Thread by @sangerkatz

The White House and Pharma were *this close* to a deal to lower Medicare drug spending by $150 billion over 10 years. But it blew up because the White House wanted to mail discount cards to Medicare beneficiaries before the election. nytimes.com/2020/09/18/us/… @jmartNYT @maggieNYT

Pharma balked at "Trump cards," which is why the president, for the second time, signed an executive order that says it will lower Medicare drug prices to the lowest price paid by foreign countries. whitehouse.gov/presidential-a…

As you may remember, the president signed such an order in July, too. But the White House never published the order in the Federal Register, as required by law. nytimes.com/2020/08/24/us/…

That order finally became public on Sunday, along with the. new one. But the new one somehow rescinds the previously unpublished order. (Here it is: whitehouse.gov/presidential-a…)

It is true that the pharmaceutical industry loathes the approach taken by this order, which would establish price controls--with low prices--for drugs purchased for Medicare beneficiaries. But the order itself is a long way from actually affecting drug prices paid by anyone.

Part of the order, which seeks to influence the prices paid for Medicare Part D drugs, seems legally vulnerable. The legislation establishing the program specifically bars the federal government from negotiating directly with the manufacturers. nytimes.com/2019/07/05/ups…

Lawsuits seem inevitable.

But aside from legal challenges, these programs will need to be designed through notice and comment rulemaking, and as pilot programs before they will go Medicare-wide. Look at the careful language here for a preview of what regulators will face.

All of which is to say: Drug prices are not going down before the election.

But it appears that Pharma was willing to make a deal that would have handed both sides a win right away. nytimes.com/2020/09/18/us/…

One final thought. I know many of these budget numbers sound like monopoly money. But $150 billion is a huge number.