I cannot in good conscience talk about the health policy agenda proposed by President Trump in the State of the Union without first countering his persistent promotion of divisive fear tactics related to immigrants depleting the social safety net. This argument has shown to be false time and time again, whether measured through tax contributions of working immigrants that support the solvency of Medicare, contributions to the economy, or the many policies that already restrict undocumented immigrants from accessing safety net programs.

Now, on to his vision for addressing prescription drug costs…

A Lofty Health Care Agenda

In last night’s State of the Union, President Trump proclaimed a vision for America with better health care: lower prescription drug prices, protecting patients with pre-existing conditions, the elimination of HIV, and tackling childhood cancer. These are all noble, bipartisan policy goals. It is worth noting that the Trump Administration has consistently supported policy decisions that directly undermine the Affordable Care Act’s protections for people with pre-existing conditions. However, if we are to assume for a moment that these stated policy goals are in fact genuine, viewers of the SOTU were still left with almost no details for how this ambitious health policy agenda would be approached.

A Plan for Prescription Drugs

Let’s take a closer look at prescription drugs. When we examine campaign proclamations, Administration white papers, and recent speeches by Health and Human Services Secretary, Alex Azar, a few more details start to emerge. Lowering prescription drug costs has been a rallying cry for President Trump since the campaign, where he proposed allowing Americans to import drugs from abroad and enabling Medicare to negotiate prices with pharmaceutical companies. The latter is notoriously prohibited by the “noninterference” clause of the Medicare Modernization Act of 2003, which brought outpatient prescription drug coverage (i.e., Part D) to Medicare beneficiaries. While there is broad public support for this policy approach on both sides of the aisle, the actual cost impact of simply striking the clause is likely marginal. Again, the devil is in the details.

Last May the Administration published a white paper on their proposed approach, “American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.” Here, we started to see a greater focus on strategies to increase competition. However, many experts noted that the proposal lacked substance, raising considerable doubt about the extent to which the Trump Administration will take real action on prescription drug costs.

Leading up to the midterms last fall, Trump proposed a variation on the negotiation theme, which would enable Medicare to pay lower prices for drugs dispensed directly by physicians through Medicare Part B. The goal would be to make prescription drug prices align more closely with what other countries pay, to counteract “global freeloading,” a phrase we heard again last night. In a speech before policy wonks and health services researchers at the AcademyHealth National Health Policy Conference just this week, Secretary Azar proposed creating “upfront discounts” for Seniors, reforming the rebate system, and requiring drug companies to disclose list prices in advertising. The true impact of this kind of price transparency remains to be seen, yet we heard President Trump proclaim its value once again last night.

Bipartisanship: A Reality or a Lost Cause

Clearly, there are a number of underdeveloped proposals currently being floated by this Administration to address prescription drug costs. Meaningful change will require a multi-pronged approach, with real bipartisan support. Only time will tell if there is space in the current political climate for President Trump to take Speaker Pelosi up on her offer to develop a bipartisan approach to tackle the persistent challenge of high and rising prescription drug costs in America.

Author’s Note: To read a summary of this reflection as well as commentary by a range of Tufts faculty on the State of the Union, check out, “What Trump Said and Didn’t Say” at TuftsNow.