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DTC-In-Perspective by Bob Ehrlich

Trump’s Drug Pricing Executive Order: What It Means for Pharma and DTC Advertising

May 12, 2025 0

The monumental Executive Order announced on May 12 is sending a chill through the pharmaceutical industry. President Trump is proposing to significantly lower drug prices in the U.S. by implementing a most favored nation pricing model. In essence, this means that for drugs paid for by the government, the price would be set at the lowest rate charged by any developed country.

There’s a lot to unpack here.

First, this doesn’t apply to all drugs—only those covered under Medicare and Medicaid. Most drugs that patients pick up at a retail pharmacy are not impacted. Also worth noting: legal challenges are expected.

Even if drug profits dip, DTC advertising is not the obvious place to cut. More importantly, DTC delivers a solid ROI—and that’s not going to change.

The rationale from the administration? Trump argues there’s no justification for Americans to pay more for prescriptions than people in Europe, Canada, or other developed nations. According to him, we’re subsidizing the world’s pharmaceutical innovation by footing the entire R&D bill, while foreign countries enjoy cheaper prices due to imposed price controls. This Executive Order aims to put pressure on those countries to contribute more—and Trump intends to tie this issue into future trade negotiations.

Even though the order currently targets only a subset of drugs, the broader industry fear is that it sets the stage for sweeping price controls. Could Congress eventually mandate that all branded drugs follow a most favored nation pricing strategy? That would have massive repercussions—crushing drug company margins and threatening the long-term viability of R&D pipelines.

Faced with this possibility, some pharmaceutical companies may even choose to cut off sales to lower-paying countries. That would be a strategic move to drive up international pricing and allow more equitable pricing for American consumers.

So—will this shake up affect DTC investment?

In my view, probably not. Even if drug profits dip, DTC advertising is not the obvious place to cut. Drugmakers still need to drive demand, especially in a competitive landscape. While companies might scale back some expenses, the $8 billion spent annually on direct-to-consumer advertising is modest compared to total promotional budgets and operational costs. More importantly, DTC delivers a solid ROI—and that’s not going to change.

What this Executive Order does indicate, however, is that the pharmaceutical industry is clearly in the crosshairs. This isn’t your traditional business-friendly Republican approach. Trump and Bernie Sanders may not agree on much, but when it comes to populist pressure on drug pricing, they’re surprisingly aligned.

While DTC advertising may escape immediate scrutiny, this move shows Trump is willing to break from the norm. Is a DTC ban still on the table? I’d say not right now—but let’s not be naïve. The populist momentum is real, and DTC marketers should stay alert, committed to responsible and effective advertising.

Bob Ehrlich

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DTC-In-Perspective by Bob Ehrlich

Congress and DTC Price Disclosure

January 30, 2025 0

The idea of mandating drug price disclosure in DTC ads is here again. A bi-partisan Senate bill was just introduced by Senators Durbin, Grassley, and six others calling for mandatory listing of the wholesale acquisition cost in ads. It is called The Drug-Price Transparency for Consumers Act of 2025.

As with prior attempts, this is bad policy. List prices are not what consumers pay. They are nowhere near what the overwhelming proportion of patients will eventually pay if insured. This bill is meant to discourage DTC advertising by creating a false belief that many drugs are “outrageously” expensive. Their rationale is consumers deserve to know the price of drugs being advertised. They say many other products list their price in ads so why not list them for drugs.

The problem is consumers only care what the final out of pocket cost is to them. Drug pricing is overly complex and that is a legitimate policy issue. Telling consumers a cancer drug is $5,000 a month in a DTC ad is not at all helpful to them if they actually pay $50 with insurance. All that faux disclosure might do is scare them into thinking they cannot afford it.

The bill sponsors’ logic is faulty that listing price creates transparency and price competition. There is no evidence that listing drug prices creates competition given the list price is nowhere near actual patient price. Yes, it may work for automobiles, but not for prescription drugs.

This bill is a blatant attempt to discourage drug ads because payers would prefer consumers not request information on high-priced drugs. Government, insurers, and other payers want to be the sole deciders on what drugs patients can get. DTC is inconvenient for them if a doctor prescribes a high-priced therapy. Does Congress think doctors are prescribing a $100,000 drug for cancer just because a consumer saw an ad?

If this bill passes, drug makers will have to add another useless super in the ad. They can do it if required but will not be intimidated into dropping their DTC ads. Clearly this bill is something the courts might weigh in on as the forced price disclosure inhibits commercial free speech.

Telling consumers a cancer drug is $5,000 a month in a DTC ad is not at all helpful if they actually pay $50 with insurance.

Unfortunately, this bill may just be one of many tactics Congress or HHS will use to try to discourage DTC ads. Robert Kennedy, Jr. wants to ban DTC TV ads outright, but that is unconstitutional so expect approaches that make it harder to do DTC. That could be through tax policy on deductibility of advertising costs, increased OPDP interpretations of violative language, more requirements for fair balance, and lobbying pressure by insurers and payers to limit DTC.

I get the frustration that Americans pay more for prescription drugs than other developed countries. This is a highly charged issue and deserves policy debate. Limiting DTC advertising for lawful products will not affect prices. That $8-10 billion being spent on DTC annually is not significantly driving up costs given our drug spending is over $500 billion annually. Of course, I admit drug companies advertise to increase demand. Given an average ROI of 2 to 1, advertising likely adds $16-20 billion to sales or about 2%. Would drug companies cut prices if they did not spend on DTC? No, they would reallocate to other promotional techniques or other investments.

It is time for Congress to stop trying to ban or restrict DTC. They are grandstanding to the American people with full knowledge their bill is not a real solution to reducing drug costs.

Bob Ehrlich