Congress and President-elect Trump have many options for lowering prescription drug prices. The problem is, few of those will deliver meaningful results.

Why it matters: The reality is the ongoing Medicare drug pricing negotiations created by the Democrats' Inflation Reduction Act may be the best bet, at least in the near term, to bring down some pharmaceutical prices.

The big picture: Growth in U.S. brand-name drug prices has outpaced inflation in recent years, and federal projections show the retail prescription drug market will total $690 billion by 2031.

• Lowering drug prices would save patients, employers and insurers money. However, drugmakers say it also would reduce their expected revenue and diminish the incentive to invest in new cures.
• The IRA's drug pricing policy — which still faces a barrage of legal challenges — reset the political tradeoffs, making it harder to water down the government's power to negotiate more drugs if Republicans pursue repeal.

As a candidate, Trump pledged to sign an executive order on day one of his presidency to "end global freeloading" and have Medicare pay the lowest price that other countries pay for drugs.

• But in October, his campaign abruptly reversed itself and dropped the proposal.
• That left him without a clear plan to address the cost of prescription medicines.

State of play: An approach like the one Trump gave up was the only one of the seven congressional scorekeepers recently reviewed that would have a "large effect," meaning it would reduce average prices for the market by more than 5% in 2031.

• This "international reference pricing" plan would yield the biggest results soon after implementation, but they would probably diminish over time, the Congressional Budget Office said.
• That's because manufacturers would adjust to the new policy by altering prices or distribution of drugs in other countries.
• Other approaches would result in a 1% to 3% reduction in average prices, CBO said, such as expanding negotiated drug prices to the private insurance market or penalizing manufacturers when a drug's price increases faster than inflation.
• And steps like eliminating or limiting direct-to-consumer prescription drug ads or speeding up market entry for generic and biosimilar drugs would yield reductions of just 0.1% to 1%, CBO said.

What we're watching: It may be tough for Republicans to square their populist rhetoric on drug pricing with more traditional GOP concerns about heavy-handed government squelching pharmaceutical innovation.

• Trump has said multiple times he felt the U.S. was getting ripped off for prescription drugs.
• But he didn't put that rhetoric into action until the waning days of his first term.
• And a rule he proposed to tie Medicare reimbursements for 50 drugs to the lowest prices paid by certain other countries stalled in the courts.

Efforts in Congress to address drug prices now mostly focus on proposals to revise patent laws that pharmaceutical companies use to protect their innovations.

Why it matters: While the bills are limited in scope, some could generate savings that could be used to offset new health spending in a year-end legislative package.

The latest: One leading effort is a bipartisan plan from Sens. John Cornyn (R-Texas) and Richard Blumenthal (D-Conn.).

• It would crack down on "patent thickets," the practice of taking out overlapping patents around one drug. The bill's backers say drug companies use those patents to fend off competition.
• The Senate passed the bill unanimously in July, but it's been left off the House floor schedule so far.
• Pharmaceutical interests argue manufacturers need to be able to use the intellectual property system to innovate after a drug is rolled out.

Two other patent bills that critics say are friendlier to drug interests were abruptly dropped from consideration by the Senate Judiciary Committee this week because they lacked the votes to advance.

• The PREVAIL Act would raise the bar for challenging patents by requiring petitioners to have standing, either by having been sued or threatened with a patent infringement lawsuit.
• The PERA Act would amend what kinds of inventions are eligible for patent protection and make it easier for certain scientific discoveries, like gene therapies, to be patented.

What we're watching: Both of the bills, sponsored by Sens. Chris Coons (D-Del.) and Thom Tillis (R-N.C.), could resurface in amended form in the lame duck session or next year.