Pharma stares down another term without a friend in the White House

The big picture: "There is no leading candidate that's a friend of the pharmaceutical industry at this point. Not DeSantis, not Trump, not Biden," said Joe Grogan, former director of the Domestic Policy Council under Trump.

• Even if "you go to the next tier on the Republican side, you'd have to be thinking about candidates who aren't even in the race yet, like Glenn Youngkin," he added.

Driving the news: Trump promised to double down on "tough-on-pharma policies" in a new campaign plank posted to his website with little fanfare last week.

• Trump indicated he wants to bring back his "most favored nation" policy, which pegged what Medicare pays for drugs to the prices in other developed countries, many of which have national government-run health systems.
• "Under my policy, the United States government will tell big pharma that we will only pay the best price they offer to foreign nations, who have been taking advantage of us for so long," Trump says in a video posted to his campaign website. "The United States is tired of getting ripped off."
• Courts blocked the most favored nation program during the Trump administration, and the Biden administration later rescinded it.

Between the lines: Trump eschewed Republican orthodoxy during his time in the White House — at least in rhetoric, as none of his major drug pricing policies were ever implemented.

• His frustration with the industry has likely only escalated since he left office. Pfizer announced that its experimental coronavirus vaccine was more than 90% effective just days after the 2020 election, reportedly angering the former president, who suggested the timing was intended to sabotage his election prospects.
• "As I have long said, @Pfizer and the others would only announce a Vaccine after the Election, because they didn't have the courage to do it before. Likewise, the @US_FDA should have announced it earlier, not for political purposes, but for saving lives!" Trump tweeted following the news.
• Many Republicans have since become deeply skeptical of the vaccines and, in some cases, their manufacturers. DeSantis, the Florida governor, has launched a statewide grand jury to investigate whether the vaccine makers misrepresented information — perhaps criminally — about the shots' safety and efficacy.

Biden is no industry ally, either. Getting Congress to allow Medicare to negotiate drug prices has been one of Biden's marquee achievements as president — and a major pain for drugmakers.

• Industry players and their allies have filed four lawsuits so far, which could potentially block the policy before it goes into effect.

• But Biden has threatened to go further: Since signing Medicare drug negotiation powers into law last summer, Biden has issued an executive order directing agencies to further decrease consumers' drug costs, and he called for expanding Medicare's negotiating powers in his budget earlier this year.

What they're saying: The pharmaceutical industry doesn't like either candidate's proposals.

• "Imposing [other countries'] misguided policies on the American people was the wrong approach when it was first introduced, and it's still the wrong approach today," a spokesperson for the Pharmaceutical Research and Manufacturers of America said in a statement to Axios.
• "Wherever governments get in the business of setting the price of lifesaving medicines, patients in those countries face delayed or denied access to innovative cures and treatments," PhRMA continued.

Reality check: Despite the escalating political rhetoric around drug prices, launch prices for drugs keep getting higher — and Medicare negotiations aren’t currently designed to address this.

• The median launch price for a new drug has increased from $2,115 per year in 2008 to $180,007 in 2021, according to a study published in JAMA last year.

Zoom out: "We are long past the idea of or the age of a perfect ally," said Nick Shipley, chief advocacy officer at the Biotechnology Innovation Organization.

• "We are much more in the age of nuance. Like, 'Hey, can I work with you in good faith?'" he added.

The bottom line: The drug industry's political troubles are likely just beginning.

• "There's not necessarily a light at the end of the tunnel," Grogan said.