TrumpRx Signals Limited Impact, but a Symbolic Shift in Drug Pricing Policy: Robert Andrews

Although TrumpRx may provide some relief from high drug prices, its practical impact is limited, especially for expensive biologics and specialty drugs, as it does not include health plan coverage, explains Robert Andrews, former US representative for New Jersey and CEO of the Health Transformation Alliance.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

The Trump administration recently announced TrumpRx, a new direct-to-consumer platform where Americans can purchase discounted medications, including select Pfizer drugs. From your perspective, what does this signal about the direction of US drug pricing policy?

It signals that the policy is headed in the right direction, because anything that would provide relief to people from very high [prescription drug] prices is welcome. It also signals, though, that this is an effort that's heavy on symbolism but relatively light on real impact.

The real impact is this. As I understand the present proposal, people can buy drugs directly through the manufacturers, through this site, but they can't have their health plan pay for it. If you're willing to pay out of pocket, it will work for you. But if you're like most Americans, most of the time, and you want your health plan coverage to cover its share of the cost—usually about 80%—it doesn't work. I'm not quite sure I understand the reason why that is, but I do think that's why it is.

The impact here, I think you will see an effect in generic drugs, where maybe you could buy what’s presently a $20 drug for $8 or $9. I think there will be people who may take advantage of that. But for the $2000 biologic for an autoimmune disease or for the $6000-a-year charge for a GLP-1 [glucagon-like peptide 1 receptor agonist], people are not going to do this. They're not going to pay for it out of pocket.

The second thing that I think is limited here is some of the pricing proposals we’ve heard about, where Pfizer, for example, announced it was going to do more to equate US prices to prices it charges overseas, like in Europe. That only applies to new drugs that are not yet in the pipeline—in other words, new drugs not yet on the market. Again, that’s a welcome gesture, but it’s not much more than a gesture, because the drugs that American consumers, employers, and health plans are paying for now wouldn’t really be affected by either of these moves.

Now, the symbolism is important in a couple of ways. The administration is saying to manufacturers, “We’re no longer just going to say, ‘Well, drugs are expensive,’ and keep paying for them. We’re going to take a critical look at what drugs cost.” Second, they’re saying to the pharmacy benefit managers—the entities in the middle—implicitly, the administration is saying, “We’re not sure you belong in the middle lane. We’re looking for ways that people can buy directly.”

The symbolism here is very significant. The practical impact, I think, is much more limited.