Trump vs Harris—who's on Big Pharma's side?

Scarcely anything unites lawmakers in America these days, but the ostensible iniquities of Big Pharma could be a rare exception.

While Donald Trump famously accused the industry of "getting away with murder” on prices, the rhetoric from Democrats has been equally stark, with Vice President Kamala Harris boasting she took on “deceptive and illegal practices.”

How might the outcome of the forthcoming presidential election affect health policy in a country that represents both the largest market for pharmaceuticals, and the most important setting for drug development?

Amidst the cacophony of name calling and disinformation, it can be difficult to discern a substantive policy direction on either side, but there are clues to what we might expect from a future Trump or Harris administration.

Regulatory oversight

Given the value strategic acquisitions can bring for large drugmakers, the industry may be concerned about a perceived tightening in the Federal Trade Commission’s (FTC) approach.

President Trump’s record in office is mixed, with certain tech and media mergers being nixed while others were waved through. However, analysts generally expect a more lenient stance from a Republican candidate, and key deals such as 2018’s CVS-Aetna merger were approved.

Stephanie Kennan, senior VP for federal public affairs at McGuireWoods Consulting, says the FTC has become stricter under Biden.

"The FTC’s makeup now is such that they really look at large mergers and question whether they will impact competition. And they're looking at them in a much more strict way than any previous administration has,” she says.

Of course, a future Harris administration may chart a different course, but Kennan expects her to be: “very much the same as Biden in terms of competition and regulation."

Biden’s battle with Big Pharma

Like his peers in Congress, President Biden has at times used highly oppositional language in relation to the industry, particularly in support of his signature policy achievement, the Inflation Reduction Act (IRA).

In a punchy State of the Union address, which marked the high point of his ill-fated reelection campaign, Biden won applause declaring he: “beat Big Pharma” with the new law,  securing seniors and taxpayers: “a better deal."

The future of the IRA is a consequential issue for drugmakers, who are concerned that an emboldened White House might seek to extend pricing controls to other products, or to the private healthcare market.

Indeed, an earlier version of Biden's $35 monthly insulin price cap would have applied to private plans, had the Senate not blocked its passage.

Starting in 2026, newly negotiated prices for select drugs—such as those for diabetes, heart failure, and cancer—will reduce costs, with savings for patients ranging from 38% to 79%. The program is expected to be expanded in future.

Harris: radical leftist?

Political contributions suggest drugmakers favor the Democratic ticket, with industry giving over a million dollars to the Harris campaign this year, more than four times the amount her opponent has received.

This might seem counterintuitive given that the Vice President, whose casting vote secured the IRA's passage in late 2022, is sure to continue enhancing the legislation.

Her track record as Attorney General of California has also been perceived as anti-industry, including high-profile legal action and support for greater pricing transparency, as well as legislation mandating that firms justify price increases while disclosing costs.

But Harris is no radical. The first round of drug price negotiations under the IRA did not unsettle investors, a reflection of the fact that, for now at least, the revenue impact remains modest.

And while she has in the past supported bolder action, including Senator Bernie Sanders' plan to ban private health insurance outright, Harris later softened her stance to allow for a transition period. A relatively progressive agenda has encouraged Republicans to ring the ‘radical socialist’ alarm bell, but healthcare policy expert Stephanie Kennan expects a more conservative approach if Harris becomes president.

"Her campaign says that her position has evolved," Kennan says, adding that Harris is: "no longer with the ‘Medicare for All’ camp and supports continuing the Affordable Care Act,” including extending a credit for premiums which recently expired.

Through its expansion of health insurance, the ACA has generally been viewed as beneficial for industry, and drugmakers would likely not support Mr Trump’s vow to repeal the legislation (citing unspecified “concepts of a plan” for its replacement), particularly given the increased instability that this would lead to.

Trump’s attacks on prices

While Democrats have fought to reduce drug costs, former President Trump has also criticized perceived industry excesses. Despite being seen by many as more business-friendly, Trump targeted pharma’s pricing practices, focusing on lowering costs through generics, biosimilars, and out-of-pocket price caps.

Kennan says Trump: “didn't vary in the goal, he varied in his tactics."

"I also would say that the Trump administration didn't have a cohesive strategy. They took aim at one issue, then another and another, rather than taking a stepwise approach," she adds.

During his time in office, Trump attempted to tie Medicare to lower international prices under a ‘most favored nation’ rule, a proposal which PwC estimated would cost major pharmaceutical players over $100 million annually, with even higher impacts for the top five companies. However, legal challenges delayed the initiative, and it was later scrapped by the Biden administration.

Another Trump initiative, a plan to import low-cost drugs from Canada, faced similar obstacles. Although Florida became the first state to gain federal approval for the program, opposition on the Canadian side and the requirement for FDA approval of each product have slowed implementation. Projected savings of up to $180 million have yet to be realized.

There is little indication from Trump's recent statements that he would represent a softer option for drugmakers, should voters grant him a second bite at the cherry in November.

On the contrary, in the run-up to his election campaign he issued perhaps his starkest warning yet, stating that if the industry: “puts profits above people, they must be investigated and held accountable.”

In 2025, one outcome is clear. As the next administration takes shape, the industry will need to navigate an adversarial Congress, with a President who has little interest in awarding favors.

But with a buoyant US economy, record drug approvals and levels of innovation at an all-time high, better patient outcomes are surely on the way nonetheless.