The visible text of the order details that presumably the HHS secretary would be directed to "implement his rulemaking plan to test a payment model pursuant to which Medicare would pay, for certain high-cost prescription drugs and biological products covered by Medicare Part B, no more than the most favored-nation price."
The text of the order indicates the White House may pursue a more aggressive version of international reference pricing than it first proposed in October 2018.
The 2018 policy would in part tie Medicare Part B payment to the average price of a marketbasket of developed countries, while a most-favored nation approach could give the United States the lowest price out of a selected marketbasket.
The order text seems to line up with prior comments by HHS Secretary Alex Azar, who said in November 2019 that Trump was "not satisfied" with the average international price approach, and instead wanted the United States to get "the best deal."
The text said the purpose of the demonstration would be to see if a most favored-nation pricing demonstration would "mitigate poor clinical outcomes and expenditures associated with high drug prices."
So far, HHS has only proposed an advance notice of proposed rulemaking on its international reference pricing plan, and would have to propose a rule and finalize it before the policy could take effect. The proposed rule has languished under review at the White House budget office since June 2019. The rulemaking timeline makes it highly unlikely that it could be finalized by the end of Trump's first term.
The visible text does not detail how a "most-favored nation price" would be calculated, and does not indicate any deadline for implementation. It is possible that details or a deadline were listed on the obscured page of the order.
The White House declined to comment on the partial text.
Trump said he planned to meet with drugmakers this week, but a meeting has not occurred. Pfizer Chairman and CEO Albert Bourla told investors on Tuesday that he was not interested in meeting with the White House to discuss the order.
"I don't think there is a need for, right now, for White House meetings," Bourla said.
Pharmaceutical Research and Manufacturers of America said the group remains willing to speak with the administration and discuss ways to lower costs for patients at the pharmacy counter.
"However, we remain steadfastly opposed to policies that would allow foreign governments to set prices for medicines in the United States," said PhRMA spokesperson Nicole Longo.
The drug-pricing orders were released shortly after former Rep. Mark Meadows took over as White House chief of staff. Meadows criticized the Trump administration's international reference pricing proposal while he was in Congress.
