Franklin D. Roosevelt had once said “In politics, nothing happens by accident. If it happens, you can bet it was planned that way”. Amidst a global pandemic, lingering economic issues, and fatally injured healthcare systems, a lot of things have changed. Countries have closed down their borders; Russia miraculously came up with a drug, while India continues the battle to flatten the curve. With all the confusion, chaos, and uncertainty, US politics in the hands of President Donald Trump keeps making the headlines, this time around with drastic changes in the prices of drugs.

President Trump recently announced that he was signing four executive orders with the aim to lower the prices of prescription drugs paid by fellow Americans. One order aims to allow for legal imports of cheaper prescription drugs, while another requires discounts from drug companies which usually remain captured by middlemen before they are passed on to the patients. “Under this transformative order, Medicare will be required to purchase drugs at the same price as other countries pay”, Trump said at the signing. However, he noted that he would delay the executive order by a month “hoping that the pharmaceutical companies will come up with something that will substantially reduce drug prices”.

For many, Trump’s sudden concerns over drug prices seem nothing more than an election stunt and a means to cover up the mishaps, the limitations, and the failures that have come around the corner with his leadership, be it, bad governance, intolerance for diversity of colour and religion, inability to regulate police violence, and the mishandling of the coronavirus pandemic.

Pharmaceutical Research and Manufacturers of America very recently stated that the move was nonetheless “a reckless distraction that impedes the ability to respond to the current pandemic – and those we can face in the future”. Although the rising public debate seems to question this move in the very first place, what one needs to be aware of is that even though President Trump repeatedly calls for lowering the cost of prescribed drugs, the Congress has not yet passed a major drug public reform. Many people are of the opinion that such dramatic changes are ‘bizarre’ and ‘disturbing’ because such proposals have been in the public realm of debates and negotiations for years because they come with extremely serious implementation challenges.

For writers like Jon Healey in his article in the StarTribune, the act is not to say that the ideas are bad. “The goals are solid, even if the means to reach them are debatable. The issue is the legal basis Trump is citing for them. I’ll just note here that the distance between these proposals and the usual free-market-centric Republican approach is vast. So vast, in fact, that the Wall Street Journal’s editorial board, which spends much of its time apologising for Trump’s policies, blasted the executive orders Monday in a piece titled “Trump’s Drug Price Panic.” Although I don’t share the Journal board’s abundant faith in free-market forces to cure the manifest ills in the healthcare industry, I do share its scepticism about the effectiveness of price controls.”

CEOs of Pfizer, Sanofi, GlaxoSmithKline, and Eli Lilly responded with concerns. Pfizer’s Albert Bourla said that the orders “pose enormous distraction” to the biopharma industry as it fights COVID-19. Pfizer would reconsider US expansions or possibly cut jobs if the measures are implemented. Sanofi CEO Paul Hudson said he’s “not expecting any impact from these conversations this year” and that the International Pricing Index (IPI) is a “very convenient subject matter” right before the election. The IPI is a “blunt instrument” that doesn’t use a “truthful comparison” of differences between various healthcare systems, including innovation and access. 

Companies like Eli Lilly And Co which remain highly engaged in the drug manufacturing business claim that such an order has consequences- too negative, and too underestimated for President Trump to fathom. This time most drug manufacturers and investors have been taken by surprise, while Trump and his supporters reiterate the move as an electoral promise that he has managed to keep and a means to hold his electorate together. Nevertheless, Trump’s international pricing order attracted the most pushback from the drug industry, with CEOs saying that the proposal ignores differences between healthcare systems.

However, what remains interesting is that President Trump, with this attempt, aims to keep such companies on his side. Soon after he made an official statement regarding a meeting involving him and several other companies which remained a headline for days. However, surprisingly, as he was departing for Wisconsin, Trump said he was meeting with drug companies during the first week of September to discuss drug prices. A spokeswoman for the industry’s trade group PhRMA said the group was “not aware of any meeting“. Such instances have raised several questions about the policy mentioned and according to Bernstein analyst Ronny Gal, the proposal does offer Trump the “opportunity to declare victory ahead of the elections”.

According to Politico, PhRMA claims its plan would save consumers $100 billion over the next 10 years. The industry group also reportedly pledged to work with the White House on additional reforms to Medicare. Still, even if these details hold true, much of the plan’s specifics remain unknown, including which drugs would be covered.

Madelaine A Feldman, MD, President of the Coalition of State Rheumatology Organisations and Clinical Assistant Professor of medicine at Tulane University School of Medicine in New Orleans, told Healio Rheumatology, “If it were to go through rule-making, not only does that take time but there are lawsuits that could happen which could extend the process into next year before we even find out if it could become a finalised, legal rule. Whereas if it were something coming directly from the manufacturers, that could be instituted before the election, which is what the administration is looking for.”