Bot Chart, page-21327

Let’s also not forget Musk/DOGE recently cut HHS staffing from 82k to 62k. Trump has already indicated he doesn’t want this to go to Congress. How many free-marketeers sit on the Hill closely watched by the strongest lobby group in the country (as measured by total spend)? I see this Exec Order as a bargaining chip part of broader political goals - global tariff negotiation, domestic reshoring and campaign optics.

Let’s be real, it’s hard to imagine a pro-market candidate enforcing price controls in the world’s most privatised healthcare system.

Headlines were grabbed by saying prices would reduce by up to 90% almost immediately? If BC were Pres, I’d be pushing for a pharma NATO - pre-agreed % of annual GDP spend on R&D by developed member countries, in exchange for faster drug access. MFN can be gamed with confidential GTN discounts (note Medicaid requires at least a 23.1% discount from a drug’s list price, and then there’s the rest of the portfolio to swap paint over, specifically further rebates for access to a preferred formulary list and/or preferential prior auth/access terms), ceasing overseas sales and IP spin outs. This also reduces reliance on China and India for APIs. I don’t think a UK PM is going to agree to pay more for US drugs while cutting NHS spending. Policy-makers know all this - the obvious is obviously wrong in 5D chess.

One must also consider that 90% of prescription drugs written in the US account for only 18% of spending. The remaining 10%, which account for 82%, are mostly made up of treatments for advanced chronic conditions and autoimmune conditions, like GLP-1s, MS and cancer. Those 90% of generics prescribed today were once the patent protected expensive brand names providing attractive ROI. We are the beneficiaries of decades long R&D.

For a long term hold, script growth and patient adoption are the only signals worth watching, the rest is just political noise.