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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 55 mins ago - World

Mexican President López Obrador tests positive for coronavirus

Mexico's President Andrés Manuel López Obrador during a press conference at National Palace in Mexico City, Mexico, on Wednesday. Photo: Ismael Rosas/Eyepix Group/Barcroft Media via Getty Images

Mexican President Andrés Manuel López Obrador announced Sunday evening that he's tested positive for COVID-19.

Driving the news: López Obrador tweeted that he has mild symptoms and is receiving medical treatment. "As always, I am optimistic," he added. "We will all move forward."

Sarah Huckabee Sanders to run for governor of Arkansas

Sarah Huckabee Sanders at FOX News' studios in New York City in 2019. Photo: Steven Ferdman/Getty Images

Former White House press secretary Sarah Huckabee Sanders will announce Monday that she's running for governor of Arkansas.

The big picture: Sanders was touted as a contender after it was announced she was leaving the Trump administration in June 2019. Then-President Trump tweeted he hoped she would run for governor, adding "she would be fantastic." Sanders is "seen as leader in the polls" in the Republican state, notes the Washington Post's Josh Dawsey, who first reported the news.

Coronavirus has inflamed global inequality

Illustration: Aïda Amer/Axios

History will likely remember the pandemic as the "first time since records began that inequality rose in virtually every country on earth at the same time." That's the verdict from Oxfam's inequality report covering the year 2020 — a terrible year that hit the poorest, hardest across the planet.

Why it matters: The world's poorest were already in a race against time, facing down an existential risk in the form of global climate change. The coronavirus pandemic could set global poverty reduction back as much as a full decade, according to the World Bank.