The future of one of President Joe Biden’s major domestic policy achievements — getting Medicare to negotiate drug prices — could either become part of the Biden administration’s legacy, be undone by the new Congress, or be weakened by the administration of President-elect Donald Trump.

Trump has remained relatively silent on the drug pricing provisions of the 2022 reconciliation bill and his future looks even bleaker now that Republicans will control both the House and Senate.

“The Trump campaign has not articulated any specific positions on drug price negotiation, but congressional Republicans are not fans of the program and have introduced legislation to repeal the IRA in its entirety,” Juliette said Cubanski, deputy director of the health insurance policy program at KFF. health research organization, referring to the law by its nickname, short for Inflation Reduction Act.

Trump will find himself responsible for administering the program after the Jan. 20 inauguration. Although he has supported Medicare price negotiations in the past, it is unclear where he currently stands on the issue. His campaign backed away from a similar proposal that would tie drug prices paid in the United States to prices paid by other countries.

Medicare drug price negotiation was passed as part of the 2022 reconciliation bill, allowing the administration to negotiate with drug companies on prices for 10 high-priced drugs starting last year. The Biden administration said these negotiated prices, which take effect January 1, 2026, would have saved Medicare $6 billion if they were in effect last year.

More than a dozen lawsuits targeting the program are also making their way through the courts, and the Trump administration’s Justice Department must decide whether it will continue to defend it. If he decides not to do so, this strategy would echo that of the Trump administration. decision in 2018 of not defending the 2010 health care law in a lawsuit brought by Republican attorneys general.

Trump has also shown a willingness not to prioritize the policy accomplishments of his predecessors, including his handling of the 2010 health care law during his first term, which saw a decline in enrollment compared to that of the Obama administration.

“It’s unclear at this point where the new Trump administration will take the Medicare price negotiation agenda,” Cubanski said.

The Trump transition team did not respond to a request for comment.

Congressional reaction

Although it’s unclear what Trump thinks of Medicare price negotiation, congressional Republicans hate it, comparing it to “government price controls” that reduce research and development of new drugs by pharmaceutical companies.

Some have promised to repeal it, but Senate Republicans, who will control the chamber starting next year, do not have a majority capable of crossing the 60-vote threshold.

But they could likely resort to reconciliation — a budgetary maneuver to get around the 60-vote requirement that was initially used by Democrats to pass the law.

But repealing the drug pricing provisions might be difficult because it saves money: The Congressional Budget Office has estimated that the bargaining provisions alone would reduce the $25 billion deficit in 2031.

Rep. Earl L. “Buddy” Carter, R-Ga., who serves on the House Energy and Commerce Committee, said in an interview that he would like to see the committee work to roll back provisions on negotiations on drug prices during the next Congress. .

“I hope it gets eliminated,” he said. “In 10 years in the state legislature and 10 years in Congress, this is the worst legislation I have ever seen.”

But Democrats defended the program. Senate Health, Education, Labor and Pensions Chairman Bernie Sanders, I-Vt. appeared alongside Biden to tout this achievement.

If the drug pricing provisions were to be implemented, said Sen. Tina Smith, D-Minn., “it would be a huge gift to big pharmaceutical companies.”

Cubanski warned that the Trump administration may not have much flexibility in how the provisions are implemented.

“There are a lot of details in the law about how the program is to be implemented that in many ways don’t give the administration a lot of leeway,” Cubanski said.

Enforce the law

The administration will nevertheless have the possibility issue directives on how the negotiations will work, including the number of meetings that will take place between the government and drug manufacturers.

The Trump administration will face key deadlines shortly after its January 20 inauguration.

By Feb. 1, the administration must select up to 15 drugs for which Medicare will negotiate prices. It’s possible the Biden administration will select these drugs before Trump takes office, but the new administration will likely want to look at that, said Jeffrey Davis, director of health policy at McDermott+, a lobbying organization, health advocacy and policy strategy. “It’s a pretty short time frame,” he said.

“Legally, they are required to implement the Inflation Reduction Law,” he said. “But even if they were required to, they could delay implementation or say they need more time.”

He added that the Trump administration could decide to deprioritize the program by shifting staff and resources to other priorities, just as it also deprioritized the administration of the 2010 health care law.

He unilaterally canceled payments to insurers intended to reimburse reduced cost sharing for patients. The insurers sued and won. But it is not clear who would have standing to continue the drug negotiation agenda.

Project 2025 — the plan for a second Trump term that was denounced by the campaign but was drafted by many of his former and current advisers — calls for repealing the program.

“Until the IRA is repealed, an administration that is required to implement it must do so in a manner that is prudent with its authority, minimizing the harmful effects of the Act’s policies and avoiding even worse unintended consequences,” the plan says.

Even if the negotiation is popular in pollsit is not yet widely understood by the general public, and Republicans could use the election results as their general mandate to repeal it.

“Efforts to lower drug prices are incredibly popular, so I think there would be a lot of thought to be given to whether or not they would try to pull back measures that would result in higher prices medications,” Eugenia Pierson, chair of the Legislative and Public Policy Practice Group at law firm Arnold & Porter, said in an interview with CQ Roll Call.

Part D pilot program

Trump will also have to make decisions on a demonstration program launched by the Biden administration this year aimed at preventing increases in Medicare Part D premiums that were triggered by the law shifting more drug costs to insurers as it capped the direct expenditure of beneficiaries. .

The stabilization program will cost $5 billion and include a $15 per member monthly subsidy to the plans and a year-over-year premium increase cap of $35 on the total Part D premium of a diet.

Republicans called the $5 billion pilot project “an out-of-control, taxpayer-funded bailout to cover up the flaws in the Inflation Reduction Act.”

When Trump takes office, it will be late to look back on the first year of the pilot. But it could easily end it before the next open enrollment period, which typically begins in October. That would likely lead to higher premiums for patients, Cubanski said.

“Without these additional subsidies (to the plans), one could imagine a scenario in which these premiums would increase significantly from current levels,” Cubanski said.

Pierson pointed out that some provisions of the drug pricing law will more immediately result in lower costs, pointing to the provision that caps out-of-pocket costs at $2,000 starting Jan. 1.

Pierson said that if Vice President Kamala Harris had won the election, the central question would be whether to push CMS to be more aggressive in negotiating drug prices.

“That’s changing now… that we’re expecting a Trump administration,” she said.