In 2022, the Biden administration passed the Inflation Reduction Act (IRA), which allowed Medicare to negotiate prescription drug prices for the first time—a reform long sought by progressive Democrats. Under President-elect Trump, the future of the program is less certain.

But if there’s one thing experts agree on, it’s that repealing the law completely won’t be easy.

“I don’t think there’s any advantage to Republicans saying they’re going to repeal the IRA, because that means repealing the cap on out-of-pocket spending, and that’s political suicide,” Douglas Holtz-Eakin said. PhD, president of the American Action Forum, a conservative think tank, referring to key provision of a $2,000 cap on out-of-pocket costs for covered prescription drugs for Medicare enrollees.

However, Andrea Ducas, MPH, vice president of health policy at the left-leaning Center for American Progress, took a different view.

“That program was in the bull’s eye Project 2025she said MedPage today. “We still have every reason to believe that this is the policy plan that the incoming Trump administration was pursuing.” (Although many of the authors are former Trump officials, the president-elect has repeatedly tried to distance himself from the policy document.)

On the other hand, drug price negotiation “enjoys tremendous public support,” she noted. So to say, “‘Hey seniors…we’re going to take away Medicare’s ability to negotiate prescription drug prices,'” is a bad look, especially when the Trump campaign kept not touching people’s Medicare. “

In August, the Centers for Medicare and Medicaid Services (CMS) disclosed the negotiated prices of the 10 drugs selected for inclusion in the program one year earlier. All were single-source brand-name drugs with no generic competition or therapeutically equivalent biosimilars that were targeted for negotiation based on their total spending in the Medicare Part D program—they are expensive, widely used, or both.

Asked if Trump might be as aggressive in trying to lower drug prices in his second term as he was in his first term, he not only introduced a “most favored nations“politics, but also drug reimportationsaid Ducas, “What you see in President-elect Trump is someone who reacts in the moment and displays a kind of intensity of interest based on where the public sentiment is.”

“He talks all the time about wanting to do something different with healthcare … something that really delivers for people, but then repeatedly comes up with nothing,” she added.

Stephanie Kennan, of McGuireWoods Consulting in Washington, DC and former senior health policy adviser to Sen. Ron Wyden (D-Ore.), said MedPage today that the lesson Republicans should have learned from trying to repeal the Affordable Care Act is that you can’t repeal something without having a plan to replace it.

In October, the The Congressional Budget Office issued a report looking at a range of drug pricing policy options. The only one that “moved the needle” was Trump’s “most favored nation” policy — the attempt during Trump’s first term to tie US drug prices to those of other industrialized nations. “But Trump said he doesn’t want to do that again,” Ducas said.

A video posted on his campaign website last year suggesting the policy could be revived was recently removed, and a spokesman confirmed the campaign he has no plans to revive politics.

Regarding the future of drug price negotiation within the IRA, a determining factor is House control. (When Kennan spoke to MedPage today as of Wednesday afternoon, about 30 home runs had not been called.)

“There’s a lot more opportunity to be bolder (and) faster if both chambers are controlled by Republicans,” Kennan said, adding that even then, building consensus within the party could be difficult.

Zachary Baron, JD, of the O’Neill Institute for National and Global Health Law at Georgetown University Law Center in Washington, DC, agreed that House control is an important “outstanding question.”

With unified control of the House, Senate and White House, Republicans could pursue either repeal or substantial reforms to the drug price negotiation program.

Even without Congress, Trump could delay implementation of the program or adopt measures “more conciliatory to the pharmaceutical industry,” which could lead to his own legal challenges, Baron said. MedPage today.

Another early signal of potential plans from the Trump administration will be its stance in defending the bargaining program in court, he pointed out. The O’Neill Institute was follow up on the results of these studieswho, until now, have more favored the federal government.

As for other changes to the program, Holtz-Eakin pointed out that because of the secrecy surrounding the Medicare price negotiation process, Trump could tweak the scheme to his heart’s content, even taking a “most-favored-nation” approach — – evaluating US versus international prices. . And “we’d never know,” he said.

No mandate for repeal

Anthony Wright, executive director of Families USA, a Washington, DC-based nonprofit, said if Trump has a mandate, it focuses on “the inaccessibility of basic items,” and that includes prescription drugs.

“So to take away the power to negotiate for the best price for the prescription drugs that seniors need would be the opposite of the mandate that it has,” Wright said. MedPage today.

While the threat to many popular patient protections was outlined in Project 2025, Wright also noted that Trump has “actively disavowed and distanced himself” from that policy document, including the authority to prescription drug price negotiation.

“I’m not saying these policies aren’t at risk, I’m saying … it doesn’t have a mandate (for repeal), and in fact, if anything, it has a mandate to do more about prescription drug pricing. negotiation,” Wright said. “President Trump talked about keeping promises (in his victory speech) … That’s how you can keep that promise, keeping this policy in place.”

John O’Brien, PharmD, MPH, president and CEO of the National Pharmaceutical Council (NPC), said “there’s a lot to like about the IRA pricing program — and still a lot of uncertainty about what it means for patients that I hope the new administration and the new Congress care about.”

“Our research suggests that IRAs can delay the launch of new drugs, reduce the number of subsequent indications approved, and limit the post-approval research used to set treatment guidelines, while encouraging insurance plans to limit access,” he said. he said. MedPage today.

Moreover, it is the NPC’s job to produce high-quality evidence to help the next administration understand the laws’ “unintended consequences” and “protect patient access to innovation,” he said.