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How recent executive orders—both under the Biden and Trump administrations—have reshaped the drug pricing landscape, and the legal challenges or uncertainties they present for pharmaceutical companies

What life sciences companies should be doing now to proactively prepare for further executive action on drug pricing and market access

The key differences in how executive policies versus legislative actions affect the pharma industry’s pricing and commercialization strategies

The legal and strategic risks executive policy shifts pose to investors and biopharma leaders who may be planning product launches or portfolio expansion over the next few years

Alice Valder Curran outlines the steps manufacturers should take to better prepare for upcoming executive actions on drug pricing and market access.

How Recent Executive Orders Impact the Drug Pricing Landscape

In the third part of his Pharma Commerce video interview, Marschall Runge, MD, PhD, dean of the University of Michigan Medical School and author of The Great Healthcare Disruption, proposes ways to ensure both fiscal responsibility and the sustainability of hospital funding.

Reducing Healthcare Prices

Amid the push for reshoring and fiscal reform, the tariffs are part of a broader effort to rebalance trade and fund domestic initiatives, as the pharma sector awaits potential levies of its own. 

Trump Imposes 25% Tariffs on Japan, South Korea, and a Dozen Other Nations 

An exploration into how flawed incentives and contractual loopholes between manufacturers and pharmacy benefit managers played their part.

Popping the Gross-to-Net Bubble, Part IV: Extreme Examples of Who Grew the Bubble

How practical is this form of pricing in the pharma setting?

Reviewing the Most-Favored Nation Model

Potential import taxes on pharma goods entering the United States continue to have effects on the industry in more ways than one. 

The Tariff Effect: Greater Supply Chain Prepares for Repercussions 

Fixing the Pharma Pricing Puzzle

, LeAnn Boyd, PharmD, Liviniti’s founder and CEO, discusses the deeper, systemic issues behind rising healthcare and drug costs that are not fully addressed by the MFN (Most-Favored Nation) executive order. She acknowledges that the healthcare landscape has seen incredible advancements in therapies that significantly improve patient outcomes and well-being. As more people utilize pharmacy benefits—rising from 50% to around 70% in recent years—overall drug spending has naturally increased. While greater access to treatments is positive, Boyd emphasizes that this doesn't fully explain the sharp rise in costs.

She views the MFN executive order as a useful initial step—a spark that brings attention to the issue, especially considering that the US pays significantly more for medications than other countries. However, Boyd expresses concern that the order lacks the depth needed to address all the systemic contributors to high drug prices.

A key issue, she argues, lies in the misaligned incentives within the drug pricing ecosystem. Many stakeholders, such as pharmacy benefit managers (PBMs) and other intermediaries, have compensation structures that are tied to the list price of medications. This creates a perverse incentive to favor higher-priced drugs, as higher costs directly translate into greater profits for these players. As long as stakeholders are financially rewarded based on drug prices rather than patient value or outcomes, upward pressure on prices will persist. Boyd concludes that unless these incentive structures are realigned to reflect value-based compensation, rather than price-driven earnings, any reform—like the MFN rule—will fall short of creating lasting change in the healthcare cost landscape.

Boyd also comments on how PBMs will be significantly impacted by the EO; why PBMs that operate on 

lat admin fee model rather than rebates create more transparency and value for both payers and patients; what meaningful drug pricing reform looks like in her view; and much more.

What would meaningful drug pricing reform look like to you?

 Number one, it has to be comprehensive. This is a very complex pricing system that we live in, and as I mentioned, there's a lot of different stakeholders along the way. You have to address drug pricing, from the group purchasing organizations (GPOs), which control a lot of the manufacturer rebating arrangements, the GPO arrangement with the individual PBMs that they're supporting, and the PBMs that have dispensing pharmacies, whether that's specialty mail retail pharmacies, as well as care.

You have to make sure that this reform is comprehensive enough that eliminates any shifting of the economics from up, down, left, right, backwards, forwards, and just truly play it straight. The cost of the drug is the cost of the therapy, and it's passed through down to the people that are paying for the drug, which is the plan that's supporting them, and the member themselves that's contributing not only co-pays, but also premium dollars into these plans. To me, it's real-time pricing information, so everybody can be informed: consumers at the time that they're getting a therapy prescribed to them, so they can make the right decisions for them, individually in connection with their doctor. Right now, regarding that pricing information, a patient does not leave the doctor's office, nor does the doctor typically know what it's going to cost that patient until they get to the pharmacy counter, and then everyone's working in a very reactive retrospective process that creates disruption, frustration, and friction for that individual patient.

How do we help patients at the point of prescribing in a more informed manner to make these decisions? You have to have real-time, transparent pricing information, and those same stakeholders that benefit from linking their revenue to the drug cost also benefit from keeping that information pretty much under wraps, and it makes it hard to get to that true cost of therapy at the point of prescribing.

In the final part of her Pharma Commerce video interview, LeAnn Boyd, Liviniti’s founder and CEO, describes what meaningful drug pricing reform looks like to her. 

Using Data to Influence Drug Pricing Policy 

, Maggie McCullough, PolicyMap’s CEO, highlights how geospatial mapping can play a critical role in identifying and addressing pharmacy deserts—areas where access to pharmacies is limited or nonexistent. With an estimated 17.7% of the US population affected, the issue is increasingly urgent, particularly as major chains like Rite Aid close locations. Using Philadelphia as a case study, McCullough explains that 13% of the city’s pharmacy locations were Rite Aid stores, and their closure could significantly impact local access to medications and health services.

Geospatial tools like PolicyMap allow stakeholders to visualize not just where pharmacies are closing or opening, but also the broader context of the communities they serve. This includes assessing whether alternative pharmacy options exist nearby and evaluating how easily residents can access them. Physical distance is only part of the picture—transportation availability, such as car ownership or access to public transit, is also crucial.

McCullough further emphasizes that pharmacy access now extends into the digital realm. Telepharmacy is a growing solution, but it requires reliable internet access and digital devices—resources not all households have. Understanding these additional barriers is essential for designing effective interventions.

By layering geographic, transportation, and socio-economic data, mapping platforms can help policymakers, health systems, and community organizations proactively identify at-risk areas before they become pharmacy deserts. This data-driven approach enables more targeted responses that account for the real-life conditions affecting healthcare access, including digital equity.

McCullough also comments on what PolicyMap’s data reveals about the relationship between pharmacy access and broader health disparities in underserved communities; how mobile and digital solutions can be deployed effectively to close the gap in areas identified as pharmacy deserts; how data-driven insights support PBMs and healthcare leaders in negotiating fairer drug pricing; and much more.

In regions with limited pharmacy access, how can data-driven insights support PBMs and healthcare leaders in negotiating fairer drug prices?

 In the pharmacy deserts, we know that these populations tend to have lower incomes, and as a result, even if they can get to the pharmacy, they may not have the money to pay for the drugs that they need to help with their conditions. This is where reducing drug pricing becomes so important. Certainly, what we've seen is that when people can best make the case for how a certain intervention—like reducing drug prices in particular deserts—not all deserts that might work, but particular deserts—and say, if we can reduce drug pricing in these areas, we're going to see better health outcomes, reduced hospitalization rates, and lower healthcare costs for the system as a whole. The ability to clearly make that argument with factual data becomes very, very important, so that it's not just an opinion. It’s about using that data, making that argument, and then thinking about the intervention, right?

What I've heard—I haven't seen any of this yet—but heard about people saying in these zones, potentially negotiating lower prices for all drugs. I've also heard about ideas of negotiating lower prices for the drugs that are addressing the chronic conditions that are most prevalent in that community, so it's a combination of the claims data and the on-the-ground, community-level data that can help make those decisions.

The one thing that I have seen that I think is really important because of all of the pharmacy pricing at some point is that there's a federal component to it. When making these maps to make the case, you want to highlight which neighborhoods are most in need. You can pinpoint them, but then make the map at a congressional district level, so you can go to congresspeople, and they can see very clearly where their constituents are suffering and how some of these interventions are going to benefit particular pockets in their community. I think bringing it home in a very clear and simple way to congresspeople is important, and I think that's one of the most powerful contributions of geospatial work to this effort.

In the final part of her Pharma Commerce video interview, Maggie McCullough, PolicyMap’s CEO, illustrates how data-driven insights can support PBMs and healthcare leaders in negotiating fairer drug prices?

How MFN Executive Order Could Affect International Drug Costs

PC: Although ways to decrease healthcare costs are certainly encouraged by pharma supply chain stakeholders, what potential long-term repercussions (if any) could President Trump's MFN executive order have on the industry?

The executive order mandates that pharmaceutical companies match or beat the lowest price paid by certain countries—such as Canada, Germany, or France—or face regulatory penalties. Tying US drug prices to international benchmarks could trigger large-scale trade disputes.

Here’s what I mean: the countries whose prices would serve as the benchmark might be pressured to raise those prices, which could cause friction with trade partners and potentially violate global treaties. At the same time, reduced profits in the US market could push pharma companies to compensate by raising prices elsewhere.

Countries with universal healthcare systems or limited healthcare budgets—many of which haven't been central to the policy debate—may experience reduced access to essential medicines. Altogether, this could result in the U.S. effectively exporting its high-cost drug model, potentially leading to an unintended global affordability crisis.

Ron Lanton, Partner, Lanton Law, weighs in on the potential international trade, pricing, and access implications of tying US drug costs to those in other developed countries under the Most Favored Nation executive order.

Where Does Healthcare Price Transparency Stand Today?

Turquoise Health’s SVP of market solutions

 describes how the recent executive order on healthcare price transparency aims to make pricing in the healthcare industry more accessible and understandable for patients. This initiative is a continuation of efforts by both the Trump and Biden administrations, with the goal of improving transparency around hospital and payer reimbursement rates. The central idea is to require all hospitals and insurance companies to publicly disclose their contractual reimbursement rates, meaning patients will have clearer insights into what insurers pay hospitals for services.

Historically, these prices were not transparent, making it difficult for patients to understand the actual costs of healthcare. While earlier laws introduced in 2019 improved pricing transparency, there have been enforcement challenges. The new executive order seeks to address these issues by ensuring hospitals and payers comply with transparency requirements. A key update in the order is the inclusion of prescription drug prices, which had previously been excluded from transparency rules.

The broader impact of this order is to make healthcare pricing as transparent and predictable as other consumer services, like booking a flight or a haircut. Although the system is not fully realized yet, this executive order lays the foundation for a future where patients can easily access upfront pricing before seeking healthcare services. This transparency is expected to simplify the decision-making process for patients, ultimately fostering a more informed and competitive healthcare environment.

O’Dell also comments on the biggest challenges healthcare organizations currently face in terms of price transparency; where the healthcare industry currently stand in terms of compliance with price transparency regulations; specific strategies Turquoise Health provides in order to help healthcare providers navigate and meet the new price transparency requirements; and much more.

Where does the healthcare industry currently stand in terms of compliance with price transparency regulations, and what steps need to be taken to achieve full compliance?

There's been a lot of evolution over the course of the last four years, so when these regulations came out, only 20% to 30% of hospitals were complying, and I really think they hoped this is going to go away. “We don't want to publish our rates. I hope this just falls by the wayside.” Lo and behold, the Biden administration comes in and starts enforcing it and says you actually have to publish your rates.

We saw a huge uptick in compliance over the course of the last four years, and now, 95-plus-percent of hospitals publish a machine-readable file. You'll see that sometimes called an MRF. What that means is that is just the standard format that they publish their rates in. Ninety percent of all payers also do the same thing. We see good compliance in that the files are out there. They're saying, “we've complied, here's the file.”

The area where I think there's room for improvement is what is in the actual file. We saw a huge improvement come in July of 2024, where hospitals had to start publishing their exact drug rates, the units of the drug, how they got reimbursed—they had to do it in a standard format, so the quality of the file improved immensely. Just because you have a file out there doesn't mean it's very useful. Over time, they've added new regulations to say we're going to enforce this and we're going to make it more standard. That's exactly, what this executive order is trying to do. It's saying we're going to enforce it, we're going to make it more standard. If you're one of those 5% that's not doing it, you're going to get a letter. If you're not doing it in the standard way that we published, you're going to get a letter. Perhaps most importantly, if you are a prescription drug payer or a prescription drug provider, it's time to start publishing your rates too. There's a term that I think is kind of a boring term when you say it, but will become very important to this, which is called historical net price. And that's what we don't have for drugs today, and that's what I think that the executive order is trying to bring out.

Historical net price just means, what is the actual price of the product after you give discounts and rebates? I won't try to explain it, but the drug value chain is incredibly complex. There're lots of middlemen, per se, and each middleman is taking a little bit of the drug price. They're saying, I'll take a little rebate, or I'll take a little discount along the way.

Historical net price is effectively just a complicated word to say, you set a sticker price on a drug, but what did it actually get bought for by the doctor's office who's going to put it into the patient? So that difference is historical net price, and what your historical net price is can be than what my historical net price is, so you might be getting a different contract discount rebate than I am, and that's still to this day, completely invisible. It’s very difficult to make prices public or to help a consumer understand what they're going to pay for something if we have no idea what the drug price is that the PBM, pharmacy, or payer are going to pay or get reimbursed for something.

In the third part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, provides an update on where the healthcare industry currently stands in terms of compliance with price transparency regulations, and what steps need to be taken to achieve full compliance.

The Complexity of Healthcare Price Transparency

What are the biggest challenges healthcare organizations currently face in terms of price transparency?

The biggest challenges I think healthcare organizations and payers face is just that the data that's required to be published is absolutely massive. The company I work for, Turquoise Health, is a price transparency company. We ingest a petabyte of data every single month, which is a massive amount of data to bring in. That means we're going out to 11,000 different sources and grabbing it from all the payers and all the hospitals, and trying to bring all that data in and standardize it. I think just the size is a very difficult part.

Perhaps even more important than that is the word that I just said, which is “standards.” In order for it to be useful, everyone's got to do it in the exact same way. It's kind of like, everyone's got to drive on the same railroad track size if you want the trains to be able to integrate and go across state lines. Same is true for these data flows. We're getting there, but we're not quite there yet, meaning that hospitals’ contracts are highly variable, so the way one hospital might contract for a service is very different, compared how the next one does. When they publish the data, now you have to find a way to make it apples to apples so that a consumer can compare. That is the absolute hardest part of price transparency—they can show you the price, but you as a consumer might not know what to make of that unless someone standardizes it.

In the second part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, Turquoise Health’s SVP of market solutions, discusses the biggest challenges healthcare organizations currently face in terms of price transparency.

Breaking Down the New Executive Order on Healthcare Price Transparency

Can you explain the key provisions of the recently released executive order on healthcare price transparency and how it will impact the healthcare industry?

These executive orders are about price transparency, and this is not a new concept for the Trump administration or for the Biden administration for that matter. This happens to be one of the few bipartisan things perhaps that's out there. In essence, what they want to do is make all hospitals and all payers make all of their contractual reimbursement rates public. Those are complicated terms if you're not in the industry, but it basically just means, what is your insurer, as a patient, pay to the hospital for the service that you received? As wild as this sounds, until these price transparency laws were out, none of that ever existed.

That was all a guessing game, and no one had any visibility into it. Over the course of the last four years, since the first version of these laws came out in 2019, we've seen a lot better prices, and we've seen a lot better data on these—what does the payer pay to the hospital?

Why are we talking today? Why does this new executive order even need to happen? It's because first they feel that the laws have not been enforced enough. They're saying, these are good laws, but we need to really make sure that hospitals and payers are doing this, and we're going to enforce it if they're not doing it. The second thing that comes through is drug prices. Hospitals and insurance companies had to make all their rates available, but somehow, the pharmacy benefit drugs, or prescription drugs—as they reference in this executive order—squeaked away and didn't have to comply with the regulations.

They're coming back and saying, we're going to enforce and we're going to make sure that drug prices are visible. What does this mean for the whole healthcare industry? I actually agree with what I think the government believes here, which is that it makes it easier for a patient to understand what they're going to pay for healthcare services before they go in. They use this term of “guaranteed upfront prices,” and that's their government speak for saying it's as easy to go get healthcare services and know what you're going to pay as it is to book a flight or go get a haircut or whatever example you want to use—that's what they're going for. We are not there yet, but these are the building blocks and foundation that they're using to get there.

In the first part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Chris O’Dell, Turquoise Health’s SVP of market solutions, outlines the key provisions of the recently released executive order on healthcare price transparency.

Unfinished Healthcare Reform

Charitable donations have long been a vital lifeline for patients struggling to afford life-saving medications, particularly those with chronic and rare diseases. Over the past few decades, various assistance programs—including nonprofit safety nets, third-party organizations, and manufacturer-sponsored free drug initiatives—have emerged to bridge the gap between medical advancements and patient affordability. However, despite these efforts, high out-of-pocket costs still prevent many individuals from accessing essential treatments. In an interview with 

, Jonathan James, CEO of Hope Charities, shares insights on reducing barriers to care and improving patient access.

PC: Are there emerging models of charitable giving or patient assistance that you believe could redefine financial access to care in the coming years?

Redefining access to care is a significant task—one that thousands of people have worked on in the United States for a long time. I believe there are numerous hurdles that need to be addressed. We've evaluated various policy changes that could meaningfully improve accessibility for people with these needs. However, achieving a laser-focused agreement remains challenging.

One piece of legislation that has brought significant change in recent years is the Inflation Reduction Act, which limited out-of-pocket expenses for people on Medicare. If you look at what we call the "Medicaid unwinding" that occurred after COVID—where people were once again required to continually prove eligibility—many individuals lost Medicaid coverage and were left in a vulnerable position. Today, millions of people in this country remain completely uninsured. Addressing these challenges requires overcoming several systemic barriers. The Affordable Care Act (ACA) was a game-changer in many ways, expanding access to commercial insurance, which was a positive development.

On the flip side, many people still don’t know how to navigate the system. They remain hesitant or uncertain, as the healthcare landscape has gone through multiple changes over time. In many states, we’ve seen that when people seek coverage through the marketplace, they initially had three to five plan options—some more competitive than when the ACA first launched. However, in certain ZIP codes, choices have since dwindled to just one plan, and that option is often expensive. Fortunately, subsidies have helped bridge some of the financial gap, but much more work is needed to ensure health insurance remains sustainable and accessible.

According to statistics from the Kaiser Family Foundation, while there is significant focus on high-cost medications, they actually account for only about 13% of total healthcare expenditures in the United States. The real financial burden lies in hospitalization and inpatient care, which make up over 50% of costs. As a result, while high-cost medications receive intense scrutiny, they represent a relatively small portion of overall spending. Meanwhile, hospitalization expenses require greater attention and cost-reduction efforts.

The system is complex in many ways, but if we can ensure people receive the care they need at home—such as timely access to the right prescriptions—the reliance on costly hospital visits would decrease. It's crucial that we continue providing robust financial assistance for individuals in critical care situations who require ongoing access to medications. Doing so will help prevent hospitalization costs from escalating even further.

 Charitable donations have played a crucial role in helping patients access life-saving medications, particularly those with chronic and rare diseases who face significant financial barriers. Over the past 25-30 years, various assistance programs—including nonprofit safety nets, third-party organizations, and manufacturer-sponsored free drug programs—have emerged to support patients struggling with the rising costs of healthcare. However, despite these efforts, many individuals still face challenges in affording their treatments, with high out-of-pocket costs often preventing them from receiving necessary care.

For conditions like hemophilia, where annual treatment costs can exceed $1 million, losing access to medication can mean a drastic decline in quality of life, forcing patients to rely on disability or face severe health complications. While charitable programs provide critical relief, they also struggle with sustainability due to funding shortages and limited public awareness. Many organizations must balance the need to educate patients about available assistance while ensuring they have enough resources to support those in need.

Healthcare policies such as the Inflation Reduction Act and Medicaid redeterminations have also influenced access to care, sometimes alleviating costs for certain populations while creating new challenges for others. While high-cost medications often receive the most scrutiny, hospitalization and inpatient care account for a much larger portion of healthcare spending. Expanding financial assistance for prescription medications could help reduce hospital admissions and lower overall healthcare costs.

Looking forward, there is a need for more sustainable models of charitable giving and financial aid to ensure that patients can consistently access the treatments they need. Policy reforms, expanded subsidies, and a greater focus on preventative care may help create a more equitable healthcare system while reducing the financial strain on both patients and assistance programs.

Jonathan James, CEO, Hope Charities, discusses how, despite policy advancements, millions of people still face barriers to healthcare access.

Latest Conference Coverage

PAP 2025: The Unfinished Work of Healthcare Reform

Hope Charities 

Charitable donations have long been a vital lifeline for patients struggling to afford life-saving medications, particularly those with chronic and rare diseases. Over the past few decades, various assistance programs—including nonprofit safety nets, third-party organizations, and manufacturer-sponsored free drug initiatives—have emerged to bridge the gap between medical advancements and patient affordability. However, despite these efforts, high out-of-pocket costs still prevent many individuals from accessing essential treatments. In an interview with 

PC: Tomorrow, you will be a part of the “Retrospective on the Impact of Charitable Donations” panel. Can you provide a brief synopsis of what the session will entail?

I’m really excited about it because it explores how we arrived at the system we have today. There are significant reimbursement challenges and barriers to care, particularly for medications that people rely on—not only for quality of life but also for life-threatening conditions that can cause permanent disability.

PC: Based on your retrospective analysis, how have charitable donations evolved in their effectiveness at reducing financial barriers to care?

Programs designed to help patients—whether through third parties, internal organizations, or various support systems and safety net programs—have been essential in maintaining access to life-saving medications. Over the past 25 to 30 years, the system has evolved in response to rising healthcare costs, which have created significant hurdles. There is a constant tension between having FDA-approved medications available and patients being unable to afford them due to high out-of-pocket costs.

We often say that the most vulnerable patients are already living with severe, disabling, and critical medical conditions. When a medication exists but remains financially inaccessible, these individuals are put in an even worse position due to financial vulnerability.

It is crucial that we address these barriers. The system that exists today has emerged from the efforts of nonprofit organizations and third parties striving to alleviate the burden on individuals. Given the current structure, programs like free drug initiatives from manufacturers and third-party patient assistance programs play an essential role in ensuring that patients receive the medications they need when they need them.

Charitable donations have played a crucial role in helping patients access life-saving medications, particularly those with chronic and rare diseases who face significant financial barriers. Over the past 25-30 years, various assistance programs—including nonprofit safety nets, third-party organizations, and manufacturer-sponsored free drug programs—have emerged to support patients struggling with the rising costs of healthcare. However, despite these efforts, many individuals still face challenges in affording their treatments, with high out-of-pocket costs often preventing them from receiving necessary care.

Jonathan James, CEO, Hope Charities, discusses reimbursement challenges and barriers to care in patients requiring life-saving medications. 

PAP 2025: How Charitable Programs Are Evolving to Improve Patient Access to Life-Saving Medications

Legal Implications of Tariffs on Pharma Supply and Prescription Drugs

PC: What are the legal implications of the latest tariffs—including the "reciprocal" variety—and what challenges do they present to the pharma supply chain?

Reciprocal tariffs could create significant disruptions in the supply chain and many commercial contracts. I don’t want to get overly technical, but many contracts include clauses that activate certain procedures or nullify agreements when events beyond a party’s control occur—such as embargoes or excessive tariffs. These clauses will become increasingly relevant as they may need to address the impact of excessive tariffs. Supply chain disruptions could arise at any moment, particularly with raw materials, which are frequently sourced from overseas.

Some people may have different opinions, but in my view, these tariffs will negatively affect the supply chain and, ultimately, our economy at every level. Prescription drug costs will likely rise significantly as a result.

Unfortunately, Congress has granted broad authority to the executive branch through legislation. Specific laws that come to mind include the Trade Expansion Act of 1962 and the International Emergency Economic Powers Act of 1977. These laws delegate power to the president to adjust tariffs in response to specific circumstances, such as national security concerns or trade negotiations, without requiring new congressional approval. Because of this, the president holds significant control over tariffs, and unless Congress enacts new legislation to curtail this power, the courts have limited options to intervene.

At this point, I’m not entirely sure how the power dynamic will unfold. It used to be that Congress and the president shared these responsibilities, but now, we have to wait and see. Tariffs could be an experiment. That seemed to be the case during this administration’s previous term—some tariffs led to negative consequences, while others remained in place.

The future of NIH-funded research is facing significant uncertainty due to changes in funding policies under the new administration. A major issue is the reduction of indirect cost reimbursements, which cover administrative, regulatory, and overhead expenses, from 50% to 15%. This shift, currently halted by legal challenges, threatens research institutions’ financial stability. Additionally, a freeze on grant proposal reviews via the Federal Register has further complicated NIH’s funding process, requiring researchers to seek alternative funding sources, primarily from the private sector. However, this shift could create a highly competitive environment, potentially stalling critical research in areas like cancer and sickle cell disease.

Political challenges, including diversity-related restrictions, further complicate clinical trials. Researchers may now need to approach trial design with a more conservative lens, which could hinder studies focused on minority populations and vaccine development. If funding and regulatory barriers persist, the U.S. risks losing scientific talent to more research-friendly environments in the EU and Asia.

While some court rulings have temporarily allowed NIH to continue research funding, long-term solutions would require Congressional action. However, given the current partisan landscape, legislative intervention to secure NIH funding against political interference appears unlikely. If the administration defies court rulings, it could create a constitutional crisis, undermining the checks and balances of the federal government.

Beyond NIH, new reciprocal tariffs could disrupt the pharmaceutical supply chain, particularly for raw materials sourced internationally. Many commercial contracts include clauses that could be triggered, nullifying agreements and exacerbating supply shortages. Given the executive branch’s broad authority over trade policy, tariff changes could increase prescription drug costs and create economic instability. With Congress unlikely to reclaim tariff-setting power soon, the full impact remains uncertain, necessitating a “wait and see” approach.

 to watch the entire interview on Pharmaceutical Executive, our sister publication.

Ron Lanton, Partner, Lanton Law, examines the legal and economic impacts of reciprocal tariffs on the pharma supply chain, including potential disruptions and increased drug costs. 

Understanding the Legal Implications of Tariffs on the Pharma Supply Chain and Prescription Drug Pricing

How a Completely Open Generic Market Could Alter Rx Costs

, Geoffrey Joyce, PhD, director of health policy at the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California (USC, describes how the 10% tax on Chinese goods and a potential 25% tariff on pharmaceuticals could have notable effects on the price, quality, and safety of generic drugs. He explains that while branded and generic drug markets operate differently, the cost of generics is typically much lower, with intense competition driving prices down. A 10% tariff on generics might not significantly impact costs because most of the price is tied to distribution, not manufacturing. However, the COVID-19 pandemic highlighted the risks of relying on countries like China and India for essential generics, which has led to a push to bring production back to the U.S.

A 25% tariff would likely make domestic production more attractive, but generics are low-margin products, so this may result in higher consumer prices. Joyce suggests that tariffs could disrupt supply chains but not lead to significant changes in US production in the short term. Additionally, the low-profit nature of the business could encourage foreign manufacturers to cut corners, potentially reducing drug quality. California's failed attempt to create its own generic drug industry illustrates the challenges in stimulating domestic production for these low-margin drugs.

While tariffs might encourage some domestic production, it could come at the cost of higher prices and possibly lower drug quality. The overall impact on the drug supply chain remains uncertain, with concerns about reliability and safety, especially if foreign manufacturers face increased production costs.

Joyce also describes what makes the generic drug market susceptible to supply chain disruptions; how the tariffs can affect price or competition within the branded drug space; health policy developments that coming down the pike that the pharma supply chain should prepare for; and much more.

What are the benefits of a completely open generic market powered by cash?

When we look at the generic drug market, we've done studies comparing what insured populations pay for generic drugs, and although the prices, the markups in dollar terms tend to be small (in percentage terms), the middlemen—the pharmacy benefit managers, etc.—make a lot of money off generics to a point where I'm not even sure they should be insured.

I think you could take them out of the insurance market. We did a study where generally, Costco beat Medicare Part D. Why? Because Costco, basically gets drugs from a wholesaler and tries to have a minimal markup, and try, in essence, to deliver value to their consumers. Once you go through these webs of insurance chains, insurance companies, PBMs, and these black, opaque boxes of everyone skimming at the top, generics are more expensive than they should be. I think if you had a completely open generic market, and people had to pay cash for it, I think actually that would improve the market.

In the final part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Geoffrey Joyce, PhD, director of health policy at the Leonard D. Schaeffer Center for Health Policy & Economics at USC, describes how PBMs financially benefit from generics, and why a completely open generic market powered by cash would be beneficial. 

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