Health

Max Nisen is a Bloomberg Gadfly columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.

President Donald Trump has gone from promising to bring down drug prices to looking like he's been captured by Big Pharma in just a few short months.

The president started out the year ripping into drugmakers and threatening to make firms bid for government business. Now? Rather than pushing for pricing legislation, his administration is reportedly settling for an executive order -- which, according to a Kaiser Health News report, may end up looking more like a pharma wish list than a menu of onerous demands.

The regulations the industry fears most include those that would give the government more negotiating power and limit drug monopolies. Those increasingly seem to be off the table. Even a strong executive order has limitations, and Trump's apparently will not be strong.

Drug stocks have been on the rise this year. Evidence of softer treatment from the White House may give them more momentum. 

Overcast
Drug price criticism by President Trumnp has cast a shadow over biopharma, but it may be lifting
Source: Bloomberg

It's by no means a golden age for pharmaceutical pricing. There's still pressure from insurers and pharmacy benefit managers, and drugmakers want to avoid the sort of public criticism that has hurt firms such as Mylan NV.

Companies including Allergan PLC and  AbbVie Inc. have pledged to limit their annual price hikes to less than 10 percent. Others have started releasing data on their price increases. And Eli Lilly & Co. has offered a big discount on its lead insulin for patients exposed to the full price of the medicine. All of this appears to have had some cooling effect on prices; the median year-over-year drug-price change for branded drugs in the first quarter was the lowest in two years, according to a Bloomberg Intelligence analysis.  

Slowdown
Branded drug price increases appear to be moderating slightly
Source: Bloomberg Intelligence

This is a notable trend for an industry that often relies on price hikes to make up for a dearth of new medicines or to boost earnings.

Still, the fundamentals of the situation -- that pharma firms enjoy essentially unfettered pricing power in the U.S. and typically don't hesitate to use it -- haven't changed. 

"Just" a 10 percent price hike annually still adds up over time for expensive medicines. And not all drugmakers are on the bandwagon: Pfizer Inc. has substantially boosted the cost of a number of drugs this year. Though there have been some exceptions, companies are largely pricing their newly launched medicines as expensively as ever. 

Despite Trump's previous rhetoric, his administration doesn't appear inclined to shake up these fundamentals.

His executive order reportedly may encourage agencies to boost value-based drug-pricing schemes, where drugmakers pay rebates if products don't perform up to a certain standard. But on the spectrum of drug-pricing remedies, this is among the pharma-friendliest; it may reduce overall spending somewhat and makes for good PR, but drugmakers still get to keep the same high base prices.

Other items reportedly under discussion -- such as loosening the FDA's approval standards and extending pharma's overseas drug monopoly protections -- are generally pro-pharma and anti-lower prices. 

The GOP health-care bill currently engaged in a biweekly cycle of death and resurrection does not directly touch drug pricing, suggesting Congress won't take up the issue in a serious way, especially when Trump appears to be signalling disinterest. 

Trump's executive order may end up being less friendly than reported; the Kaiser story was about policies being discussed by a working group, led by an ex-pharma lobbyist, helping to prepare the order. The administration may not want to court political backlash with such a transparently industry-friendly measure. 

And Trump will always be a populist-minded loose cannon who may return to the drug-pricing well in the future if he's in need of some easy political points.

But the potential for truly dramatic changes to the pricing paradigm seems to be lessening by the day.

This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

To contact the author of this story:
Max Nisen in New York at mnisen@bloomberg.net

To contact the editor responsible for this story:
Mark Gongloff at mgongloff1@bloomberg.net