Trump could make changes to Medicare drug price negotiations

President Donald Trump will probably not eliminate a historical process that allows Medicare to negotiate the prices of drugs with manufacturers, even when it moves to erase the other achievements of Joe Biden's historical policies.

But Trump will probably make some changes in those price conversations, and may not require the help of Congress.

“Trump is looking to nibble the edges of the law,” said Matthew Kupferberg, partner of the Frier Levitt Life Sciences Group, added that the president “does not seek to completely abandon the drug negotiation process at this time.”

However, it is not yet clear how Trump will bow. While some legislators and health policy experts said that Trump could weaken the negotiations in a way that helps the pharmaceutical industry, other experts said they could duplicate and try to save patients and federal government even more money to overcome Your predecessor.

The path he takes could have great bets for the prices of 68 million beneficiaries of Medicare in the US. UU. They pay their medications. Will also have great implications for companies such as Novo Nordisk, Bristol Myers Squibb, Pfizer and Merckamong others, whose drugs were included in the first two rounds of conversations.

Negotiations are a key provision of the Biden, or IRA inflation reduction law, which aims decade. The pharmaceutical industry is fiercely opposed to price conversations, arguing in a large number of demands that threaten the profits and discourage drug innovation.

The Trump administration has offered few details about its approach to negotiations, in addition to saying in January that it will aim for a “greater transparency” in the second current cycle of the process and listen to any idea to improve it from external stakeholders.

Making significant changes in the law or repealing it would be a battle uphill because it requires the help of Congress, where Republicans have the most of the thin one. Rayo in high medical care costs has strong bipartisan support in a nation where patients pay two or three times more for prescribed medications than people in other developed countries, which makes it a potentially unpopular movement for Trump.

Therefore, the Trump administration could move to implement the provision differently from that of Biden, even changing how the government interprets the criteria for selecting the law for drugs, among other potential changes.

“I think it is a matter of how they interpret part of the legal language,” said Juliette Cubanski, deputy director of the Medicare policy program in KFF, a health policy organization.

Cubanski said we can expect a first vision of any change in the coming months.

The Trump administration will begin the process of negotiating months for a second cycle of 15 drugs, which will be valid for new prices in 2027. The Biden administration selected those medicines in January before Trump assumed the position. Medication manufacturers have until the end of February to decide whether to participate in conversations, which will probably do it because otherwise they face strong financial sanctions.

Until now, Trump has only indicated the need for more transparency in Medicare medication price negotiations. Kupperberg said that could mean revealing more information about the government's justification to select drugs or settled in prices.

During the first round of conversations, Medicare provided opportunities for the public contribution of patients, caregivers and consumption groups. But Kupperberg said the Trump administration could move to bring other interested parties beyond manufacturers and patients, such as insurers or even intermediaries called pharmacy benefits.

“It could be a much broader type of negotiation process,” he said.

The administration could also reinterpret the guidelines of the law, which could change the selected products and how many prices fall, according to Amy Campbell, associate dean of sciences of the law and health of the Law School of the University of Illinois in Chicago.

For example, IRA says that the medications selected for negotiations must have been in the market for at least seven years without generic competitors, or 11 years in the case of biological products such as vaccines. But the Trump administration, by selecting another drug round, can have “more loose standards” to determine if a medicine has competition in the market and should be exempt from negotiated prices, said Campbell.

Trump could also review what Medicare considers a medication in order to negotiations, Cubanski said of Kff. Currently, you can select different products that share the same active ingredient as a single product, to which the pharmaceutical industry is opposed.

The Biden administration, for example, included three of Novo Nordisk brand medications with the same active ingredient, the semaglutida, which a product in the second cycle of price conversations. That includes the medication to lose weight, the diabetes pill Rybelsus and the injection against Ozempic obesity. Of the three, Ozempic constitutes most of Medicare's expense.

Any of these changes in how Medicare selects medications could benefit medication manufacturers and reduce income that loses lower prices.

The most important question is how aggressively Medicare will negotiate prices under Trump, said Cubanski. Currently, the final negotiated price for a medicine cannot exceed an upper limit, or price of “roof”, established by anger.

Trump could influence Medicare's initial price offer for a medicine is closer to the price of the ceiling, which could weaken the program's capacity to ensure a deeper discount.

It is much less likely that important changes occur in price negotiations, since they would require the help of Congress. For example, one of the biggest problems of the pharmaceutical industry with the process is what drug manufacturers call the “penalty of the pill.”

The law essentially saves biological products such as new negotiated prices vaccines for 13 years after receiving approval from the United States, compared to only nine years for small molecule medications that come in the form of a pill or tablet. The industry argues that discrepancy discourages companies to invest in the development of small molecule medications, which are more convenient for patients.

Cubanski said the bipartisan legislation was introduced last year that proposes to eliminate the penalty of the pill. If that bill is going through the Congress and Trump's desk, “I don't see why I wouldn't sign it,” said Cubanski.

He added that there seems to be a growing interest in legislative changes in the negotiation program, but “if you get enough support in Congress, it is still really an open question.”

There is not the same level of bipartisan support for changes in anger as for efforts such as the reform of the pharmacy benefits manager, said Jesse Dresser, a partner of the Department of Life Sciences of Frier Levitt.

“I could see something like [PBM reform] It happens long before I could see trying to open the anger and adjust it, even if it is something that the administration could finally support, “Dresser said.

It is not clear how Trump will address the current legal fight between manufacturers and the Federal Government on the Medicare program.

The legal challenges of the pharmaceutical industry, which argue that conversations are unconstitutional and should stop, so far they have not been successful in court. Nine demands were ongoing from January.

“Will the Trump administration continue to defend the program? Or maybe not defend the program aggressively?” Cubanski said. “I think those are some key questions.”

If the Trump administration stops defending the program in the Court, the judges could make decisions on the matter without any opposition, said Kupferberg. But he said he does not believe that the administration wants that result.

The Trump administration probably “wants to take control of that process, where the parties prepare an agreement or review and change the interpretation of the law,” Kupferberg said.

He added that it does not seem that Trump would like the entire negotiation program to disappear depending on the demands. This is because it would leave Trump in the position of finding a replacement for Medicare drug price negotiations, and “we still can't see one,” Kupferberg said.