| It sure sounded big, with President Donald Trump posting Sunday that he would sign an executive order slashing prescription drug prices “by 30% to 80%.” But the actual event had drugmakers breathing a sigh of relief. Americans have long paid more for their medicines than patients in other parts of the world, sometimes shockingly more. Case in point is Novo Nordisk’s blockbuster medicine Ozempic. The list price for the slimming diabetes drug is nearly $1,000 in the US, more than 10 times the cost in some other countries. In Japan, it costs $76, and in the UK, a four-dose supply is less than $100. This is something many politicians, including Trump, have targeted for years. Pharmaceutical companies argue that they need robust profits to bankroll the development of medical advances. So in the US they generally set drug prices at whatever the market will bear. But other nations negotiate to get more drugs at lower prices. “Starting today, the United States will no longer subsidize the health care of foreign countries,” Trump said while signing an executive order aimed at bringing those discounted prices and the US ones closer together. Trump’s executive order requires that drugmakers be given price targets for their medicines within 30 days. If the industry doesn’t come to the table and make “significant progress” — though there were no specifics on details or timing — the federal government will impose low prices unilaterally. It may also take steps to import low-cost medicines from abroad. Trump directed that US officials investigate foreign nation “freeloading.” JPMorgan analyst Chris Schott said it would be nearly impossible to force US companies to charge higher prices abroad. And countries that provide universal health insurance — and have the most leverage when negotiating prices — aren’t likely to drop them unilaterally. Before signing the order, Trump singled out pharmacy benefit managers, the middlemen who negotiate with employers and insurers to determine what drugs are available on preferred coverage lists. It may be possible to remove those PBMs entirely from the equation, Trump said, if drugmakers sell their products directly to the American public at the same lower prices they offer abroad, known as most favored nation pricing. “We're going to cut out the middlemen,” he said. “They’re worse than the drug companies.” It remains to be seen whether the White House will actually deliver on this drug-price effort. In 2020 during his first term, Trump signed a similar though narrower executive order to bring some US drug prices down to most favored nations pricing. But it died in the courts. Regardless of what happens, the pharmaceutical industry appears to have dodged a major bullet with a Trump action that was weaker than many had feared. US drugmaker stocks rose on Monday. Yet still looming on Washington’s to-do list are potential cuts to the Medicaid insurance program for the poor and tariffs targeting the drug sector. We’ll see if Big Pharma is able to escape again – or at least delay – those actions as effectively. — Michelle Fay Cortez | 
