The Presidential Election Results Might Be Clear, But the Health Policy Implications Are Not

The presidential election is all over but the shouting, as they say. You don’t subscribe to the Curve for political commentary or analysis, so I’ll spare you. If you’re looking for that this morning, you should have your pick of folks elsewhere with a theory on What It All Means. 

But regardless of how you voted, I hope you woke up this morning ready to work for the kind of society you want to live in. 

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In theory, I should spend some time today highlighting the pharma policy issues likely to dominate in a Trump administration. But I fear that’s kind of an empty exercise. 

In small part, that’s because the political dynamics remain fluid, which is a fancy way of saying we don’t know which party will control the House (and likely won’t know for some time). The composition of the lower chamber will serve as either a brake or an accelerant for the Trump agenda, and we don’t know which of those it will be yet. 

But in large part, too much speculation is useless because no one is quite sure what kind of issues will dominate in a Trump administration. Trump walked back his position on the one issue that is right in the wheelhouse of this newsletter -- drug-pricing policy -- by abandoning international reference pricing, and he offered no alternative set of policies. 

Indeed, it’s not even clear what kind of people will be setting health policy for Trump. Former Trump administration leader Joe Gorgan told STAT last month that Robert Kennedy’s embrace of Trump had somewhat scrambled Trump’s health policy agenda. 

I have no idea how the Kennedy thing will play with the more traditional free-market approach of other prominent Republican health policy wonks, and I suspect that Trump doesn’t either. 

That doesn’t mean that I’ll ignore the palace intrigue, though I’ll try to keep it to a minimum. There are certainly some topics likely to be floated in the coming weeks where I’ll share links but that will be more for educational than predictive purposes.

(Think boning up on Part D in a world without stabilization, what happens to the FTC’s PBM efforts without Lina Khan, and the thousand unanswered questions about the legal and administrative elements of the IRA. Axios, for what it’s worth, thinks that PBM reform will continue unabated by the shifting political sands.)

Otherwise, my plan is mostly to sit back and wait for the dust to settle. I suspect there will be a lot of dust. 

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One notable exception to the “keep the election stuff to a minimum” rule is the California ballot question on 340B, Proposition 34. As has been well documented, this is really not about 340B but rather a bunch of landlords trying to stick it to another landlord, which also (weirdly) happens to be a 340B provider, the AIDS Healthcare Foundation.

The results of that initiative are generally unimportant to everyone who isn’t the AIDS Healthcare Foundation, but I can’t help but wonder if there isn’t some general benefit of the idea of 340B floating out to a broader audience as a concept.

The ballot measure seeks to require 340B dollars to be connected to actual patient benefit, at least in the narrow case of the AIDS Healthcare Foundation. Again, the narrow case is not of any practical importance, but the whole thing is built on the assumption that yeah, sure, there ought to be some direct connection between 340B and patient support. 

Right now, support for the measure has a slim majority, but the votes are still being counted. That means that more than 4 million Californians have affirmed, at least in principle, the idea that if you want 340B revenue, you’d better make sure those dollars flow to patients.