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Donald Trump held a press conference Wednesday in New York City that mostly concerned his campaign's alleged (and very, very unproven) ties to Russian government operatives. But when one reporter broached the subject of the Obamacare repeal that is set to slowly work its way through Congress, Trump responded with a bit of blink-and-you'll-miss it news: He wants the federal government to be able to negotiate with drug companies on medication prices.The US, he said, needed to "create new bidding procedures for the drug industry because they're getting away with murder… We're the largest buyer of drugs in the world, and yet we don't bid properly, and we're going to start bidding, and we're going to save billions of dollars over a period of time." (Drug prices are abnormally high in America compared to other countries, and a potential factor is that Medicare, one of the biggest buyers of drugs, isn't allowed to negotiate with pharma companies.)This was not a brand-new position—Trump talked about negotiating with drug makers during the campaign—but almost immediately after his press conference remarks, pharma stocks dipped and stayed down until trading closed.Big pharma stocks soared just after Trump got elected, as did the broader market, on the assumption that Trump's anti-regulation views would make him an unabashedly pro-business president. But the president-elect's apparent support for letting Medicare negotiate drug prices—a position normally held by Democrats—is potentially bad news for the pharma industry.There a lot of questions, however: Will Trump really follow through on his pledge to stop drug companies "getting away with murder"? And if Medicare does negotiate with big pharma, will that really drive down prices? To find out more, I spoke to Daniel Hartung, a pharmacist and associate professor at Oregon State University who conducted a study on skyrocketing drug costs in 2015. He told me it literally might be easier to lower drug costs by tweeting at big pharma than by trying to negotiate.VICE: Is Trump right about big pharma getting away with murder?
Daniel Hartung: Well, it's pretty clear that the pharmaceutical industry does not [give] a favorable impression to the public, so it's always a good political point to make.Can Trump just decide to let Medicare negotiate drug prices?
There would have to be some sort of congressional action that would take place to allow that to occur. Many people debate whether that would be effective from a pragmatic standpoint—having a gigantic federal bureaucracy negotiate prices for every drug that Medicare purchases.What does that debate involve?
Just from the Medicare perspective, when [the Medicare Prescription Drug Modernization Act] was legislated in the early 2000s, the compromise to get the thing passed, to get support from pharma, was to put in the provision that the federal government wouldn't negotiate directly [with drug companies], but basically have all the business dealings and purchasing done by the private Part D plans.Why would that provision be a good idea?
The theory was that competition on the part of the Part D plans would bring down costs for beneficiaries, and to some extent that's happened. Over the years, legislators have talked—this pricing issue has been around for a while, and it's kind of resurfaced again—and people have discussed the notion of allowing Medicare as a federal purchaser to negotiate by itself to try and get better rebates or discounts.Has there ever been any progress on making that more than just a notion?
It's always been kind of a political nonstarter, largely because the pharmaceutical industry has such a big lobbying arm. But it was definitely a talking point in the last presidential elections, with, I think [Bernie] Sanders and [Hillary] Clinton [supporting it]. And Trump.Do you see legislation passing under Trump that would allow for these kinds of negotiations?
I'm not sure. For a person who comes from a business background, it's hard to imagine that he could propose and get the political will together to put forward a broad-based, aggressive price-setting, or more aggressive negotiating tactics against the pharmaceutical industry. I think his rhetoric right now is still in campaign mode, where it's just very popular to say what he said about the pharmaceutical industry getting away with murder. Supposedly there's going to be something in the new version of the Affordable Care Act, when it's replaced, that speaks to drug prices, but I have no idea [what that would be]. I don't think anyone else knows either.Are there any other ways to stop these prices from climbing?
In the days leading up to the inauguration, he's aggressively gone after companies in specific industries on Twitter and whatnot. And from a public perspective seems to have elicited specific changes in response, real or perceived. That's not a coherent policy solution to the problem, but I think there are, perhaps, some things that could be done.Are you saying he might be able to tweet at pharmaceutical companies and force them to make price changes?
Given the fact that pharma is really acutely aware of its PR image right now, and also partly aware that the new president is not afraid to publicly excoriate any particular company over unpopular things they've done. Perhaps there may be a slowing in some of the increases that have been observed, because of the fear of being publicly castigated by Trump. I can see that happening. But I can't envision a policy solution that would be proactive that would have a real tangible effect.Would the effect of bullying the companies be lower prices?
I definitely find it realistic that there could be a slowing in some of those [price] increases that have been observed just because there's a massive amount of public scrutiny on this issue right now. There might be some fear like, "We need to rein ourselves in right now, because who knows what might happen from a legislative perspective." I could see an increasingly vocal president having some kind of effect in terms of the public image of pharma, and them not wanting to reap any sort of increased regulation, or any regulatory stick aimed at them.What policy would you suggest Trump pursue if he wanted to reduce healthcare costs?
If I could make one suggestion that would save some money very quickly—and I'm not sure what would be required legislatively—it would be allowing dual-care Medicare-Medicaid enrollees to receive their benefits from the Medicaid side. There would be more rebates coming in than we currently see gathered from the Medicare program. I think there's potentially billions there that could be saved.This interview has been edited for length and clarity.Follow Mike Pearl on Twitter.
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Daniel Hartung: Well, it's pretty clear that the pharmaceutical industry does not [give] a favorable impression to the public, so it's always a good political point to make.Can Trump just decide to let Medicare negotiate drug prices?
There would have to be some sort of congressional action that would take place to allow that to occur. Many people debate whether that would be effective from a pragmatic standpoint—having a gigantic federal bureaucracy negotiate prices for every drug that Medicare purchases.What does that debate involve?
Just from the Medicare perspective, when [the Medicare Prescription Drug Modernization Act] was legislated in the early 2000s, the compromise to get the thing passed, to get support from pharma, was to put in the provision that the federal government wouldn't negotiate directly [with drug companies], but basically have all the business dealings and purchasing done by the private Part D plans.Why would that provision be a good idea?
The theory was that competition on the part of the Part D plans would bring down costs for beneficiaries, and to some extent that's happened. Over the years, legislators have talked—this pricing issue has been around for a while, and it's kind of resurfaced again—and people have discussed the notion of allowing Medicare as a federal purchaser to negotiate by itself to try and get better rebates or discounts.
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It's always been kind of a political nonstarter, largely because the pharmaceutical industry has such a big lobbying arm. But it was definitely a talking point in the last presidential elections, with, I think [Bernie] Sanders and [Hillary] Clinton [supporting it]. And Trump.Do you see legislation passing under Trump that would allow for these kinds of negotiations?
I'm not sure. For a person who comes from a business background, it's hard to imagine that he could propose and get the political will together to put forward a broad-based, aggressive price-setting, or more aggressive negotiating tactics against the pharmaceutical industry. I think his rhetoric right now is still in campaign mode, where it's just very popular to say what he said about the pharmaceutical industry getting away with murder. Supposedly there's going to be something in the new version of the Affordable Care Act, when it's replaced, that speaks to drug prices, but I have no idea [what that would be]. I don't think anyone else knows either.Are there any other ways to stop these prices from climbing?
In the days leading up to the inauguration, he's aggressively gone after companies in specific industries on Twitter and whatnot. And from a public perspective seems to have elicited specific changes in response, real or perceived. That's not a coherent policy solution to the problem, but I think there are, perhaps, some things that could be done.
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Given the fact that pharma is really acutely aware of its PR image right now, and also partly aware that the new president is not afraid to publicly excoriate any particular company over unpopular things they've done. Perhaps there may be a slowing in some of the increases that have been observed, because of the fear of being publicly castigated by Trump. I can see that happening. But I can't envision a policy solution that would be proactive that would have a real tangible effect.Would the effect of bullying the companies be lower prices?
I definitely find it realistic that there could be a slowing in some of those [price] increases that have been observed just because there's a massive amount of public scrutiny on this issue right now. There might be some fear like, "We need to rein ourselves in right now, because who knows what might happen from a legislative perspective." I could see an increasingly vocal president having some kind of effect in terms of the public image of pharma, and them not wanting to reap any sort of increased regulation, or any regulatory stick aimed at them.What policy would you suggest Trump pursue if he wanted to reduce healthcare costs?
If I could make one suggestion that would save some money very quickly—and I'm not sure what would be required legislatively—it would be allowing dual-care Medicare-Medicaid enrollees to receive their benefits from the Medicaid side. There would be more rebates coming in than we currently see gathered from the Medicare program. I think there's potentially billions there that could be saved.This interview has been edited for length and clarity.Follow Mike Pearl on Twitter.