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For a couple of months now, I’ve been making jokes about how the right way to understand what’s coming from the Trump administration around health policy is just to shrug and say “Nobody knows.”
But I’ve also believed that this gag would run its course. Governing requires choices, and choices are illuminating.
Or, at least, they should be illuminating.
The early reality of Trump 2.0 is — still — “nobody knows.” Much was made of Trump’s day one executive order rolling back a Biden executive order calling for CMS to come up with some ideas on lowering drug prices. And CMS, sure enough, floated three pilot programs.
So did the Trump order jettison the pilots? Or was it just a symbolic act? Initially, the answer was “nobody knows.” That allowed all manner of both low-information clickbait and reasonable speculation to propagate.
Yesterday, though, STAT finally found a (partial) answer: at least one of the three pilots — the one about paying for gene therapies — is indeed moving forward, suggesting that Trump’s order was Sharpie and fury, signifying nothing. No word on the other two pilots, which might well end up dead, but not because of the executive order.
And today, CMS dropped an announcement that the agency will move forward with Medicare “negotiations,” releasing a thin statement confirming that, sure, they’ll keep enforcing the law. It was framed in some quarters as evidence that the new administration is committed to the program, but the lack of details and the lack of any sort of clear authority figure makes it impossible to parse.**
Is the Trump CMS going to stay the course of negotiations? Despite a ton of media coverage, nobody knows.
Of course, that was small potatoes compared to the fact that the Medicaid payment portal was shut down most of the day yesterday due to confusion about a Trump order to stop the flow of money to government grants.
No one quite knew what Trump was driving at, and efforts to clarify that no, Medicaid wasn’t supposed to be impacted, and yes, the payment portal should be back up and functioning is probably cold comfort to the millions counting on the government paying its bills.
“Nobody knows” used to be a fun joke. It’s becoming a cruel one.
** My guess on this, FWIW, is that the administration has seen the online conversation on drug prices spiral a bit out of control here. The contention that Trump is walking away from the topic — from price controls, from $35 insulin, from any sort of check on drug pricing — is not hard to find, and I assume that the dual announcements on the CMMI pilot and the drug-negotiation program are designed to quiet that. Good luck.
Novo Nordisk has asked the federal appeals court hearing its IRA lawsuit to hustle up (the precise legal language is “set oral argument as soon as practicable and resolve the appeal expeditiously following argument”). Novo noted that the selection of Ozempic/Wegovy for the next round of “negotiations” amplifies the need to get the underlying issue in that case resolved.
Robert Kennedy, Jr.’s first confirmation hearing is underway as I write. I’m not able to watch, but rest assured that I’ll flag anything interesting on drug pricing tomorrow. On my radar: how he really feels about march-in rights.
I need to sit down and think through a whole bunch of new initiatives from Express Scripts/Evernorth that promise to make rebated prices available to patients and amp up patient-directed transparency. I tend to be skeptical about this kind of thing, but I’m leaving it here without comment. If you have thoughts, please hit “reply” and tell me how to think about it.
Cost Curve is produced by Reid Strategic, a consultancy that helps companies and organizations in life sciences communicate more clearly and more loudly about issues of value, access, and pricing. We offer a range of services, from strategic planning to tactical execution, designed to shatter the complexity that hampers constructive conversations.
To learn more about how Reid Strategic can help you, email Brian Reid at brian@reidstrategic.com.
