OPINION:
Germany just picked a fight with American patients.
At the very moment President Donald J. Trump is demanding that wealthy nations pay their fair share for American medicines, Berlin moved the other way. Its new cost-containment law squeezes more savings from the American companies that discover these medicines and leaves U.S. patients bearing even more of the global bill.
The German parliament passed the law last month. It more than doubles the mandatory rebate that manufacturers pay on brand-name medicines, from 7% to 15.5%. It locks German list prices in place through 2030. And for the first time, it lets German insurers force patented, brand-name medicines into tender-style price competitions — a tactic Germany had reserved for generic drugs until now. Berlin called it a fix for its strained insurance system. In plain terms, it is a wealthy nation balancing its books on the backs of American patients.
Germany was on notice. U.S. Trade Representative Jamieson Greer opened a Section 301 investigation in June into exactly these kinds of pricing practices, examining whether Germany’s approach to drug reimbursement discriminates against American commerce. Germany had an off-ramp, and U.S. Trade Representative Greer made that explicit.
“This is a serious step backwards at a time when our trading partners need to step up and start paying their fair share to fund innovative pharmaceutical research and development,” Greer said. “We believe that the United States and Germany can find a path forward that expands access to the most innovative drugs for the German people while ensuring fair reimbursement for the pharmaceuticals made by American workers.”
Instead, Berlin doubled down — and punted any real relief to a vague future dialogue with no deadline and no real money behind it.
And Americans are left holding the bill. Foreign governments set artificially low prices for the same medicines Americans pay full freight for, then act surprised when American families carry far more than their share of the cost of every new cancer therapy and every new Alzheimer’s treatment. Every Euro a foreign government refuses to pay does not disappear. It lands on the American patient standing at a U.S. pharmacy counter, with data showing Americans pay more than three times the price that similarly developed nations pay.
Voters see it, and they are behind the President. A recent national survey from McLaughlin & Associates found nearly three in four voters want the President to keep pushing foreign governments to pay their fair share — with majority support among Democrats and Independents too.
The President has gotten results by negotiating for them. His Most-Favored-Nation agreements are bringing the prices Americans pay in line with those in other developed nations, and TrumpRx is delivering direct savings for patients paying cash — discounts of up to 85% off list prices — with more to come as the deals expand. In the meantime, some trading partners have chosen to come to the table. Germany chose the opposite.
And lowering the prices here at home won’t end the freeloading on its own—not while every other country keeps underpaying for the same medicines. The only way to stop it is to make the freeloaders finally pay their fair share.
Congress also has a tool right now to bring foreign governments to the table. The USTRx Act, introduced by Rep. Jodey Arrington, would protect the savings the President has already won — by keeping trading partners from undercutting his deals and shoving the bill back onto Americans. USTRx would create a Chief Pharmaceutical Trade Negotiator at the U.S. Trade Representative’s office — a dedicated official whose job is to track foreign pricing schemes, report on them every year, and recommend trade remedies when a country like Germany decides free-riding is easier than paying its share.
A broad coalition of more than forty conservative, taxpayer, and free-market organizations recently urged Congress to pass it. It is a targeted bill, and it deserves a vote.
Germany’s parliament just handed American policymakers a case study in why. The administration has shown that firm, market-based negotiation can deliver savings for American patients without gutting the research that produces new cures. Congress should give it the tools to hold out for more countries willing to pay their share — and fewer laws like Germany’s.
Getting this right means one simple thing: Every country that benefits from American medicine should help pay for it.
• Chad Mizelle, Former Justice Department Chief of Staff under Attorney General Pam Bondi
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