If he does, it will be another major break with his party’s longstanding policy positions

By Herbert Rothschild

I pledged that, until Israel allows the resumption of food aid into Gaza, I’ll begin every column with a reminder that it is intentionally starving 2 million people. Actually, on Monday Israel allowed nine aid trucks to enter. I don’t consider this a reason to stop. A week earlier, the United Nations had reported that one in five Gazans — 469,500 people — are experiencing extreme starvation.  

Let’s give a name to one who has already died: Jinan Iskafi. On May 13, in his floor remarks introducing a resolution to restore humanitarian aid to Gaza, U.S. Sen. Peter Welch, D-Vermont, told his colleagues, “I have behind me the picture of an infant girl in Gaza who starved to death this past week. Her parents could not get the lactose-free formula that she needed to keep her alive. That formula was on one side of the Gaza gate, that starving child was on the other. There was never even an effort to just hand that formula to keep that young girl alive over the fence or to open the gate.”

Now to my topic. Beginning with the negotiations in 2003 over the Medicare Modernization Act, which created Medicare Part D, a large majority of Republican lawmakers have opposed allowing the federal government to bargain with pharmaceutical companies for price reductions. The act specified that “The Secretary [of Health and Human Services] may not interfere with the negotiations between drug manufacturers and pharmacies and [Part D] plan sponsors, and may not require a particular formulary or institute a price structure for the reimbursement of covered Part D drugs.”

Between 2003 and 2022, Republicans blocked all efforts to remove that non-interference provision. Finally, over the opposition of every Republican member of Congress, Democrats passed the Inflation Reduction Act, which (among many other provisions) included Medicare’s authority to bargain for lower prices of a limited number of drugs.

The consequence of Republican pandering to the drug companies has been that we in the U.S. in general pay 2.78 times more for prescription drugs than 33 other nations. And the price we pay for some drugs is many times higher than that. In a previous column, I referred to a Senate hearing at which Sen. Bernie Sanders asked the CEO of Novo Nordisk why the list price for a four-week supply of its diabetes drug Ozempic lists for $969 in the U.S., but for $155 in Canada, $122 in Denmark and $59 in Germany.     

It’s a commonplace now for commentators to point out that President Donald Trump has no respect for long-standing Republican policy positions. I find it impossible to pass a general judgment on this iconoclasm. Obviously, his open scorn for the rule of law is an appalling departure from a tradition Republicans used to honor, along with everyone else in public life. On the other hand, I welcome his willingness to stop supporting unconstrained economic globalization, despite how clumsily he has pursued an alternative course.

That clumsiness, originating in an inflated assessment of his own abilities and his impatience with established procedures that might assure a proper realization of his intentions, may doom once again another departure from long-standing Republican policy, namely, his efforts to reduce prescription drug prices.

Trump tried to intervene in his first term, only to be frustrated by a federal court ruling. In 2020, he issued an executive order seeking to link the prices Medicare pays for certain drugs to the lowest price paid for them by other developed countries. A federal judge in Maryland issued a temporary injunction, ruling that Trump had signed the order without going through the standard notice-and-comment process that is required for significant regulatory changes under the Administrative Procedure Act. Because that ruling came in December, his term expired before he could deal with the setback.

Trump is trying again. He issued an order on May 12 that, according to a report in The Hill, “will roll out a ‘most favored nation’ policy which, he hopes, will allow the U.S. to pay for prescription drugs at the same price as ‘the Nation that pays the lowest price anywhere in the World.’” And in what Trump called an attempt at “equalizing,” he directed the Department of Commerce and the U.S. trade representative to take “all appropriate action” against “unreasonable and discriminatory” policies in foreign countries that suppress U.S. drug prices abroad.

The May 12 order also directed Health and Human Services Secretary Robert F. Kennedy Jr. to set “clear targets” for prescription drug price reductions within 30 days. Trump expects that the order will induce drug companies to open negotiations with HHS to lower their prices.

If that is not the outcome, then Kennedy will then impose a “most favored nation” pricing model that will cap U.S. prices at the lowest rates paid by other similarly wealthy countries. The government will also consider expanding drug imports from other countries where drug prices are often cheaper.

Whether this time Trump will succeed in significantly lowering prescription drug prices by executive order remains to be seen. If the drug companies come to the table, he may settle for far less than he wants, which has been true of his tariff negotiations to date. Further, the industry is sure to repeat its legal challenge if it is unhappy with the negotiations, because Trump again has ignored legally required procedures.

Two days after Trump issued his executive order, Oregon Sen. Jeff Merkley announced that he, along with three colleagues, had introduced the End Price Gouging for Medications Act. Their bill also adopts the most favored nation approach. It would require drug companies to offer medications in the U.S. at the lowest price per drug offered in 12 other developed countries: Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland and Great Britain.

If Trump finds that he cannot lower drug prices by fiat, hopefully he’ll pressure congressional Republicans at last to support legislation to achieve the same end. Or maybe his ego won’t permit anyone but himself to get credit for a result he insists he wants.

Herbert Rothschild’s columns appear Fridays. Opinions expressed in them represent the author’s views. Email Rothschild at herbertrothschild6839@gmail.com.