中金点睛·2026-01-27 23:50Core Viewpoint - The article discusses the ongoing efforts by the Trump administration to lower drug prices in the U.S., highlighting the strong pricing power of pharmaceutical companies and the complexities of the healthcare payment system, which includes private insurance and pharmacy benefit managers (PBMs) [2][35]. Summary by Sections U.S. Healthcare System Overview - The U.S. healthcare system is characterized by high medical service costs and low insurance coverage rates compared to other developed countries, with total healthcare spending reaching approximately $4.9 trillion in 2023, accounting for 17.6% of GDP [4][5]. - From 1960 to 2023, per capita national health expenditure in the U.S. increased from $146 to $14,570, a 99-fold increase with a compound annual growth rate of 7.6% [4]. Insurance Coverage and Efficiency - The U.S. insurance coverage rate is relatively low among developed nations, with 2023 coverage at 92.4%, lower than most OECD countries [9]. - The efficiency of healthcare services is also a concern, with the U.S. showing only an 8.8% decrease in all-cause mortality from 1999 to 2022, compared to a 25.9% decrease in the UK during the same period [7]. Medicare and Medicaid - Medicare, the primary public insurance program, covers approximately 65 million elderly and disabled individuals, while Medicaid covers about 91.7 million low-income individuals, with a compound annual growth rate of 7.0% in spending from 2013 to 2023 [18][19]. - Private insurance dominates the U.S. healthcare system, covering about 207 million people, or 62% of the population, with employer-sponsored plans being the most common [19]. PBM Role and Pricing Mechanisms - Pharmacy Benefit Managers (PBMs) play a crucial role in the drug supply chain, managing drug formularies and negotiating prices, but their profit mechanisms, including rebate retention and price differentials, contribute to high drug prices [26][28]. - The consolidation of PBMs has raised concerns about their influence on drug pricing and transparency, prompting regulatory scrutiny at both state and federal levels [30]. Drug Pricing Reforms - The Trump administration has initiated several measures to reduce drug prices, including the Inflation Reduction Act, which allows for direct price negotiations for Medicare-covered drugs [33][35]. - The administration's efforts include setting price caps on insulin and negotiating discounts with pharmaceutical companies, with significant reductions observed in negotiated drug prices [33][39]. Pharmaceutical Pricing Trends - According to ICER, the median list price of new drugs is projected to increase by 24% and the net price by 51% from 2022 to 2024, indicating the continued strong pricing power of pharmaceutical companies [2][40]. - The article concludes that the interplay of the healthcare payment system, PBM profit mechanisms, and pharmaceutical pricing power complicates the effectiveness of drug price reform initiatives [39][40].