Media

Key Takeaways

• Both Donald Trump and Joe Biden’s pharmaceutical policies focused on addressing two important issues: supply chain security and drug pricing. While their views on the former were largely aligned, their approaches to the latter exhibited notable differences in attitude and implementation.
• Trump leveraged executive authority to adopt a more combative stance toward big pharmaceutical companies than previous Republican presidents. In July 2020, he issued several Executive Orders (EOs) on drug pricing that strengthened anti-kickback measures, waived prohibitions on cheaper imports, and incentivized drug makers to lower insulin and epinephrin costs. Trump also pushed for an unprecedented “Most Favored Nation” (MFN) plan to tie U.S. drug prices to their retail prices in wealthy OECD countries.
• Biden leveraged a mix of EOs, congressional actions (e.g., the Inflation Reduction Act), and other policy tools to deepen leverage for drug price negotiations, strengthen inter-agency coordination, and introduce more caps on out-of-pocket spending. He also tasked the department of Health and Human Services (HHS) with developing experimental payment plans for cancer treatment, gene therapy, and other complex remedies.
• A re-elected Trump may try to revive his MFN pricing plan and impose tougher anti-kickback restrictions on pharmaceutical benefit managers (PBMs). A second Biden administration would likely maintain its current course, increasing the range of drugs subject to pricing negotiations and expanding HHS research on experimental pricing plans. Both candidates support domestic production of active pharmaceutical ingredients (APIs) and personal protective equipment (PPE), although Biden may be relatively more amenable to “friendshoring” while Trump may insist on pursuing “onshoring.”