国泰海通｜医药：特朗普药价威胁再起，短期内影响有限

Core Viewpoint - The article discusses the potential impact of Trump's proposed drug pricing policies on the U.S. pharmaceutical industry, suggesting that while there are significant threats, the short-term effects may be limited due to existing structural challenges in the industry [1][2]. Group 1: Background and Current Situation - U.S. pharmaceutical spending is at a high level, with per capita drug spending reaching $1,564 in 2022, significantly higher than other developed countries. The compound annual growth rate (CAGR) from 2018 to 2022 was 6.2% [1]. - The increase in drug prices is primarily driven by innovative drugs, which have long-term pricing above inflation, while generic drugs continue to decrease in price. The complex pricing system supports the stability of high prices for innovative drugs [1]. - The U.S. pharmaceutical trade deficit is expanding, with imports projected at $213 billion and a deficit of $118.6 billion in 2024. Ireland has become a major source of this deficit due to tax advantages [1]. Group 2: Policy Implications - Trump's proposal for a "Most Favored Nation" (MFN) pricing policy aims to anchor U.S. drug prices to the lowest prices in developed countries, potentially reducing prices by 30%-80%. However, legal complexities may hinder its implementation, and the focus will likely remain on reforms within the Medicare framework [2]. - The Pharmacy Benefit Manager (PBM) system is identified as a structural monopoly that drives up drug prices, with rebate percentages for chronic diseases exceeding 50% and some reaching 80%. The top three PBMs control 80% of prescriptions, leading to a highly concentrated market [3]. - Trump's proposed 25% tariffs on European drugs aim to encourage domestic manufacturing, but the high costs and long construction timelines for U.S. production facilities may limit the effectiveness of this strategy in the short term [3].