The problem is fairly straightforward: We Americans pay more for our drugs compared to the rest of the world. How we got to this point involves many moving pieces like the cost of new drug development and marketing and Bush-era legislation that prohibits Medicare from using a bidding process to get the best drug deals. Add to that the political money trail—lobbying costs and the big dollars invested in political campaigns and the big bucks the pharmaceutical industry spends to lobby spends on Congress is drawing a great deal of media and constituent attention.

Throw in patent limitations and we’re left to wonder how much drug prices can be regulated and how far President Trump and Congress are willing to go in an effort to tame drug costs.

Big pharma’s influence is there. But there is a broader question: do enough Republicans and Democrats have the courage to monitor drug companies to reduce prices as they continually receive big contributions from the drugmakers?

Ah, there’s the rub.

When it comes to drug pricing, Trump and Sen. Bernie Sanders (D-Vt) political polar opposites, are on the same page—they each want to reduce the consumer cost of drugs

So far, Trump has signaled that he wants to go pretty far. In the weeks leading up to Friday’s inauguration, Trump accused the pharmaceutical industry of “getting away with murder” and said he would change the way the country bids on drugs in an effort to reduce costs.

In his Twitter response, Sanders agreed with Trump’s statement that the pharmaceutical industry  is ‘getting away with murder,’ but questioned if “Trump and the Republicans have the guts to police drug companies and lower prices?”

There’s plenty of politicking that remains to be played out.

But the first hint of how difficult it may be to change legislation to open the door for negotiating on bidding on drugs, ostensibly to lower prices, came this month on the Senate floor when Sanders and Sen. Amy Klobuchar (D-MN) introduced a budget resolution amendment to allow pharmacies and patients to import low-cost medicine from Canada.

It was defeated, 52-46, mostly along familiar party lines although 13 Democrats voted against the budget resolution while 12 Republicans voted in favor.

Most Senators who opposed the Sanders plan have been recipients of hefty pharmaceutical industry largess, including Orrin G. Hatch, (R-UT), Mitch McConnell, (R-KY) Cory Booker, (D-NJ), Patty Murray, (D-Wash), Robert Casey Jr., (D-PA) Patrick Toomey, (R-PA) Rob Portman, (R-Ohio) and Michael Bennet (D-Col.), according to Open Secrets.  Among that group, only Chuck Schumer  (D-NY), Joe Manchin III (D-WVa) voted yes.

The GOP vote was not surprising, but the Democratic tally was particularly intriguing.

Among the Democratic “no” votes that stood out was that of New Jersey Sen. Cory Booker, D, certainly seen as a Democratic rising star, according to Open Secrets. And of course Booker represents New Jersey, headquarters of many pharmaceutical companies. From 2009 to 2016, Booker has received more than $277,000 from the pharmaceutical industry. Other Democratic naysayers included fellow Garden State senator Bob Menendez, who received $284,000, Pennsylvania’s Bob Casey, who received $291,000 and Washington Sen. Patty Murray, a recipient of $363,000.

The bottom line: costs.

In case anyone needs reminding, here are some of the comparisons between the drug prices in the U.S. and other countries.

If you went to Spain and bought one bottle of painkiller OxyContin, the price may be $36, but in the U.S. it’s $265. The average price for Humira, the immensely popular drug for rheumatoid arthritis, is about $552 in South Africa, but $2,669 in the U.S., according to the International Federation of Health Plans

“There’s no reason why there should be so many differences,” says Tom Sackville, the iFHP’s chief executive. “It illustrates the damaging effects of an inadequately regulated healthcare market.”

Trump, in a Tweet, noted: “We’re the largest buyer of drugs in the world and we don’t bid properly.” He added, “Our drug industry has been disastrous, they’re leaving left and right. They supply our drugs but they don’t make them here, to a large extent.”

As Trump says, most of our drugs are manufactured overseas. about 80% in China and India, studies show.

The loudest voice in the room?

Sure to have a loud voice in any pricing discussion and regulation is the major drugmaker lobbyist, Pharmaceutical Research & Manufacturers of America, (PhRMA) which has for now remained remarkably reticent about Trump’s comments.

When we asked about Trump’s “getting away with murder” comment, PhRMA had no direct statement. Earlier it issued a low-key statement to HealthDataBuzz, saying it is “committed to working with the new administration and Congress to improve American competitiveness and project American jobs.”

In addition, PhRMA said it plans to work with President Trump and lawmakers “to advance proactive, practical solutions to improve the marketplace and make it more responsive to the needs of patients.”

PhRMA noted how biopharmaceutical companies invested $70 million a year in research and development in the U.S. – and are responsible for 4.5 million American jobs. Jobs, of course, represent an issue close to Trump’s heart, as he loudly demonstrated in the campaign and in his inaugural speech.

Lobbying, Money and Price Negotiations

“Pharma has a lot of lobbies, a lot of lobbyists and a lot of power,” Trump said.

Indeed, in 2016, more than $186 million was spent on lobbying from pharmaceuticals and health products, with 1,429 lobbyists reported. PhRMA alone accounted for more than $18.9 million making it the biggest spender in lobbying, according to Open Secrets.

In the presidential election campaign, Hillary Clinton (D) received $2 million, Bernie Sanders (D), $310,000 and Trump (R), $259,480, according to Open Secrets

After the losing vote in the Senate on his effort to import lower cost drugs from Canada, Sanders said he intended to speak to “every Democrat who voted against the amendment to find their concerns and look forward to joining us in the future.”

The future may come soon enough.

Sanders said he will soon introduce legislation with Rep. Elijah E. Cummings (D-MD) to allow Medicare to negotiate with drugmakers and to permit the importation of safe and affordable drugs from other countries.

In the meantime, PhRMA is getting ready for a big marketing campaign this month to get its messages across, with the idea of spending “tens of millions” each year to get the word out about its industry, according to Fierce Markets.

The drug pricing battle may have just begun.

– By Joe Cantlupe and Margaret Dick Tocknell