Trump Blasts Drug Prices, Sidesteps Health Reform

In his State-of-the-Union address to Congress this week, President Donald Trump continued his harangue about unfair drug prices in the United States, one of his favorite themes. Trump also promised to combat the opioid crisis and to press for a national “right-to-try” law. But even though he bragged about the administration’s success in eliminating the mandate for individuals to obtain health insurance, he surprised many observers by failing to call for full repeal of the Obama administration’s Affordable Care Act (ACA).

Trump drew strong applause for his pledge to bring down prescription drug costs and ensure that US consumers don’t pay more than those in other countries. It’s “very, very unfair” for drugs to cost more in the US, he said, promising to fix this “injustice” and that “prices will come down substantially.” He linked the issue to his plan for ending the US “era of economic surrender,” characterized by bad trade deals and inadequate protection for American intellectual property.

These promises to Congress echoed comments the day before at the swearing-in ceremony for new Health and Human Services (HHS) Secretary Alex Azar. Trump advised Azar, who was previously a top executive at Eli Lilly, of the imperative of getting drug prices “way down” and to “unravel the tangled web of special interests” that drive up the cost of medicine. The President noted that other countries pay a “fraction” for the exact same drug, and that “nobody knows that process better than Alex.”

Yet in a public comment on Trump’s speech to Congress, Azar highlighted the President’s call for a more aggressive approach to combat the opioid crisis, as opposed to drug access and affordability. Azar promised to implement the administration’s strategy for improving treatment, prevention, and recovery services for opioid abusers and to support research on pain and addiction treatments. The new HHS secretary also sent out a message commending FDA’s high rate of drug approvals in 2017, as part of a review of HHS accomplishments.

While President Trump highlighted the repeal of the ACA’s individual mandate during his first year in office, health policy experts noted that he said nothing about repealing or replacing ObamaCare, a main goal for many Republican legislators. However, eliminating the mandate that encourages young, healthy individuals to purchase coverage is expected to erode the broader state-based exchange system in many markets, as will further defunding and undermining of ACA regulations and programs.  

Somewhat of a surprise was Trump’s call for Congress to enact legislation designed to provide terminally ill patients with access to promising experimental therapies. Although the many state right-to-try laws offer little additional support for individuals with serious conditions, the White House and Azar may put more pressure on FDA to support such efforts, in addition to granting expedited access and moving quickly to approve new therapies that can demonstrate effectiveness.