Trump’s Executive Order Aims to Slash Prescription Drug Prices: Experts Weigh In
Former President Donald Trump’s recent announcement of an executive order targeting prescription drug prices in the United States has ignited a debate about the current cost of medications and the potential savings for Americans. The order, centered around a "most favored nations" drug pricing model, proposes that Americans should pay the lowest price for a drug that is available in other developed countries. Trump suggested that some prescription drug and pharmaceutical prices could be reduced by 50% to 80% or even 90% almost immediately.
Katy Dubinsky, a New York pharmacist and CEO of Vitalize, expressed support for the initiative, recognizing that it addresses a longstanding issue. However, she cautioned that implementing such changes would not be a simple task. Dubinsky pointed out that the executive order does not lead to immediate cost reductions. Instead, it directs government agencies to begin drafting the necessary regulations, a process that could take several months.
The Most Expensive Prescription Drugs in the U.S.
Dubinsky outlined some of the most expensive prescription drugs currently available in the U.S., along with the conditions they treat:
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Lenmeldy (atidarsagene autotemcel) by Orchard Therapeutics – $4.25 million: This medication is used to treat metachromatic leukodystrophy (MLD), a rare genetic disorder that damages the nervous system. Dubinsky explained that it is administered once and is intended to halt or slow down the progression of the disease in young children.
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Hemgenix (etranacogene dezaparvovec-drlb) by CSL Behring – $3.5 million: This medication is prescribed for individuals with hemophilia B, a bleeding disorder. According to Dubinsky, this one-time treatment helps the body produce its own clotting factor, eliminating the need for regular infusions.
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Elevidys (delandistrogene moxeparvovec-rokl) by Sarepta Therapeutics – $3.2 million: This medication is designed for young boys and is used to treat Duchenne muscular dystrophy (DMD), a condition that causes muscle weakening over time. Dubinsky noted that it aims to slow down the rate at which the disease progresses.
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Skysona (elivaldogene autotemcel) by Bluebird Bio – $3 million: This medication is used for cerebral adrenoleukodystrophy (CALD), a severe brain disease that affects boys. Dubinsky stated that the therapy aims to slow down the damage before symptoms worsen.
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Zynteglo (betibeglogene autotemcel) by Bluebird Bio – $2.8 million: Zynteglo is used to treat beta-thalassemia, a blood condition that typically requires regular transfusions. Dubinsky explained that this gene therapy can help patients produce healthy red blood cells on their own, reducing the frequency of needed transfusions.
Top Drugs by Sales Volume
John Stanford, executive director of Incubate, a Washington-based coalition of early-stage life-science investors, provided insights into the top five most expensive drugs based on sales volume. He noted that when the government focuses on the most expensive drugs, it typically considers sales volume rather than the high list price of rare disease therapies that have a smaller patient pool. Stanford added that officials often prioritize total drug spending by Medicare and other government programs.
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Keytruda (pembrolizumab) by Merck — $25 billion revenue (2023): Keytruda is an immunotherapy medication used to treat various cancers, including melanoma, non-small cell lung cancer, and liver cancer. Stanford highlighted that Keytruda has become Merck’s most valuable asset, enabling the company to expand its cancer treatment portfolio with over 1,000 active clinical trials.
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Eliquis (apixaban) by Bristol Myers Squibb and Pfizer — $18.95 billion: Eliquis (apixaban) is a crucial drug for both BMS and Pfizer. Apixaban is prescribed to prevent blood clot formation and treat deep vein thrombosis and pulmonary embolism (a blood clot in the lungs).
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Ozempic (semaglutide) by Novo Nordisk — $13.93 billion: Ozempic, prescribed for type 2 diabetes, has gained popularity due to its weight-loss effects and other health benefits. Stanford mentioned that Ozempic’s sales are driving Novo Nordisk’s broader push into GLP-1s for obesity, heart disease, and liver conditions, all areas with high development costs and uncertain scientific outcomes. The company has invested in scaling up production to meet the demand for GLP-1s and avoid supply shortages.
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Humira (AbbVie) — $14.4 billion (U.S. 2023 revenue): Humira has been one of the highest-grossing drugs in history, generating over $200 billion during its exclusivity period. The injectable medication, containing the active ingredient adalimumab, is used to treat rheumatoid arthritis and other inflammatory conditions.
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Biktarvy by Gilead — $11.85 billion: Biktarvy is an HIV treatment that includes the ingredients bictegravir, emtricitabine, and tenofovir alafenamide. Stanford noted that Biktarvy is not only a leading HIV treatment but also the financial foundation for Gilead’s expansion into cancer research.
Impact and Potential Consequences
Dr. Jacob Glanville, CEO of Centivax, a San Francisco biotechnology company, suggested that the executive order would likely not significantly affect vaccines and most generic drugs. He explained that most vaccines Americans receive cost less than a hundred dollars, while generic drugs are often priced at less than a dollar per pill.
Glanville predicted that the order would primarily impact newer brand-name drugs still under IP exclusivity, antibody therapies, cellular therapies, gene therapies, and personalized cancer vaccines. He acknowledged that some of these treatments are extremely expensive, ranging from $100,000 to $500,000 for a treatment course, but are also often the most effective options for certain cancers, autoimmune disorders, or rare diseases.
Glanville noted that the pharmaceutical industry might argue that reducing the prices of these medicines would lead to a significant reduction in investment in developing such breakthroughs. He also pointed out that these medicines eventually become generic, at which point their prices decrease.
Glanville emphasized that from a patient’s perspective, the cost of medical care in the United States is unsustainable, and extremely expensive medicine is a contributing factor. However, he added that the insurance system and hospital business also play a role. He suggested that if the prices of new medicines are capped, efforts should also be made to reduce the cost of clinical trials and drug manufacturing to avoid hindering innovation.
