'Rig the system': Alarm sounded as Trump backtracks on major promise

U.S. President Donald Trump on Tuesday signed an executive order that aims to delay Medicare negotiations for a broad category of prescription drugs, handing the deep-pocketed pharmaceutical industry a major win as it lobbies aggressively against efforts to rein in its pricing power.

Trump's order, titled "Lowering Drug Prices by Once Again Putting Americans First," instructs Health and Human Services Secretary Robert F. Kennedy Jr. to work with Congress to "modify" the Medicare drug price negotiation program that was established under the Biden administration and has already yielded significant results despite pharma companies' best efforts to block it in court.

Specifically, Trump calls for a four-year extension of the period during which small-molecule prescription drugs are exempt from price negotiations with Medicare. Under the Inflation Reduction Act, small-molecule drugs—which are typically taken in pill form and represent 90% of medications currently in circulation—are not subject to the price negotiation process until at least nine years after their Food and Drug Administration approval date.

Steve Knievel, a drug policy advocate at Public Citizen, warned in a statement that by pushing back the negotiation date for many drugs, Trump's order could do the opposite of its stated goal, potentially reversing recent progress on an issue that has long plagued the United States.

"Further delaying Medicare drug price negotiation would lead to higher prices for patients and taxpayers, not lower ones," said Knievel. "Empowering Medicare to negotiate drug prices is the only significant legislative measure taken to address Big Pharma price gouging in the last 40 years. Now Trump proposes to undermine that singular achievement."

"Extending negotiation delay periods," Knievel added, "is nothing but a total capitulation to the demands of drug corporation lobbyists that want to continue to overcharge Medicare beneficiaries and taxpayers."

The advocacy group Protect Our Care said following the order that "Trump just caved to Big Pharma—again."

"His new executive order pushes to delay Medicare drug price negotiations, giving drug companies four extra years to price gouge seniors," said Protect Our Care. "The only winners here are the drug companies."

The president's new order echoes language that pharma lobbyists have used in their messaging against the Medicare price negotiation program, which the industry has opposed from the start.

The first section of the order states that the four-year difference between when small-molecule drugs and biologics are subject to Medicare price negotiations under current law is known as the "pill penalty"—a label that the pharmaceutical industry's largest lobbying organization has invoked repeatedly in its attacks on the Biden-era program.

The "pill penalty" language was also used in ads run by a group called Seniors 4 Better Care, which—as Sludge's Donald Shaw and David Moore revealed—"is not really a seniors group, but rather a front for a lobbyist-led shell group called the American Prosperity Alliance."

"Seniors 4 Better Care has ramped up its spending on ads that appear to be targeting Trump and his inner circle," Shaw and Moore reported in February.

Earlier this year, Republican lawmakers in the House and Senate—including leading recipients of pharmaceutical industry campaign cash—introduced legislation that would delay the price negotiation process for small-molecule drugs, signaling GOP support for the objectives laid out in Trump's executive order.

"Make no mistake," Patients for Affordable Drugs executive director Merith Basey said of the legislation, "this is yet another attempt by Big Pharma to rig the system in its favor—at the expense of patients."

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