SCOTT DETROW, HOST:
When the Trump administration talks about accomplishments of the president's second term, it often mentions the deals he has struck with pharmaceutical companies to lower drug prices. Now, inflation and affordability are key issues for voters in the coming midterms. That puts the spotlight on just how successful his efforts have actually been. NPR pharmaceuticals correspondent Sydney Lupkin has been tracking the president's plan for drug prices in Medicaid, which covers 66 million Americans who are low-income or have disabilities, and she joins us now with an update. Hey there.
SYDNEY LUPKIN, BYLINE: Hi.
DETROW: What exactly was Trump's original promise for Medicaid drug prices?
LUPKIN: Yeah, well, let's go back to September of last year. That was when the president and his health officials were in the Oval Office announcing the first of what he calls the most-favored-nation deals with drug companies.
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PRESIDENT DONALD TRUMP: Today, Pfizer is committing to offer all of their prescription medications to Medicaid, and it will be at the most-favored-nations prices. It's going to have a huge impact on bringing Medicaid costs down like nothing else.
LUPKIN: And Trump said he expected other drug companies would do the same. I reached out to Pfizer and 16 other major drug companies. None of them would confirm that all of their drugs would be discounted or tell me how many would be discounted. I asked the federal agency in charge of Medicaid, and they wouldn't answer that either.
DETROW: Help me understand why it would matter that it's not all of the prescription drugs on Medicaid.
LUPKIN: Yeah, Dr. Thomas Wang of Brigham and Women's Hospital in Boston (ph) says it worries him because companies can game the system.
THOMAS WANG: Companies have every incentive to cherry-pick the products for which they already give Medicaid the best discounts and for which the international price may not be that much lower.
LUPKIN: But even if pharmaceutical companies are offering lower prices on a wide range of products - which we don't know yet - it can't just take effect across the board. The feds have set it up as a voluntary pilot program. That means every state has to decide whether to opt in and agree to certain conditions. And the ramp-up has been slow. Ameet Sarpatwari is a professor of population medicine at Harvard who's studied drug pricing and drug policies for more than a decade.
AMEET SARPATWARI: It's always a bad sign when you keep pushing back your deadline.
LUPKIN: States now have to sign binding agreements by September 30.
DETROW: Any sense why states would be deciding not to take part in this, not to sign up?
LUPKIN: Yeah, because it could be financially risky. The federal government splits the cost of Medicaid with the states. In most states, Medicaid is the biggest part of their state budget after education. So to help control costs, individual states already have programs to restrict some drug coverage - for example, through prior authorization or by requiring patients to try the other cheaper drugs first. But under this pilot program, states might have to toss out their own criteria and offer unfettered access to some drugs if they want the negotiated price. Here's Sarpatwari again.
SARPATWARI: Then all of a sudden, your state Medicaid plans might be spending a whole lot more because a whole lot more people might be getting the drug.
DETROW: What states are deciding to opt in?
LUPKIN: So we don't know the full list. So we know Massachusetts, California applied, but they want to see the final details before committing. So, Scott, there are a lot of uncertainties, delays and a general lack of transparency. Given all that, it's probable that the number of drugs covered and the number of states involved may be lower than what Trump originally promised.
DETROW: That is NPR pharmaceuticals correspondent Sydney Lupkin. Thank you so much.
LUPKIN: You bet. Transcript provided by NPR, Copyright NPR.
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