Ken Perez: How 3 presidential candidates are defining their prescription drug pricing policies

What do voters care most about? It’s arguably the most salient question in every election cycle. Each March, to answer that question, Gallup asks Americans to rate their concern about a variety of national issues. This year’s survey asked respondents about 14 different issues.^a Inflation came out on top, with 55% of those surveyed worrying “a great deal” about it. And among the top six issues, there were two closely related to inflation — the economy (52%), which was tied for third, followed closely by the availability and affordability of healthcare (51%).

The three leading presidential candidates

According to an analysis by RealClear Polling of averages from 11 polls conducted between April 12 and May 7, the presidential election was at that time a three-way race, with former President Donald Trump at 41.5%, President Joe Biden at 38.8%, and Independent Robert F. Kennedy, Jr. at 10.8%.^b

Given the public’s concern about inflation and the cost of healthcare, the respective policy track records and campaign statements of the three leading candidates have prioritized reduction of prescription drug prices. While Trump, Biden and Kennedy all promise to decrease prescription drug prices, how they intend to do so varies significantly.

Robert F. Kennedy, Jr.

Kennedy has simply promised to take on the pharmaceutical companies and to “[c]ut drug costs by half to bring them in line with other nations.”^c

The latter statement is reminiscent of Trump’s July 2020 executive order, “Lowering Drug Prices by Putting America First,” which directed the Center for Medicare and Medicaid Innovation at CMS to implement the Most Favored Nation (MFN) Model to test how Medicare could limit its payment for 50 single-source, physician-administered Medicare Part B drugs and biologics to no more than the lowest price charged in similar countries.

Former President Donald Trump

During his term as president, Trump issued more than 200 executive orders, eight pertaining to healthcare. Most of them were subsequently revoked by Biden, including the aforementioned executive order regarding the MFN Model, which was pulled by CMS in a final rule published on Dec. 29, 2021. CMS was prompted to pull the model by four lawsuits from the pharmaceutical industry, which resulted in a legal stay that prevented it from going into effect.

According to “Better Health Care Choices at Lower Costs,” a 151-word section on Trump’s campaign website, “further reduce the cost of prescription drugs” is included in a list of six policy proposals or objectives.^d But specifics as to how that objective would be achieved are not provided.

President Joe Biden

Unlike the policies set forth by both Kennedy and Trump, Biden’s policies to reduce prescription drug prices have been detailed. To date, Biden’s signature legislative achievement has been the Inflation Reduction Act of 2022 (IRA), whose mandates included:

• Medicare “negotiation” of prescription drug prices (100 drugs by 2031)
• A $2,000 per year cap on out-of-pocket prescription drug costs for Medicare beneficiaries starting in 2025
• A $35 per month insulin cap for Medicare beneficiaries
• Rebates to Medicare for drug price increases greater than inflation

Then, in his State of the Union 2024 address, Biden amplified a few of the IRA’s health policies:

• Medicare negotiation of prescription drug prices “for 500 drugs over the next decade”
• “Cap prescription drugs at $2,000 a year for everyone”
• “Cap the cost of insulin at $35 a month for every American who needs it”

In like manner, the budget for federal fiscal year 2025, which was released four days after the State of the Union, repeated those policy proposals and added some clarity, noting that it:

• “Significantly increase[es] the pace of negotiation; bringing more drugs into negotiation sooner after they launch”
• Extends the $2,000 per year cap to the commercial market
• Extends the $35 per month insulin cap to the commercial market
• Expands the inflation rebates to the commercial market

Of course, the executive branch’s budget reflects the administration’s policy stances — essentially a legislative “wish list” — and does not have the force of law.

A reality check

All three leading presidential candidates say that they want to decrease the cost of prescription drugs, but they differ as to how they would seek to accomplish that objective. In addition, regardless of who occupies the Oval Office, the pharmaceutical lobby is powerful, and the executive branch is checked and balanced by the legislative and judicial branches.

Perhaps the most formidable roadblock for implementation of significant policy reforms regarding prescription drug prices is the current divided and unproductive Congress, which passed only 34 bills in 2023 — only 13% of the annual average of 261 for the past 50 years.

Thus, politics remains, in the famous words of 19th century German statesman Otto von Bismarck, “the art of the possible,” with the aspirational statements of all three presidential candidates tempered by the political realities of Washington. 

Footnotes

a. Saad, L., “Inflation, immigration rank among top U.S. issue concerns: Worry about illegal immigration and terrorism has increased most over past year among 14 issues rated,” Gallup, March 29, 2024.
b. RealClear Polling, “2024 General Election: Trump vs Biden vs Kennedy vs West vs Stein,” accessed May 8, 2024.
c Kennedy/Shanahan campaign website, “People who work hard should be able to afford a good life,” accessed May 8, 2024.
d. Donald J. Trump for President 2024, “Better Health Care Choices at Lower Costs,” accessed May 8, 2024.