President Trump held a high-profile event this week with Mark Cuban and others to announce the expansion of Trump RX, the prescription drug discount platform at trumprx.gov, adding over six hundred affordable generic drugs through Cuban’s Cost Plus Drugs operation and claiming the site has already been visited more than ten million times and saved consumers over $400 million since its February launch.
C. Steven Tucker, founder and principal broker at healthinsurance.com and one of the most knowledgeable health insurance experts in the country, joined Dan Proft on Chicago’s Morning Answer to separate what is genuinely new about Trump RX from what is essentially a repackaging of existing resources.
Tucker said the most important thing to understand about Trump RX is that it is powered by GoodRx, and the thousands of prescription discounts available at trumprx.gov have been available at goodrx.com for many years. His clients have been using them for a long time, as have millions of Americans around the country. The website name is new, the federal branding is new, and the addition of Cuban’s six hundred generic drugs is a genuine and welcome addition. But Trump’s claim that nobody has ever seen anything like this does not square with the reality that GoodRx has been providing virtually identical prices for years. The practical benefit is consolidation, giving consumers one central hub so they do not have to open a separate browser window, and the potential volume effect Cuban described, where greater utilization drives down Cuban’s own costs and eventually his prices, is plausible though not yet proven.
Tucker’s bigger concern is that the most significant driver of inflated drug costs, particularly brand name and specialty drugs, is not being addressed. He pointed to the 340B program, which was created in the early 1990s to allow hospitals serving genuinely underserved communities to purchase drugs at roughly half the manufacturer’s price. Following the Obamacare Medicaid expansion, utilization of the program has grown by approximately seventy-four percent, and wealthy hospital systems including major academic medical centers are now capturing the discount and charging patients with private insurance more for those same drugs, generating billions of dollars in revenue with virtually no oversight of where the money is going. Tucker said hospital systems are building new facilities with 340B revenue while the program’s original purpose of helping low-income communities has been largely abandoned. He said the Wall Street Journal has published what he considers a definitive exposé of the grift, and that the president should address 340B directly rather than focusing exclusively on consumer-facing discount platforms.
He said Pharmacy Benefit Manager elimination would also be a meaningful step, and agreed with the general argument that PBMs extract enormous rents without adding genuine value. On Trump’s most favored nation drug pricing initiative, Tucker said the full picture will not be clear for at least three years because Pfizer, one of the largest pharmaceutical companies in the world, received a three-year waiver from the new tariff requirements. He said price controls of this kind are generally something one expects from Democratic administrations rather than Republican ones, and that a predictable consequence of forcing drugs to be sold at the lowest global price in the American market is that pharmaceutical companies simply stop selling those drugs in lower-income countries where populations depend on them, a humanitarian cost that deserves more attention in the policy debate.
Proft noted that he had asked the ACA’s architect Ezekiel Emanuel about the Wall Street Journal’s critique of Obamacare’s surtaxes, which are not indexed for inflation and are hitting more middle-class taxpayers each year, and that Emanuel’s response was essentially that the law just needs some updating and maintenance. Tucker said he would have had several questions for Emanuel, including whether he considers it good that one hundred and forty-six health insurance companies have exited the individual marketplace nationally since Obamacare’s implementation, whether he considers it acceptable that Illinois and Michigan are now the only Midwestern states still offering PPO policies in the individual market while all surrounding states offer only restrictive HMOs, and whether he thinks a bronze-level plan costing a couple in their fifties twenty-four hundred dollars per month with a ten-thousand-six-hundred-dollar deductible represents a success.
He contrasted Illinois’s situation with states like Indiana, where clients are paying half the monthly premium of Obamacare-compliant plans with roughly half the deductible, have access to national PPO networks, and can lock their premiums in for three years through short-term health insurance made available under Trump’s first-term regulatory changes. Illinois residents have none of those options because Governor Pritzker has prohibited non-Obamacare short-term health insurance, leaving Illinois consumers with a market dominated almost entirely by a single Blue Cross PPO and a handful of restrictive HMOs.
On the state’s health insurance exchange, Tucker said Illinois abandoned the federally perfected healthcare.gov, which taxpayers across the country spent a billion dollars developing, and now mandates use of getcovered.illinois.gov, a site that crashes eighteen to twenty-two times during a typical application completion. The transition produced a crisis earlier this year in which consumers who paid their December premiums on time to obtain January first coverage did not actually receive coverage for weeks or in some cases months because the exchange failed to transfer enrollment data to Blue Cross, leaving people without health insurance through mid-March while still owing three months of back premiums simultaneously.