Trump and HHS Secretary Alex Azar speak at a White House event on drug prices. Photo: Chip Somodevilla/Getty Images

The Trump administration's next steps on drug pricing could come quickly: The White House budget office is reviewing a new proposal to change the way pharmacy benefit managers — the middlemen between drugmakers and the pharmacy counter — get paid.

What I'm hearing: Even by the standards of the drug supply chain, this is likely to be an extremely complex and in-the-weeds rule. It's not entirely clear how much of PBMs' payment structure the administration can change on its own, without any help from Congress.

What they're saying: “While we cannot comment on pending regulations, the President’s ‘American Patients First’ blueprint to lower drug prices and reduce out-of pocket costs clearly states that we are looking at removing safe harbor protections for drug company rebates. It should not come as a surprise that this would require rulemaking," HHS spokesperson Caitlin Oakley said.

Driving the news: The administration took another significant step on drug pricing yesterday — arguably its most impactful step to date — when Food and Drug Administration Commissioner Scott Gottlieb rolled out a new plan to spark the development of more biosimilar drugs.

  • Biosimilars are, in effect, generic versions of highly complex (and very expensive) biologic drugs. Biologics look like the future of drug development, but the biosimilars market has been slow to heat up.
  • Yesterday's announcement may not pay immediate dividends, but building a competitive market now could definitely yield noticeable savings in the future — even though these products likely won't offer the same steep discounts we're used to with traditional generics.

"This week, we will see more action to reform drug pricing in America than we have seen in a number of years," Health and Human Services adviser Dan Best says in a blog post.

  • For the most part, Best's post rounds up what the administration has done so far and criticizes "some in the media" for "still claiming that the Trump Administration’s plan for reforming drug pricing isn’t delivering."

Reality check: A strong market for biosimilars would make a big difference for future patients. Changes in the PBM industry could, too — PBMs are powerful players who operate in near-total secrecy. President Trump's plan has the potential to affect change.

But some of what HHS is hyping is just not that big a deal.

  • For example, Best touts the recent announcements that Pfizer and Novartis would delay their most recent round of price increases — which Trump himself also noted on Twitter this morning.
  • Here's some context from my colleague Bob Herman: The list price of Novartis' cancer drug Gleevec has gone from $26,000 in 2001 to $146,000 in 2017. And it's not going down — it's just staying put, temporarily, at $146,000.

Taking a five-month breather on price increases is more of a public relations play than a business strategy, and it's far from structural change that would affect future price hikes. To wit: Pfizer's now-delayed increases are set to kick back in at the end of the year.

Go deeper

Updated 2 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Politics: Pence chief of staff Marc Short tests positive for coronavirus — COVID-19 looms over White House Halloween celebrations
  2. Health: Fauci says maybe we should mandate masks if people don't wear them — America was sick well before it ever got COVID-19
  3. World: Polish President Andrzej Duda tests positive for COVID-19.

Pence chief of staff Marc Short tests positive for coronavirus

Marc Short with Katie Miller, Vice President Pence's communications director, in March. Photo: Doug Mills/The New York Times via Reuters

Marc Short, Vice President Mike Pence’s chief of staff, tested positive for the coronavirus Saturday and is quarantining, according to a White House statement.

Why it matters: Short is Pence's closest aide, and was one of the most powerful forces on the White House coronavirus task force.

9 hours ago - World

Opposition leader Leopoldo López flees Venezuela

Venezuelan opposition politician Leopoldo López outside the Spanish embassy in Caracas, in 2019. Photo: Juan Barreto/AFP via Getty Images

Leopoldo López, a former political prisoner and prominent Venezuelan opposition leader, has left the country, his Popular Will party confirmed in a statement Saturday.

Why it matters: He's been highly influential in the push to oust President Nicolás Maduro's regime and a mentor to opposition leader Juan Guaidó. He'd been in the Spanish ambassador's Caracas residence since escaping house arrest in April 2019 following a failed military uprising.