特朗普没有实际政策，要求制药商降低美国价格
【中美创新时报2025 年 5 月 13 日编译讯】（记者温友平编译）特朗普总统周一签署了一项行政命令，要求制药商自愿降低美国主要药品的价格。但该命令并未援引任何明显的法律依据来强制降低药品价格。该命令称，如果制药商不遵守规定，政府将考虑采取监管行动或在未来从其他国家进口药品。《纽约时报》记者Margot Sanger-Katz and Rebecca Robbins对此作了下述报道。
对于制药行业来说，这可以说是一次胜利，因为该行业一直在准备迎接一项可能对其利益造成更大损害的政策。
上周，特朗普大肆宣扬即将发布的一项“重磅消息”。周日晚上，他在“真相社交”（Truth Social）网站上发帖，宣布将根据“最惠国”定价模式，将美国药品价格与其他国家的药品价格挂钩——他在第一任期内曾尝试过这项政策，但未能成功，只针对医疗保险中的一小部分药品。
他周一的行政命令并没有做到这一点。受此消息影响，制药类股周一上涨。
特朗普的行政命令发布前几个小时，众议院共和党人提出了一系列广泛的医疗政策改革方案，这些改革方案将在未来十年内削减医疗补助计划（Medicaid）和奥巴马医改市场约7000亿美元的资金，并导致约860万美国人失去医保。国会拒绝在该方案中加入任何直接限制药品价格的条款。
该行政命令还要求联邦机构调查欧洲国家为何获得较低价格，并敦促它们支付更多费用。特朗普政府推高欧洲价格的筹码有限。
特朗普周一在签署行政令前表示：“我不是在批评制药公司。我实际上更批评的是国家，而不是制药公司。”
特朗普通过行政命令选择不提出可能更具约束力的措施，例如呼吁其政府与国会合作立法或制定法规来改变政府医疗计划支付某些药品费用的方式。
哈佛医学院研究药品政策的阿米特·萨帕特瓦里 (Ameet Sarpatwari) 表示：“这项行政命令读起来更像是一份鼓舞人心的声明，而不是认真尝试发起一项政策变革。”
许多共和党议员反对管制药品价格，但特朗普长期以来一直抨击现行制度，即制药公司对美国的收费远高于世界其他地区。
他在周一的活动中表示：“我们将与其他国家一起帮助制药公司。”
特朗普威胁要利用贸易政策迫使欧洲国家提高处方药价格。但制药公司已经与各国政府签订了合同，如果它们试图提高新药价格，欧洲国家可能根本不会承担这些费用。药品定价专家警告称，欧洲药价上涨并不一定会导致美国药价下降。
特朗普在其第一任期内曾试图颁布一项更具实质性的政策，以降低联邦医疗保险（Medicare）支付的部分药品价格，但未能成功。联邦医疗保险是为65岁以上或身有残疾的美国人提供的医疗保险计划。该计划原本仅适用于在诊所和医院使用的50种药品。联邦法院裁定，特朗普政府跳过了政策制定过程中的一些步骤，从而阻止了该计划的实施。
目前尚不清楚，如果按照原计划执行，这项政策是否能够通过法律审查。一些专家在采访中表示，特朗普需要国会通过一项法律。
白宫曾调侃这项声明具有重大意义。周一的行政命令表面上要求进行比特朗普第一任期内提出的更广泛的改革，影响范围将扩大到更多药品和所有美国人，而不仅仅是部分医保患者。但它缺乏明确的降价实施机制。
“这听起来几乎就像：我们只是要求降低价格，看看情况如何，”范德堡大学研究药品定价的卫生政策教授斯塔西·杜塞齐纳说。她说，除非采取更实质性的行动，“否则我预计药品价格近期不会下降。”
该命令称，如果初步行动未能在降低美国药品价格方面取得足够进展，特朗普政府可能会“提出一项实施最惠国定价的规则制定计划”。
民主党已提出多项法案，旨在使美国药品价格与其他国家更加接轨，拜登政府期间通过的立法也允许联邦医疗保险（Medicare）直接就该计划中使用的部分药品价格进行谈判。总体而言，降低药品价格的政策在共和党和民主党选民中都很受欢迎。
制药行业也一直在为特朗普誓言即将实施的进口药品惩罚性关税做准备。关税很可能会推高美国部分药品价格，并削减制药商的利润，即使他们可以转嫁部分额外成本。
制药商游说团体在周一发表的声明中表示，美国不应该向其他国家了解其药品价格。
但主要的行业组织美国药物研究与制造商协会对特朗普威胁利用贸易谈判来迫使外国政府“支付其应得的药品费用”的做法表示赞赏。
美国药物研究和制造商协会首席执行官斯蒂芬·J·乌布尔 (Stephen J. Ubl) 表示：“美国患者不应该为全球创新买单。”
美国的品牌药品价格平均是其他同类国家的三倍。
制药商通常围绕从美国获得的丰厚利润来制定商业战略。
但在美国，除了拜登时代针对医疗保险（Medicare）中有限数量药品的计划外，政府很少正式参与制定药品价格。特朗普政府目前正在监督该计划。
本月，密苏里州共和党参议员乔希·霍利和佛蒙特州民主党参议员彼得·韦尔奇提出一项法案，将美国药品价格限制为一组同等国家支付价格的平均水平。
韦尔奇在接受采访时表示，他同意特朗普的观点，即美国人支付的费用过高，而国际比较有助于制定更公平的价格。但他认为国会需要解决这个问题，以确保政策的持久性。
他说：“通过立法来做到这一点确实很重要。”
题图：2025年5月12日星期一，唐纳德·特朗普总统在华盛顿白宫罗斯福厅与美国卫生与公众服务部部长小罗伯特·F·肯尼迪（右二）和医疗保险和医疗补助服务中心负责人穆罕默德·奥兹博士（右）共同出席新闻发布会。特朗普总统签署了一项行政命令，要求制药公司自愿降低药品价格。（埃里克·李/《纽约时报》）埃里克·李/纽约时报
附原英文报道：
With no real policy, Trump asks drugmakers to lower US prices
By Margot Sanger-Katz and Rebecca Robbins New York Times,Updated May 13, 2025, 2:03 a.m.
President Donald Trump speaks at a news conference with Secretary of Health and Human Services Robert F. Kennedy Jr., second from right, and Dr. Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, right, in the Roosevelt Room of the White House in Washington, on Monday, May 12, 2025. President Trump signed an executive order that asks pharmaceutical companies to voluntarily lower drug prices. (Eric Lee/The New York Times)ERIC LEE/NYT
President Trump on Monday signed an executive order asking drugmakers to voluntarily reduce the prices of key medicines in the United States.
But the order cites no obvious legal authority to mandate lower prices. The order said the administration would consider taking regulatory actions or importing drugs from other countries in the future if drugmakers do not comply.
It was something of a win for the pharmaceutical industry, which had been bracing for a policy that would be much more damaging to its interests.
Last week, Trump hyped a coming announcement that was “as big as it gets.” And on Sunday evening, he teed up the order in a Truth Social post, writing that he would link US drug prices to those in peer countries under a “most favored nation” pricing model — a policy he attempted unsuccessfully in his first term for a small set of drugs in Medicare.
Trump’s executive order came just hours after House Republicans offered an expansive set of health care policy changes that would cut around $700 billion from Medicaid and the Obamacare marketplaces over a decade and would cause an estimated 8.6 million Americans to become uninsured. Congress declined to include any provisions to directly limit drug prices in that package.
The executive order also called on federal agencies to investigate why European countries get lower prices and to push them to pay more. The Trump administration has limited leverage to drive up prices in Europe.
“I’m not knocking the drug companies,” Trump said Monday before signing the order. “I’m really more knocking the countries than the drug companies.”
With his executive order, Trump opted not to propose measures that could have had more teeth, such as calling for his administration to work with Congress on legislation or writing regulations to change how government health programs pay for some drugs.
“The executive order reads more like an aspirational statement than a serious attempt to initiate a policy change,” said Ameet Sarpatwari, who studies pharmaceutical policy at Harvard Medical School.
Many Republican lawmakers oppose controls on drug prices, but Trump has long railed against the current system, in which pharmaceutical companies charge the United States significantly higher prices than the rest of the world.
“We’re going to help the drug companies with the other nations,” he said at Monday’s event.
Trump threatened to use trade policy to push European countries to pay more for prescription drugs. But drug companies are already locked into contracts with governments, and if they try to charge more for new medicines, European countries may balk at covering them at all. And higher prices in Europe would not necessarily lead to lower prices in the United States, drug pricing experts warned.
In his first term, Trump tried unsuccessfully to enact a more substantive policy to reduce some drug prices paid by Medicare, the health insurance program for Americans who are over 65 or have disabilities. That plan would have applied only to 50 drugs, administered at clinics and hospitals. A federal court blocked it, ruling that the administration had skipped steps in the policymaking process.
It is not clear whether that policy could have passed legal muster had it been pursued by the book. In interviews, some experts said Trump would have needed Congress to pass a law.
The White House had teased the announcement as seismic. Monday’s executive order, on its face, calls for much broader changes than Trump proposed in his first term, affecting more drugs and all Americans, not just some Medicare patients. But it lacks a clear mechanism for enacting the price reductions.
“It almost sounds like: We’ll just ask for lower prices and see how that goes,” said Stacie Dusetzina, a health policy professor at Vanderbilt University who studies drug pricing. Barring more substantive action, she said, “I would not anticipate drug prices to come down in the near future.”
The order said that if the initial actions did not make enough progress in lowering US drug prices, the Trump administration may “propose a rule-making plan to impose most-favored-nation pricing.”
Democrats have introduced numerous bills to bring American prices more in line with those of foreign peers, and legislation passed during the Biden administration allows Medicare to negotiate directly on the price of a limited set of drugs used in the program. In general, policies that would lower drug prices are very popular among both Republican and Democratic voters.
The drug industry has also been bracing for punishing tariffs on imported medicines, which Trump has vowed to impose soon. Tariffs would most likely drive up some drug prices in the United States and cut into drugmakers’ profits even if they can pass along some of the added costs.
In statements Monday, lobbying groups for drugmakers said the United States should not look to other countries for how much it pays for drugs.
But the main industry group, PhRMA, applauded Trump for threatening to use trade negotiations to push foreign governments “to pay their fair share for medicines.”
“US patients should not foot the bill for global innovation,” said Stephen J. Ubl, PhRMA’s chief executive.
Brand-name drug prices in the United States are three times as high, on average, as those in peer nations.
Drugmakers typically design their business strategy around the substantial profits they bring in from the United States.
But in the United States, the government has very little formal involvement in setting drug prices, other than the Biden-era program for a limited number of drugs in Medicare. The Trump administration is now overseeing that program.
This month, Senators Josh Hawley, a Missouri Republican, and Peter Welch, a Democrat from Vermont, introduced a bill that would limit drug prices in the United States to an average of the prices paid by a group of peer countries.
In an interview, Welch said he agreed with Trump that Americans are overpaying and that international comparisons could help set fairer prices. But he thinks Congress needs to tackle the issue to ensure a durable policy.
“It’s really important to do this legislatively,” he said.
