The high cost of prescription drugs in the U.S. has emerged as a pressing issue for many voters this election cycle.
Fifty-five percent of Americans said they are worried about being able to afford prescription drugs, according to an Oct. 4 KFF Health News survey. In addition, the survey found 28% have difficulty affording prescription drugs, and 31% have not taken medications as prescribed due to costs.
As the presidential election approaches, here is a breakdown of Vice President Kamala Harris and former President Donald Trump's positions and proposals on prescription drug pricing.
Kamala Harris
On the campaign trail, Ms. Harris has emphasized her commitment to comprehensive drug pricing reforms and highlighted the Biden administration's actions to lower costs, The New York Times reported Oct. 8.
- Medicare negotiation
In August 2022, Ms. Harris cast the tiebreaking vote in the Senate to pass the Inflation Reduction Act, which granted CMS the power to negotiate the price of select prescriptions, targeting medications without generic or biosimilar competitions. The law ended a 19-year-old ban preventing Medicare from negotiating directly with drug manufacturers.
CMS in August released prices for the first 10 medications selected for negotiations, which will take effect in 2026. The agency said it expects to save $7.5 billion in 2026, saving those enrolled in Medicare Parts B and D an estimated $1.5 billion.
CMS will also select up to 15 more drugs covered under Part D for negotiation for 2027, and 15 more covered by Part B or Part D for 2028. In subsequent years, up to 20 drugs will be selected for negotiations. .
Ms. Harris is proposing to accelerate Medicare price negotiations by potentially increasing the number of drugs negotiated each year or shortening the time before newer, name-brand drugs can be negotiated. This could involve adding more drugs annually than currently allowed under the Inflation Reduction Act; however, her campaign has not provided specific details.
- Caps on out-of-pocket spending
The IRA also introduced a $35 monthly cap on insulin costs and $2,000 annual cap on out-of-pocket drug costs for Medicare recipients. Ms. Harris has proposed expanding these caps to all Americans. However, policy experts told the Times such an initiative would likely face challenges in Congress, with many lawmakers concerned about the budgetary implications.
- PBM regulation
As part of her economic agenda shared in August, Ms. Harris vowed to crack down on pharmacy benefit managers' "abusive practices," which her campaign says raise costs for Americans. She aims to curb these practices by increasing transparency and competition among PBMs, as these entities are often accused of driving up drug prices through hidden fees and a lack of accountability.
The National Community Pharmacists Association praised the announcement, with CEO Douglas Hoey stating, "We are very pleased that Vice President Harris is focused on the predatory, anti-competitive companies that are driving up the costs of prescription drugs, driving small, independent pharmacies out of business, and restricting health care access for millions of patients."
Mr. Hoey also urged Mr. Trump to commit to PBM reform, saying it is a bipartisan issue in Congress.
PBMs such as CVS Caremark, OptumRx and Express Scripts have recently come under increasing scrutiny from federal regulators, particularly for opaque practices affecting drug pricing and healthcare costs.
In September, the Federal Trade Commission filed lawsuits against the three PBMs, accusing them of inflating insulin prices through anti-competitive behavior.
In response to the lawsuits, CVS Health and Express Scripts said they have lowered insulin prices and increased competition, arguing that high insulin costs are because of drugmakers, not PBMs.
Donald Trump
Mr. Trump has also positioned drug pricing as a focus, stating on his platform that he pledges to "reduce costs through increased transparency, promote choice and competition, and expand access to affordable healthcare and prescription drug options." His campaign also emphasized protecting Medicare and ensuring older adults receive necessary care without facing excessive financial burdens.
- Medicare negotiation
Mr. Trump has spoken against the Inflation Reduction Act's climate provisions and has repeatedly called for the end of clean energy tax credits offered through the IRA. When asked by the Times, Mr. Trump's campaign declined to comment on whether he would rescind CMS' drug negotiation powers during a second presidential term. The pharmaceutical industry and some Republicans have opposed the provision. If the program were to be repealed under another Trump presidency, the Republican party would likely aim to replace it with another program to lower drug costs, a former senior administration official for Mr. Trump told the publication.
During his campaign in 2016, Mr. Trump promised to allow Medicare to negotiate drug prices directly, but did not implement the measures during his presidency, according to an Oct. 3 KFF Health News report.
During his time as president, he proposed a drug pricing plan known as the "most favored nation" model, which would have capped Medicare payments for drugs at the price paid by certain wealthy countries. The aim was to shift more of the financial burden of prescription drugs onto other nations. However, the plan never gained traction and faced opposition from both drug companies and conservatives.
While Mr. Trump has not prominently discussed the idea on his campaign trail in 2024, he released a video last year defending the proposal, stating that foreign countries had been "taking advantage" of the U.S. The video has since been removed, according to the Times report, and the Trump campaign recently walked back the proposal.
- Caps on out-of-pocket spending
During his presidency, Mr. Trump backed a bipartisan bill that would have set a $3,100 cap on out-of-pocket drug costs for Medicare, according to the Times. However, despite original momentum and support from both parties, the bill stalled and was not passed into law. One of the key reasons for this was opposition from the Senate, particularly from some Republican lawmakers who were concerned about the bill's implications on pharmaceutical innovation and free-market principles, as well as lobbying efforts from the pharmaceutical industry.
While he has not detailed his stance on the current IRA caps in his 2024 campaign, his support for cost caps during his first term suggests he would continue to support similar measures. The Trump campaign has not specifically called for doing away with the current $2,000 cap.
- PBM regulation
Mr. Trump has not been discussing pharmacy benefit managers on the campaign trail. While he has criticized the pharmaceutical industry for high prices, he has not laid out a specific plan for PBM regulation in his 2024 campaign. The Trump administration in 2018 proposed a major change that would have threatened PBM's business model by altering how the government pays for drugs, though it was never enacted, according to the Times. Republicans are divided in their views on PBMs. Some argue PBMs are not responsible for high drug costs, while some state attorneys general in conservative states have sued PBMs.