Rare disease drugmakers try to avoid Trump price cuts

July 21, 2026 - 17:42

Pharmaceutical companies that specialize in treatments for rare diseases are scrambling to shield their products from possible price cuts under a potential second Trump administration. During his first term, President Trump pushed for policies linking drug prices to lower international benchmarks, a move that disproportionately affects orphan drugs, which already operate on thin margins due to small patient populations. Industry lobbyists are now meeting with Republican advisors to argue that capping prices on these therapies would stifle innovation and leave patients with no alternatives. The concern is that Trump's "most favored nation" proposal, which would tie U.S. prices to the lowest rates paid abroad, could be revived. Drugmakers warn that without high domestic profits, they cannot recoup the massive research costs required for diseases that affect fewer than 200,000 people.

Meanwhile, a new poll shows that a majority of GOP voters want stricter enforcement against health care fraud. The survey, conducted by a conservative advocacy group, found that 78% of Republican respondents believe the government is not doing enough to prosecute fraudulent billing in Medicare and Medicaid. This sentiment aligns with Trump's own rhetoric about "draining the swamp," but it puts party leaders in a bind. Many GOP lawmakers have historically opposed increasing funding for fraud detection agencies, arguing it leads to overregulation. Voters, however, see fraud as a direct driver of higher premiums and taxes.

Separately, pharmacy benefit managers are finding new ways to sidestep state transparency laws. A report released this week reveals that PBMs are using complex rebate structures and "alternative funding programs" to avoid disclosing how much they pocket from drug transactions. States like Ohio and Louisiana passed laws requiring PBMs to report their pricing models, but companies have responded by shifting revenue streams to unregulated subsidiaries. Patient advocates say this undermines efforts to lower out-of-pocket costs, as hidden fees continue to inflate prices at the pharmacy counter.