prices, a plan that was not enacted during his term.

The Inflation Control Act will be enacted under the Biden-Harris Administration in August 2022. Price negotiable It then specified the number of medicines that could be included in the negotiations per year.

Medicare’s initial negotiations with the pharmaceutical industry took place in the summer of 2024 and resulted in lower costs for 10 Medicare Part D drugs, including the blood thinner Xarelto and the drugs Farciga and Jardiance, which treat type 2 diabetes, heart failure and kidney disease. The resulting savings of $1.5 billion will extend through 2026 to about 8.8 million Medicare Part D patients who take these drugs. Prices for these drugs remain Twice as many of them and in four other developed countries.

Price negotiations for 15 more Medicare Part D drugs are expected to take place in 2027. Subsequent drug negotiations could include Medicare Part D drugs received at pharmacies and Medicare Part B drugs administered or received at a physician’s office.

Another aspect of the inflation control law is The out-of-pocket cost is $2,000.But this won’t come into effect until 2025 and will simply pass on the costs above the cap to taxpayers.

Continuing progress

When assessing a complex issue such as drug pricing, it is often difficult to attribute policy success to one administration versus another, with some ideas proposed during the Trump administration that never came to fruition until the Biden-Harris administration implemented and expanded them.

For example, Medicare price negotiations proposed in the Trump administration’s “blueprint” have been signed into law by President Biden, but the results of this policy will not be visible until the next administration. And regardless of who is to blame for this success, only a fraction of Medicare enrollees will see relief from high drug prices as a result.

To truly lower prescription drug costs, we need to identify the maximum price people are willing to pay for the following benefits: Cost per quality-adjusted life year Set prices at the federal, state and private payer levels and be prepared to walk away from negotiations if prices exceed those levels. But this is not a panacea. In particular, Rare and Ultra-Rare DiseasesIt will likely need to be phased in over time to avoid industry collapse.