A Final Try by Trump to Cut Drug Prices May Stumble in Court

Though Mr. Trump described the policy as transformational, it may have very limited impact for most Medicare beneficiaries. The policy applies only to a category of drugs that patients get from doctors in an office or a hospital, not to drugs they buy themselves at the pharmacy counter. While some seniors do end up paying for a share of such drugs, the vast majority have special insurance that protects them from the cost. That means that the savings are likely to benefit the government more than individual patients. It will have no effect on the prices paid by people who get insurance through work or buy their own health plan.

But the plan, as written, would also change how medical providers are paid for administering those drugs, reducing their payment, too. An effort by Obama administration health officials to reduce those payments faced major opposition from the medical industry and was ultimately scuttled.

“America’s hospitals and health systems have very deep concerns about the substance and legality of today’s Most Favored Nation Model interim final rule,” said Tom Nickels, an executive vice president for the American Hospital Association, in a statement.

Mr. Trump announced two other major health policies. One would eliminate the rebates paid by drug companies to middlemen purchasers, a priority of Alex M. Azar II, the secretary of the Department of Health and Human Services. Another would loosen some anti-kickback rules on business relationships between doctors and other businesses, in an effort to improve cooperation between different players in managing patients’ health.

For years, Mr. Azar sought completion of the rebate rule, but faced opposition from the White House, including Joe Grogan, the former head of the Domestic Policy Council, who worked aggressively to kill the policy. Mark Meadows, the White House chief of staff, has worked with Mr. Azar this year to revive it as part of a package of drug pricing initiatives, senior administration officials said.

In a statement, a spokeswoman for PhRMA, the leading trade group for drugmakers, did not say whether the industry would bring lawsuits against the pricing rule. “It defies logic that the administration is blindly proceeding with a ‘most favored nation’ policy that gives foreign governments the upper hand in deciding the value of medicines in the United States,” said Nicole Longo, the group’s director of public affairs, who called the policy “unlawful.”

The statement was more supportive of the rebate rule, which drugmakers have tended to support.

Mr. Trump’s news conference was dotted with grievances against the pharmaceutical industry. He complained that he was the victim of “millions and millions of dollars in ads” targeting his drug pricing initiatives. He said Americans “have been abused by big pharma and their army of lawyers, lobbyists and bought-and-paid-for politicians.” White House officials are still upset about the collapse of an agreement with the pharmaceutical industry this summer to offer discounts to Medicare beneficiaries.