The text of the order indicates the White House may pursue a more aggressive version of international reference pricing than it first proposed in October 2018.

Trump signed four drug-pricing executive orders on Friday but the White House has refused to release the text of the most controversial order that involves requiring U.S. Medicare to pay the same price for drugs (Medicare Part B) that other countries pay. The President said the order would go into effect a month after signing – Aug 24th.

Trump held up the order for a photo op after signing it and the text of two out of the order's three pages were visible in a photo taken by the @AP and reviewed by @modrnhealthcr.

The text of the order indicates the White House may pursue a more aggressive version of international reference pricing than it first proposed in October 2018.

The 2018 policy would in part tie Medicare Part B payment to the average price of a basket of developed countries, while a 'most-favoured nation' approach could give the U.S. the lowest price out of a select basket. The visible text does not detail how a favoured nation price would be calculated nor indicate any deadline for implementation.

The drug industry is particularly leery of this last approach since Democrats want to use it more broadly to allow Medicare to directly negotiate prices. 

The White House has declined to comment on the partial text.

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