Healthcare, Politics and the 2024 Election | Asembia 2024

Sarah Butler

Although healthcare has so far not been the predominant topic of the 2024 Presidential election, the results will have a huge impact on healthcare regardless of who wins, according to Sarah Butler, chief commercial officer at the consulting company ADVI Health.

How the Inflation Reduction Act is implemented and the role of pharmacy benefit managers in drug pricing are likely to be two areas that could look very different in a second term for President Joseph Biden or Donald Trump.

Lindsay Bealor Greenleaf, JD

Butler and her colleague Lindsay Bealor Greenleaf, JD, solution leader, federal and state policy at the ADVI Health, presented today at the 20th annual Asembia Specialty Pharmacy Summit in Las Vegas on politics and healthcare.

In an interview before the meeting, Butler and Greenleaf talked about how healthcare could change after the next election.

Q: Could the outcome of the 2024 election have an impact on the Inflation Reduction Act?

Butler: The Inflation Reduction Act has been the most significant change in terms of how we pay for drugs in this country that we’ve had in a number of years. Post-election this is going to be a priority for either administration. President Joseph Biden has already suggested that he wanted to expand Medicare’s drug price negotiation program from 10 to 50 drugs per year. Former President Donald Trump during his administration had discussed policies such as an International Pricing Index and Most Favored Nation.

Greenleaf: President Biden would love to expand on the government price setting policy and make the inflation Reduction Act even bigger and apply to more drugs. Trump’s focus, as you'll recall from his first administration, was on “foreign freeloading,” an idea that America is not getting the best deal on prescription drug prices. There were two past policies that the Trump administration started to enact — International Pricing Index and Most Favored Nation — but they were then blocked by the courts. If we have a second Trump administration, they might attempt to put forth these models again.

Q: But it would take an act of Congress to repeal the Inflation Reduction Act?

Butler: At this time, we haven't heard that a potential Trump administration be vocal on what they would do in the context of the IRA. But they would have a little bit of flexibility. I expect that they would also probably want to look for other ways that they could make their mark on lessening drug prices for Americans.

Greenleaf: Under a future Trump administration, we would assume that they would implement the Inflation Reduction Act but it would take a bit of a different form. A Trump administration would try to implement it in a way that’s maybe a bit less punitive than what we would think under a Biden administration. With regard to the drug price negotiation policy, CMS has a lot of discretion with setting that negotiated price. You would think a Trump administration might come up with a more generous price than the current administration.

Q: How do you think the presidential candidates are thinking about pharmacy benefit managers?

Greenleaf: PBMs have been in the spotlight, and as a general theme, I think that will continue. Republicans in Congress have been the hardest on PBMs, but we are starting to see more Democrats agree with the notion that PBMs are playing a role that increases out-of-pocket costs. This will become a more bipartisan effort for reform.

With that said, if I worked for a PBM, I'd be more nervous under a Trump administration than a Biden administration. I think President Trump will do the best he can to implement policies that have some kind of effect on PBMs. Under the last Trump administration, we had the OIG rebate rule, a regulation that would have required rebates be passed down at the point of sale for Medicare Part D. That would have been a big policy shift, but that’s gone now. But you could imagine a second Trump administration trying something else to address the PBM role.

Butler: We haven’t seen PBMs get a lot of attention in the political environment. But just a month ago, Mark Cuban was testifying in Congress and providing very direct commentary on the PBM model. We are starting to see a transition occur to a more cost-plus transparent model. For example, CVS recently announced its Cost Vantage program, where pharmacies will be reimbursed differently from what they have previously. And Express Scripts also launched ClearNetwork, which relies on different measures for acquisition costs in the pharmacy space. These are really significant shifts for their traditional business model.

I think that the PBMs are even preparing to be part of the conversation on drug pricing.