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What did pharmaceutical industry and patient advocacy groups say about Trump's and Biden's pricing proposals?
Executive summary
Pharmaceutical trade groups and major drugmakers broadly criticized President Trump’s May 2025 Most-Favored-Nation (MFN) and tariff-driven pricing push as legally risky and harmful to innovation, while some manufacturers later struck MFN-style deals with the Trump administration to lower prices for selected products (including obesity drugs) and expand Medicaid/Medicare coverage [1] [2] [3]. Patient-advocacy groups and public-health analysts are portrayed differently across reporting: many applaud lower out‑of‑pocket costs for patients under deals announced by the White House, but other advocacy and policy experts warned earlier that MFN mechanisms are legally complex and might not deliver expected savings [2] [1] [4].
1. Industry’s initial reaction: pushback on MFN and price alignment with other countries
Pharmaceutical industry lobbyists framed Trump’s MFN and international-reference-price approach as fundamentally flawed, arguing it would “devastate” smaller biotech firms and undermine incentives for innovation; PhRMA emphasized that the real drivers of U.S. prices include middlemen and foreign underpayment, not industry pricing alone [5]. Reuters and CNBC reported that trade groups warned the proposal would be difficult to implement and could cost drugmakers substantially over a decade, with PhRMA estimating large financial impacts and cautioning that importing lower prices from “socialist countries” would hurt future drug development [1] [4].
2. Legal and practical skepticism from experts and analysts
Legal experts and analysts told reporters the executive order and MFN-style rules face procedural and legal hurdles, noting prior attempts to implement international-reference rules were blocked by courts and rescinded under the Biden administration — signaling litigation and regulatory complexity if revived [4]. Health policy analysts also cautioned that MFN mechanisms can’t easily “undo the basic economics” of global drug markets and could prompt pharmaceutical companies to shift pricing strategies abroad [4] [6].
3. Pharma’s strategic recalibration: from opposition to negotiated deals
Despite earlier denunciations, several major manufacturers ultimately negotiated agreements with the Trump administration to provide MFN-like pricing or exemptions tied to U.S. manufacturing commitments; Pfizer, AstraZeneca, EMD Serono, Novo Nordisk and Eli Lilly are cited in reporting as entering deals to curb prices and expand coverage — notably for obesity and diabetes drugs — with some arrangements including a $50 monthly Medicare copay or other reduced consumer costs [3] [7] [2]. Journalists reported this as a shift from wholesale legal opposition to targeted bargaining to avoid tariffs or secure market access [8] [3].
4. Patient‑advocacy response: relief over lower costs, mixed on approach
The White House touted the deals as delivering “dramatic” price reductions and broader access under Medicare and Medicaid, a message welcomed by patient advocates focused on out‑of‑pocket relief for high-cost drugs such as GLP‑1 obesity treatments [2] [9]. But available reporting also records concerns from some policy observers (and implicitly some advocates) that piecemeal deals and tariff threats could produce unequal access, legal uncertainty, or price-shifting effects globally — critiques detailed by analysts rather than a single unified patient‑group voice in the pieces provided [4] [6]. Available sources do not mention a full, unified roster of patient-advocacy group statements across both administrations.
5. Biden-era contrast: negotiation authority vs. coverage proposals
Coverage and negotiation under the Biden administration took a different route: Biden-era policies leaned on Medicare negotiation under the Inflation Reduction Act and sought to expand coverage (for example, proposals to cover anti‑obesity medications in Medicare Part D) that at times were not finalized; reporting notes the Biden CMS had declined to finalize an anti‑obesity coverage rule earlier in 2025 — a procedural contrast to the Trump administration’s negotiation-and-deal tactic [3] [9]. Industry commentary and some outlets suggested drugmakers preferred Trump’s focus on middlemen reforms and manufacturing incentives to Biden’s direct negotiation tools, which industry sees as a bigger threat to profit margins [10].
6. Politics and incentives: tariffs, bargaining power, and potential gaming
Trump’s strategy combined the explicit threat of tariffs and MFN enforcement with the carrot of exemption via negotiated price deals — a bargaining posture that appears to have produced manufacturer agreements on select products [8] [2]. Analysts cautioned this dynamic could prompt manufacturers to reprice internationally or favor deals for high‑revenue drug classes while leaving other drugs untouched, creating uneven impacts for patients and foreign systems [6]. PhRMA and BIO framed the approach as risky for innovation and smaller companies, underscoring the industry’s political and economic incentives to resist broad systemic change [5] [4].
Limitations and takeaway: reporting shows clear industry opposition to blanket MFN approaches and legal doubts from experts, but it also documents targeted manufacturer deals that reduced prices for certain drugs and expanded coverage under the Trump administration; coverage of unified patient‑advocacy positions is incomplete in these sources, and long‑term effects on innovation, global pricing behavior, and Medicare/Medicaid costs remain contested in the pieces cited [1] [2] [4] [6].