WASHINGTON — With 50 days to go before the 2020 election, President Trump is taking his wildest swing yet at the pharmaceutical industry. He’s likely to miss, but that might not matter.
There’s virtually no chance that the policies his administration rolled out on Sunday will save Americans any money on prescription medicines before Election Day. The scheme, to cap how much Medicare pays for drugs based on lower prices in foreign countries, can’t realistically be implemented by Nov. 3. Even if Trump tries a risky regulatory workaround, any changes would almost surely be delayed by a pharmaceutical industry legal challenge.
But the policies might still achieve their intended goal: Ingratiating Trump to voters who see pharmaceutical costs as a key issue. Even if the president’s policies haven’t actually saved Americans money at the pharmacy counter, campaign experts said, his years of aggressive rhetoric and the last-ditch drug pricing ploy could still help him win support.
“It’s a very savvy political move,” said Jon McHenry, the vice president of North Star Opinion Strategies, a Republican-aligned polling firm. “What you see is voters saying: ‘OK, he’s actually trying to do something on drug prices.’ That’s something that the Obama administration didn’t do, that’s something that Congress hasn’t taken on. So he probably does get some credit for following up on something that he said he would do during the  election — without anyone getting to judge, ultimately, whether it’s good policy.”
Trump’s latest drug pricing action follows years of dead-end attempts to regulate lower prices. The pharmaceutical industry successfully blocked a rule that would have forced them to put their prices in television ads. No state has successfully facilitated the importation of cheaper drugs from Canada, despite Trump’s rhetoric. Drug companies have continued to hike list prices for brand-name drugs for much of Trump’s four years in office.
Nonetheless, Trump has repeatedly crowed about one metric that showed a one-time price dip in 2018, and lashed out at the pharmaceutical industry via Twitter. Last month, the Trump campaign launched an aggressive digital ad campaign that casts Joe Biden, the Democratic presidential nominee, as the drug industry’s preferred candidate.
The ad blitz and Trump’s aggressive rhetoric, by some measures, have been effective. While voters generally trust Democrats, and Biden, over Republicans on health policy, one recent Kaiser Family Foundation poll showed Trump held a 46-42 edge over Biden on a single health care issue: drug pricing.
The latest policy rollout is also wildly popular among Trump’s base. A recent poll from McLaughlin & Associates, which did polling work for the Trump campaign during the 2016 election, found that 87% of voters, including 84% of Democrats, support the “most favored nations” policy.
Even some Democrats admit that Trump’s last-minute executive actions, taken together with his years of anti-pharma rhetoric and voters’ wariness of Biden’s drug pricing platform, could put Biden on the defensive in November.
“Am I frustrated that he is even with Biden, or slightly ahead, on the issue of prescription drugs?” asked Brad Woodhouse, the executive director of the Democratic Party-aligned group Protect Our Care. “Yeah. Because I know … that he has actually done nothing.”
Woodhouse added that Democrats will “respond aggressively,” but that Trump’s actions don’t constitute a “silver bullet.” He insisted, too, that the Trump campaign “should be extremely disappointed that he is roughly tied with Vice President Biden,” given the effort Trump has taken to campaign on the issue.
It remains to be seen how much drug pricing will impact the November election. Though drug pricing has been a consistent throughline in Washington policy debates throughout Trump’s term, the Kaiser Family Foundation found that health care now ranks below the coronavirus pandemic and policing as top election issues for likely voters.
“President Trump has talked quite a bit about lowering drug prices for his entire time as president, and clearly that topic of discussion has had some resonance,” said Mollyann Brodie, executive director of public opinion and survey research at the Kaiser Family Foundation. “It’s the place where he has a fair opportunity to go on the offense … because he has been so consistent about talking about it throughout his presidency. And right now, on so many other health care issues he is playing defense.”
Trump has virtually no chance of enacting his “most favored nations” policy before the November election. The challenges are innumerable: His administration is trying to redesign a vast part of the U.S. drug pricing system in less than two months.
Lesser regulations have taken much longer to implement and still flopped. The Obama administration spent nine months pushing a narrower change to Medicare Part B, only to abandon the policy amid resounding pressure from drug makers and doctors. The Trump administration abandoned a narrow policy that would let Medicare Part D not cover a small subset of drugs sold in pharmacies after struggling for six months to win over skeptical patient groups.
Already, experts are cautioning that Trump’s idea would be strikingly difficult to implement, time constraints notwithstanding. MedPAC, a group that advises Congress on Medicare policy, cautioned the Trump administration in 2018 that its earlier attempt at implementing an international pricing program might not have been feasible. They noted, in particular, that Trump’s idea could leave doctors and the vendors they would work with to buy drugs in an untenable financial position.
It’s still unclear how the Trump administration plans to tackle these issues: It has not released any formal regulations implementing the international pricing idea for either drugs covered by Medicare Part B or D. Those regulations typically flesh out, often in excruciating detail, how a new drug pricing policy will work.
Even if the Trump administration has already thought through these challenges and releases thorough regulations, it won’t have enough time to implement the policy using regular procedures, which typically requires at least 30 days of public comment between when a regulation is proposed and finalized. Agencies are also typically required to wait 30-60 days between finalizing a rule and actually implementing it. That means even a timeline that doesn’t leave room for health officials to read or write the regulations would still take 60 days.
Drug industry lobbyists expect Trump to try and get around this issue by using a rare regulatory maneuver that would allow him to implement the policy immediately, without issuing a draft proposal or taking comments. If Trump pursues that route, the drug industry has all but pledged to sue to prevent the regulations from taking force.
Such a lawsuit would likely result in a judge temporarily delaying the policy while the court decides its legality. That, too, would almost surely prevent Trump from implementing this policy before the November election.
Sunday’s executive order is the latest sign that Trump is planning to campaign hard on drug pricing going into the November election. But the question still remains if that’s a winning strategy.
Amid the coronavirus pandemic, widespread unrest over police brutality, and an economy roiled by widespread shutdowns, health care has dropped precipitously on most voters’ priority lists.
The recent Kaiser Family Foundation poll, which found Trump leading Biden on drug pricing, also found that health care writ large was the fifth-most important issue for voters this election cycle. Only 10% of surveyed voters rated it as their most important issue.
Brodie, the Kaiser Family Foundation pollster, noted this was the first time in “such a long time” that she had seen health care play such a marginal role in voters’ decisions. That has led pollsters, including Brodie, to question whether even a sweeping policy, like Trump’s most recent proposal, could truly make a dent in the election.
“This is an election really about President Trump and whether you’re [casting] a vote for him or a vote against him and very much about the state of our economy in the context of a pandemic,” Brodie said.
Kristy Pultorak, a pollster at the firm FTI Consulting, which has health care and drug industry clients, put it more bluntly.
“In previous years this would have been something that would have really drawn people’s attention,” Pultorak said. “It could have been a game-changer.”