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President Trump and congressional Republicans are on very different pages on prescription drug prices. Although Trump has wavered on his policy ideas, he generally backs a populist set of reforms. The rest of the GOP stands by its traditional free-market ideas.

This leaves Trump two options if he wants to get something done: Fall in line with the rest of his party, or reach across the aisle. "I think he may find that in order to get something significant done, he's gotta work with Democrats," said Rep. Elijah Cummings, who has been talking to Trump about his ideas.

What Trump wants, according to what he's said in public (although he's gone back and forth) and what Cummings said they discussed:

  • Allowing Medicare to negotiate prices
  • Allowing the importation of drugs from abroad, from places like Canada

Why we're watching this: After the embarrassing defeat of Obamacare repeal last week, the president could use a win, especially one with such widespread public support.

"I think with the defeat of repeal, the pressure will be on to do something about all the concerns about high prices. Drugs seem like the obvious place to go," said John Rother, who heads the Campaign for Sustainable Rx Pricing. "They need a win on health care, and they need to resume their standing with consumers and constituents. This would be a way to do that."

But other Democrats aren't convinced Trump is serious when he says he wants to crack down on the pharmaceutical industry.

  • Sen. Bernie Sanders, who talks about a lot of the same policy ideas as Trump: "I think he lied a lot," he said. "It's one thing to say something in a campaign about how you're going to come up with health care for all, how you're going to fight for working people, then surround yourself with Wall Street titans and billionaires that do exactly the opposite of what he said."
  • Sanders has a point, although the problem is less Wall Street than just mainstream conservatives. Vice President Mike Pence voted against Medicare's prescription drug benefit more than a decade ago in the House, one of only a few Republicans to do so. And Department of Health and Human Services Secretary Tom Price supported traditional Republican drug policy in the House as well.
  • Sen. Chris Murphy: "Perhaps drug prices is a way for Trump to work with Democrats, but it doesn't seem like he has the capability to do that."

Signs Trump could be serious:

  • Cummings met with Trump on the issue earlier this month, and Trump has called him to follow up three times.
  • Trump knows polling shows voters are eager for Washington to do something to lower the price of drugs, Cummings said. He also knows "it's one thing he could do that would benefit a lot of his constituents. And not just the 36 percent that are polling in favor."
  • Sen. Joe Manchin, who has visited the White House several times, said he and Trump have also talked about prescription drug prices. But, Manchin said, Trump's going to have to decide which congressional votes he's going to seek, knowing the far-right are hard to get. "If you gotta get the votes, you gotta get the votes where they are."

What congressional Republicans say: Many are gung-ho about doing something about drug prices, but generally want to stick to ideas involving increasing market competition and getting generics to market faster.

  • In the House, the Energy and Commerce committee has already held a hearing on such a bill.
  • "I happened to be talking to Sec. Price about this this morning. I just think there's a lot more interest in FDA and innovation and thinking through this than there has been in a long time," Sen. Roy Blunt told me.

But others aren't so sure Trump will get anything done on the matter, both because of how politically controversial it is and because of the current gridlock both between parties and within the GOP.

  • "He wanted to do health care reform too," said Sen. Richard Burr. The votes have never been there for policies like importing drugs and allowing government price negotiations, Burr said: "The legislative body is its own animal."
  • Sen. John McCain, one of the few Republican supporters of importing drugs from Canada, said he thinks tackling the issue could be a good political win. "But I've been trying to go there for about 20 years," he added.

The bottom line: McCain voiced what many Hill-watchers are beginning to wonder following the catastrophic failure of Trumpcare: "I don't know if we're going to do anything," he said with a shrug.

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