ISSUES DRIVING THE VOTE:
President Trump is racing to slash drug prices in the waning weeks of the campaign, finalizing a plan to let states import medicines from Canada and directly appealing to senior voters with $200 discount cards to help them defray their out-of-pocket costs.
The moves reflect a polling deficit with Democratic rival Joseph R. Biden and slipping support among seniors after efforts to pass more durable measures through legislation died out and the coronavirus upended Washington.
In some ways, Mr. Trump remains a man stuck between bold promises and the orthodoxy of his party.
The president says he’s taking the fight to drug companies, but Democrats say it’s a slew of half-measures compared to the tough negotiation he promised in 2016. He backed a bipartisan drug-pricing bill in the Senate, but aspects of the legislation split the Republican caucus and it never received a vote.
“The pharmaceutical lobby remains very strong and has a long-term relationship with the Republican Party over not getting the government involved in regulating drug prices. It is really Trump’s populism versus long-term conservative dogma on price regulation,” said Robert Laszewski, a health policy consultant in Virginia. “Democrats could theoretically give him the votes he needs, but they would also be giving Trump a big health care win. So yes, he really is caught in a kind of political no man’s land.”
Mr. Trump went his own way, announcing a packet of executive orders in July that besides drug importation would target insulin prices, pass certain rebates to consumers instead of “middlemen” and align the cost of certain Medicare drugs with what other nations pay.
But he’s still playing catchup — and even appears to be faltering, according to a poll released Friday that found half of registered voters trust Mr. Biden, the Democratic nominee, to reduce drug prices, compared to 43% for Mr. Trump.
Voters in the Kaiser Family Foundation tracking poll had given Mr. Trump a slight edge on the issue in September. Last month’s bounce may have been due to Mr. Trump’s decision to announce the executive orders and promote them during the GOP’s convention week in August.
However, his numbers on the issue have historically been “underwater” and seniors — the voters most likely to take prescription drugs — tend to give Mr. Biden an edge on the topic, according to Ashley Kirzinger, associate director for public opinion and survey research at the Kaiser Family Foundation.
“President Trump sees his record on this as a winning issue, but I’m not sure voters agree,” she said.
The cost of prescription drugs dropped by 0.6% in 2018 but then rose by 3% in 2019, according to the Bureau of Labor Statistics’ breakdown of the Consumer Price Index.
In July — a typical month for prescription-price hikes — 67 drugs increased in cost by an average of 3.1% — a bigger increase than the previous July, according to an analysis by GoodRx.com. The price of more than 850 brand-name and generic drugs jumped by an average of 6.8% during the first half of the year.
“The prices charged by drug companies continue to increase, the amount paid by consumers continues to increase. There’s nothing in sight at the moment to arrest those increases,” said David Mitchell, a cancer patient and founder of Patients for Affordable Drugs Now, a political action committee.
On the stump, Mr. Trump is leaning hard into his plan to establish a “favored nations” clause, so that Americans pay no more than what Germany, Japan and other developed nations shell out for the same doctor-administered drugs in Medicare Part B and prescription drugs in Part D.
“We will pay the lowest drug prices in the world, OK?” Mr. Trump told Iowa supporters this week.
The proposal elicits cheers from rally-goers but ardent pushback from free-market groups who typically side with Mr. Trump but think the proposal amounts to “socialist” price controls.
Some liberals, including Sen. Bernard Sanders of Vermont, have proposed similar foreign-indexing plans. But the main prize for Democrats, including Mr. Biden, is giving Medicare the power to directly negotiate lower drug prices from companies.
“Drug manufacturers not facing any competition, therefore, can charge whatever price they choose to set,” the Biden campaign website says. “There’s no justification for this except the power of prescription drug lobbying.”
Mr. Biden also wants to eliminate a part of the tax code that lets Big Pharma deduct the cost of their ads and create an advisory board that would recommend reasonable debut prices for groundbreaking “specialty” drugs.
He wants to let U.S. consumers import drugs from other countries, so long as the health secretary deems it safe, and limit price increases to no more than inflation as a condition for participating in Medicare or his proposed “public option” under Obamacare.
Those ideas overlap with Mr. Trump, whose Food and Drug Administration finalized a pathway for states to import medicines from Canada.
The Trump-endorsed drug-pricing overhaul from Sens. Chuck Grassley, Iowa Republican, and Ron Wyden, Oregon Democrat, included an inflation cap. It advanced out of committee last year but appears dead in this Congress.
It never received a vote in the full chamber — Mr. Grassley says GOP support was growing, yet Democrats walked away from the table after he reintroduced a version in July — and House Democrats laid down a more aggressive marker with “H.R. 3,” a bill requiring the federal government to negotiate down maximum prices for insulin and dozens of single-source, brand-name drugs.
House Democrats say Mr. Trump “pulled his punch” on negotiating directly with Big Pharma and he should have backed their legislation instead of issuing orders that require a lengthy rulemaking process.
The White House says the president has a “great record to be proud of.”
“While Democrats refused to be honest partners and bring about bipartisan change to the law that would have delivered cost savings for seniors, it has not stopped the president from pursuing aggressive executive action to lower prices further, including most favored nation prices, discount cards, and drug importation,” deputy press secretary Judd Deere said.
Mr. Mitchell, the patient advocate, said there’s been tangible movement on the Canada-importation plan but he’s disappointed with the lack of progress on other ideas that could bring prices down.
“My biggest problem is with follow-through. I think this administration has not followed through on [Mr. Trump’s] proposals,” he said. “They rolled out the first version of the international reference pricing in 2018 on the eve of the election, then it languished for two years. Then he dusted it off a few weeks ago.”
With Election Day looming, Mr. Trump surprised many when he announced a plan to dispense $200 discount cards to millions on Medicare. Critics saw it as a last-minute gambit to get seniors’ votes.
The administration hasn’t released many details, but the first round of cards is expected to go out soon.
“Nobody has seen this before. These cards are incredible. The cards will be mailed out in coming weeks,” Mr. Trump said on Sept 24.
Administration officials have said they will fund the $6.6 billion initiative through money Medicare has set aside for “402 demonstration” projects.
“We know that many seniors struggle to afford their medication and because of these high costs may forgo treatment,” said Johnathan Monroe, spokesman for the Centers for Medicare and Medicaid Services. “The administration is committed to lowering out-of-pocket costs for our nation’s seniors. We will announce more information about the Medicare prescription drug cards soon.”