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So whose ox is being gored under the Trump Administration’s blueprint to lower prescription drug prices? Well, if you guessed the powerful and politically well-connected multinational pharmaceutical companies — surprise — you’re wrong! A close look at the myriad policy proposals and actions announced by the White House and its Department of Health & Human Services (HHS) point to a focus mainly on drug prices but not drug manufacturers.

While the Administration is tweaking how Medicare reimburses hospitals and physicians for certain drugs and is seeking feedback on the idea of passing drug rebates directly to seniors, the bottom line is that the various proposals under consideration mostly takes aim at some of the key players in the $450 billion U.S. drug market: pharmacy benefit managers, health plans and providers but largely spares the drugmakers themselves from suffering any real pain.

In terms of industry feedback to the blueprint, two consistent themes emerge from comments by the top players in the drug market: everyone generally opposes government price-setting which is already prohibited by law and all agree that drug prices are the fault of someone else. Pharma’s leading trade group takes its aim against PBMs while the other key players— PBMs, hospitals and health insurers — charge that its drugmakers\themselves which are blame for today’s problems with drug pricing.