Rising care costs This year, thelist price of more than 3,000 drugs went up, while the price ofonly 117 went down, according to data compiled by Rx SavingsSolutions. (Photo: Shutterstock)

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President Donald Trump announced last month that the GOP willbecome “the party of health care,” and news reports suggest heintends to make it a top issue in his reelection campaign.

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So when Mick Mulvaney, the acting White House chief of staff,touted the administration's work on prescription drug prices — ahot-button issue that has drawn scrutiny from across the politicalspectrum, and one that voters say should be a top priority — we were intrigued.

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Related: Drug pricing hearings: How far will the politiciansgo?

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On “Fox News Sunday” April 7, Mulvaney said: “Drug prices in this country actually came downlast year for the first time in 50 years. That's because DonaldTrump's president.”

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This statement is particularly hard to prove affirmatively. Drugprices are measured through a host of metrics and affected by allsorts of political and economic forces.

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We reached out to the White House for more explanation. Itsstaff directed us to a report published last October by its Council of Economic Advisers, aswell as to data suggesting the consumer price index forprescription drugs declined in January 2019 compared with January2018.

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But experts who reviewed that data said it doesn't necessarilysupport Mulvaney's claim — and certainly not by the magnitude hesuggests.

A broad brush, and some missing data

We interviewed five experts who all agreed that, no matter whichmetric was used, evidence is lacking to unequivocally say drugprices decreased last year. The most generous reading came fromMatthew Fiedler, a health economist at the Brookings Institution:It's “within spitting distance of something that's true.”

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But with more examination, the claim's veracity becamemurkier.

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“Drug prices” can refer to many things: a list price, a netprice (what is paid after rebates, or the discounts negotiated byinsurers or other payers), the pharmacy's price or total nationalspending on prescription drugs.

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Let's start with the latter. Data from the Kaiser Family Foundation shows total spending on prescriptiondrug prices has climbed during the past several years. (KHN is aneditorially independent program of the foundation.) In 2018, totalspending continued to grow, just at a slower pace. That's apositive trend, experts noted, but it isn't the same thing asspending going down.

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“It doesn't mean we're spending less money on drugs thanbefore,” said Stacie Dusetzina, an associate professor of healthpolicy at Vanderbilt University.

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We also examined the CPI data the White House provided. It couldsuggest that in the past year prescription drugs' list prices haveindeed dropped, and even by a meaningful amount.

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But the CPI data doesn't account for whether manufacturerslowering their list prices have also changed the size of therebates they provide. That's essential information in understandingif the real price of a drug — what insurance pays and, ultimately,what consumers pay — has actually changed.

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These trend lines also vary depending on the 12-month periodthey cover, argued Walid Gellad, an associate health policyprofessor at the University of Pittsburgh. January to January couldshow a list price decrease, but July to July could show anincrease.

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Plus, the CPI data includes only drugs sold through retail, orabout three-fourths of all prescriptions. That excludes manyhigh-priced specialty meds sold only via mail order, argued MichaelRea, who heads Rx Savings Solutions, a consulting firm.

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It also paints with a broad brush — obscuring, many said, justhow many list prices are continuing to climb.

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This year, the list price of more than 3,000 drugs went up,while the price of only 117 went down, according to data compiledby Rx Savings Solutions. Last year, ananalysis by the Associated Press revealed that, from January toJuly, 4,412 branded drug prices went up, while 46 were cut.

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So, Mulvaney's downward price claim didn't come out of thin air.But interpreting the data to mean that drug prices are down ignorescrucial parts of the prescription drug marketplace.

The White House's work

Mulvaney also said Trump has played a key role in bringing downdrug prices. When we asked the administration what he meant, aspokesman pointed to their efforts to bring more generic drugs tomarket — a boost the White House said has fueled competition andhelped make lower-price alternatives available to consumers.

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But there's no evidence yet to suggest that the boost in genericdrug approvals has that effect. Experts said it takes time forthese products to reach the marketplace, create competition anddemonstrate a measurable impact on prices.

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Indeed, many of those generics, while approved, never went to market. This WhiteHouse assertion also doesn't account for high-priced, branded drugsthat lack a generic counterpart.

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Yes, Trump's tough talk — accusing pharma companies of “getting away with murder” — may have persuaded some drugmanufacturers to hold off on increasing their prices — at leasttemporarily, or until after the government releases key stats onhow many prices have gone up, Dusetzina said. But it's hard toseparate that phenomenon from the pressure also levied by Congressand state legislatures.

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For what it's worth, the administration has proposed many newpolicies meant to curb drug prices, many noted, such as eliminatingsome kinds of rebates, or changinghow Medicare Part B pays for drugs. But none of those havetaken effect — so they haven't brought prices down.

The ruling

Mulvaney said, “Drug prices in this country actually came downlast year for the first time in 50 years. That's because DonaldTrump's president.”

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At first glance, CPI data could conceivably support the argumentthat the list prices for some prescription drugs dipped. But thatdata doesn't include many high-priced specialty drugs that drivecosts up, and the pattern it illustrates can change based on thetime frame selected.

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The CPI data set obscures the individual drugs for which thelist prices have increased — with far more going up than down. Italso does not account for a drug's true “net price.”

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Mulvaney's statement also does not reflect trends showing that,nationally, spending on drugs has continued to climb, even if thatgrowth has slowed. There is also no evidence to support theargument that Trump himself is responsible for changes in drugpricing.

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This claim has an element of truth, but it ignores key facts andcontext that would give a very different impression. We rate thisclaim Mostly False.

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Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente. This fact checkwas produced in partnership with Politifact.


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