President Trump’s love/hate relationship with pharma will undoubtedly affect the care of my patients as he described in his speech to a joint session of Congress. On the hate side, during his speech President Trump called out the government’s need to “…work to bring down the artificially high price of drugs and bring them down immediately.” The words that ring out are “artificially high price,” referring to a marketplace failure to assure “fair” pricing and “immediately”—meaning now! In the past, Trump described several efforts to lower drug costs. These efforts included everything from allowing re-importation, increasing competition, and raising mandated rebates and negotiating prices, to name a few. Most of these efforts would require time to lower drug prices, and immediate impact would most likely be achieved through the Presidential bully pulpit, by simply calling out or tweeting displeasure with a specific pharma company’s drug pricing, potentially backed with the threat of eminent domain or loss of patent exclusivity.
The Love Side
On the love side, the President called attention to two of his invited guests, Megan and John Crowley. John Crowley leads Amicus Therapeutic, which he founded to produce a treatment for his daughter, Megan, suffering from the rare and serious Pompe Disease, which typically claims the life of its victims by age 5. Through John’s efforts, his daughter is now 20 years old and a sophomore at Notre Dame. During President Trump’s description of the Crowley’s fight, he emphasized the “slow and burdensome FDA approval process which keeps too many advances, like the one that saved Megan’s life, from reaching those in need.” He continued, “If we slash the restraints, not just at the FDA but across our government, we will be blessed with far more miracles like Megan. In fact, our children will grow up in a nation of miracles.” This emphasized commitment to promote getting life-saving treatments to patients.
How to Reconcile Love/Hate?
The problem is how the two ends of this spectrum reconcile themselves. Physicians hope pharmaceutical manufacturers have incentives to produce more innovative products, getting them to my patients quicker. And this requires several critical conditions: (1) that market conditions (profit potential, FDA process) favor this behavior; and (2) that these treatments are affordable in the eyes of payers and patients. The latter is increasingly important, as patients experience higher cost sharing. If patient’s out-of-pocket is perceived as too great, patients will abandon treatments.
No matter the course the Trump administration takes—hopefully one that produces the right environment for life-saving treatments to quickly come to market—pharmaceutical manufacturers will be tasked with articulating their value beyond the traditional payer stakeholders to government officials, health systems, and patients as these parties will play an increasing role in which treatments get to my patients. To quote President Trump “Who knew healthcare could be so complicated?” Those of us that care for patients everyday certainly did.