Trump to Drop Call for Medicare to Negotiate Lower Drug Prices

But top administration officials, like Alex M. Azar II, the secretary of health and human services, and Dr. Scott Gottlieb, the commissioner of the Food and Drug Administration, strenuously oppose those ideas. Republicans argue that the federal government has such overwhelming power as a buyer that it could basically set a price that manufacturers would have to comply with.

And since taking office, Mr. Trump has not endorsed such proposals.

Many ideas in the president’s “blueprint to lower drug prices” can be carried out unilaterally by the secretary of health and human services. But the blueprint also includes several legislative proposals from the president’s 2019 budget request.

One legislative proposal would allow low-income people on Medicare to obtain free generic drugs, without co-payments. Another would, for the first time, establish an overall limit on Medicare beneficiaries’ out-of-pocket costs for prescription drugs. Mr. Trump also wants to lower costs for consumers at the pharmacy counter by requiring Medicare drug plans to pass on at least one-third of the rebates they receive from drug manufacturers.

Mr. Azar, testifying on Capitol Hill on Thursday, described the problem this way: “Prescription drug costs in our country are too high. List prices are too high. Seniors and government programs are overpaying due to lack of negotiating tools. Out-of-pocket costs are too high. And foreign governments are freeloading off of our investments in innovation.”

Democrats are driving for a more aggressive approach. Representative Peter Welch, Democrat of Vermont, said: “We acknowledge that drug companies make life-extending and pain-relieving drugs, and that’s a good thing. But the price gouging is killing patients.” Consumers, he said, are being “held hostage to the pricing power of Big Pharma.”

The Food and Drug Administration approved 1,027 generic drugs last year, a record, and nearly 90 percent of prescriptions are filled with generic medicines, for which consumers often pay less than $25.

But increasing numbers of costly new brand-name drugs are also entering the market. Some provide highly effective treatments for some forms of cancer and other diseases. But the prices sometimes exceed $100,000 a year, and even patients with health insurance may be responsible for tens of thousands of dollars in co-payments.