For the pharmaceutical industry, Trump vs. Harris is a showdown between two industry enemies

Former President Donald Trump and Vice President Kamala Harris agree on a rare point in their otherwise bitter and divisive dispute: It is up to the government to lower high drug prices in the United States.

Harris cast the deciding vote in the Senate in 2022 on a bill that would allow Medicare to negotiate drug prices for its more than 60 million insured people. Previously, she was an aggressive regulator of the pharmaceutical industry as California's attorney general.

As president, Trump would likely continue Medicare price negotiations unless the drug industry can put something more compelling on the table, people close to him say. During his first term, he proposed several measures to reduce prescription costs but had limited success in implementing them.

However, the pharmaceutical industry could benefit if Trump continues to fail to push through such proposals.

“His efforts were largely fragmented and faced resistance from both industry and lawmakers,” said Sergio Jose Gutierrez, a political strategist who has worked primarily with Democrats in the U.S. “The lack of a coherent strategy and limited ability to implement meaningful change made his approach less effective compared to what a Harris-Waltz administration could offer.”

According to KFF polls, the industry is increasingly under attack from politicians in both parties over drug prices that most Americans consider unreasonable. The outcome of the election could therefore determine the fate of pharmaceutical companies. Their predicament is a dramatic turnaround from years past, when the companies enjoyed a reputation for being virtually untouchable. For more than a decade, the manufacturers successfully fended off proposals to let Medicare negotiate lower drug prices before losing the battle two years ago.

The shift in their political standing is reflected in pharmaceutical companies' donations to candidates. An industry that gave three to four times as much to GOP candidates as to Democrats in the 1990s and early 2000s is now playing it safe. So far in the 2024 election cycle, pharmaceutical companies have donated $4.89 million to Democrats and $4.35 million to Republicans, according to OpenSecrets, a nonpartisan research group.

Harris received $518,571 from industry and Trump received $204,748.

At the Democratic convention in Chicago last week, Harris and her fellow Democrats touted their success in lowering drug prices. Harris' supporters point to her past and present.

During her tenure as Attorney General of the State of California, she was involved in cases that resulted in pharmaceutical companies being fined nearly $7.2 billion (about $22 per person in the United States).

Her vote to pass President Joe Biden's Inflation Reduction Act not only paved the way for Medicare price negotiations, but also for an annual cap on total drug spending by Medicare beneficiaries at $2,000 and a cap on monthly insulin supplies at $35.

“In the United States of America, no senior citizen should have to choose between filling their prescription and paying their rent,” Harris said on August 15 in her first joint appearance with Biden since he dropped out of the presidential race.

She has promised that if elected president, she will extend both the annual cap on drug spending and the cap on insulin prices to all insured Americans, not just those with Medicare.

Harris also supported a controversial policy that would, in some cases, give the federal government the ability to create more competition in the market by seizing patents on some expensive drugs developed with federal funds.

Doug Hart, 77, of Tempe, Arizona, spent about $7,000 a year on prescription drugs. A drug he takes to prevent blood clots is getting cheaper as part of Medicare price negotiations. The retired union leader said the reduction will be significant and is one reason he supports Harris.

“The Republicans all voted against the Medicare negotiations. Harris broke the tie in the Senate and allowed the negotiations to proceed,” said Hart, a board member of the Arizona Alliance for Retired Americans, which works to mobilize returning union members and activists on progressive issues.

While the Republicans as a party remain relatively friendly toward the pharmaceutical industry, Trump is willing to challenge the Republican Party's orthodoxy by taking action to combat high drug costs.

During his tenure, he sought to align drug prices under Medicare with lower international prices, a proposal that health research firm PricewaterhouseCoopers estimated would cost five drugmakers as much as $500 million annually. The so-called “most-favored nation” clause was blocked due to legal challenges and later repealed by the Biden administration.

Trump issued an executive order allowing the import of drugs from Canada and other countries. Florida this year became the first state to receive federal approval to import certain prescription drugs from Canada. However, the state faced resistance from Health Canada, the Canadian ministry responsible for national health policy.

And on his campaign website, Trump posted a video in which he questioned whether health problems in children were the result of “overprescribing” medications.

“Too often, our public health system is too close to the pharmaceutical industry – they make a lot of money, the pharmaceutical industry – big corporations and other special interests and is unwilling to ask the difficult questions about what is happening to the health of our children,” he said. “When the pharmaceutical industry defrauds American patients and taxpayers or puts profits before people, it must be investigated and held accountable.”

Trump has not spoken much about drug prices during his 2024 campaign, but allies and former advisers say he remains committed to lowering prescription drug prices if re-elected.

He would likely focus on increasing competition in generics and biosimilars, allowing drugs made in the U.S. but sold abroad to be imported back into the U.S., and limiting out-of-pocket costs for insulin, former Trump administration officials say. Other goals could include lowering drug prices in the Medicare 340B program, which requires pharmaceutical companies to provide outpatient drugs at reduced prices to eligible health care organizations that serve low-income and uninsured patients.

“The most important issue that was on his mind during my time in the White House, and that I continue to hear him talk about, is lowering drug prices,” said Theo Merkel, a senior scholar at the conservative think tanks Paragon Health Institute and Manhattan Institute. Merkel also served as a special assistant in the White House under Trump. “I'm confident that will be at the top of the agenda,” he added.

Catherine Hill, a spokeswoman for the Pharmaceutical Research and Manufacturers of America (PhRMA), said the industry association looks forward to working with any future presidential administration.

She criticized the Biden administration's plan to negotiate prices for Medicare, as well as Trump's plan to bring U.S. prices in line with those of other countries. This month, the administration announced new, reduced prices for 10 drugs in the program after negotiations between the federal government and drugmakers. The lower costs will take effect in 2026.

“Previous price controls imposed by the Biden administration threaten to stifle this innovation,” Hill said. “Undermining intellectual property protections and adopting other countries' price controls will further undermine innovation and jeopardize patient access to medicines.”