- One of the executive orders aims to speed up the timeline for a proposal the administration introduced late last year to allow states, drug wholesalers and pharmacies to import certain drugs from Canada. Drug companies have pushed back fiercely on that proposal, arguing there is “no way to guarantee the safety of drugs that come into the country from outside the United States’ gold-standard supply chain.” The Canadian government also opposes the measure, warning that the drug supply for Canada’s 37 million residents cannot possibly fulfill the demands of the much larger U.S. market and that allowing importation would cause severe drug shortages for Canadians.
- Another aims to tie some Medicare drugs’ prices to those paid in other countries with significantly lower list prices — a so-called “international pricing index.” The idea, which Trump called the “granddaddy of them all,” is anathema to most congressional Republicans, who see it as price fixing, as well as to the pharmaceutical industry.
- The third proposal purports to end a widespread practice in which drugmakers give rebates to insurance middlemen in government programs such as Medicare. The administration’s goal is to channel that money to consumers instead. Trump killed the rule last year, which is favored by the drug industry, after initially embracing it when he saw projections showing it would raise Medicare premiums for many seniors.
- The fourth proposal requires the provision of insulin and/or an EpiPen free through an existing program mandating pharmaceutical companies to provide steep discounts to thousands of hospitals and community health centers that serve large numbers of low-income patients. Drugmakers have targeted the program, known as 340B, arguing some facilities getting the discounts should not be eligible.
In addition to a built-in delay to August 25, in order to give Big Pharma a shot at them, it is unclear whether the Executive Orders have any effect other than to encourage DHHS to proceed with ongoing rulemaking proceedings under the Administrative Procedure Act. And whether the administration relies on the EOs or speeds up the administrative process, expect litigation to challenge these rules. The EOs have drawn criticism from both sides of the aisle in Congress, and even Margarida Jorge, campaign director for Lower Drug Prices Now, has dismissed them as a campaign stunt: “These Executive Orders are not about policy, they’re about politics. The only reason for President Trump’s rekindled interest in lowering drug prices is his dwindling poll numbers, and realization that our country’s senior citizens are abandoning him thanks to his bungled handling of the coronavirus crisis.”
Further evidence that this is not a serious attempt to accomplish anything concrete: As reported by Stat, "As of late Friday afternoon, the White House had not made public the text of Trump’s executive orders. And on a conference call with reporters following Trump’s announcement, health secretary Alex Azar provided little detail as to when and how each of the administration’s latest proposals would be implemented."
