Summary of Conference Call Notes Industry Overview - The discussion revolves around the U.S. pharmaceutical market and the implications of drug pricing reforms initiated by the Biden administration through the Inflation Reduction Act (IRA) and previous statements by former President Trump regarding drug price reductions. Key Points and Arguments 1. **Government Negotiation Power**: Prior to the IRA, the U.S. federal government lacked the legal authority to negotiate drug prices. The IRA has empowered the Centers for Medicare & Medicaid Services (CMS) to negotiate prices, but this only applies to Medicare (30% payment share) and Medicaid (approximately 10% payment share), leaving commercial insurance (40% payment share) without negotiation power [1][2][3]. 2. **Trump's Price Reduction Focus**: Trump's proposed drug price reductions primarily target Medicaid, which represents about 10% of the market. Medicaid prices are generally lower compared to Medicare and commercial insurance due to higher rebates [1][2]. 3. **Drug Pricing Concepts**: The U.S. drug market has various pricing concepts. Trump's initiatives focus on the Wholesale Acquisition Cost (WAC), but there is a significant difference between the net price reported by pharmaceutical companies and the WAC due to rebates [1][2]. 4. **Net Expenditure vs. WAC**: For example, a drug with a WAC of $100 results in a net expenditure of only $78, with the actual net price being $62.2. The 22% difference between WAC and net expenditure suggests that reducing drug prices by 22% would have minimal impact on the overall market, including pharmaceutical companies and distributors [1][2][3]. 5. **Market Size and Price Buffer**: The total U.S. drug market is estimated at $910 billion, with net expenditures around $650 billion and reported sales by pharmaceutical companies at $430 billion. This indicates a price buffer exceeding 50% from WAC to reported sales, and nearly 30% from WAC to net expenditures [1][2][3]. 6. **Impact of IRA Negotiations**: The first round of IRA negotiations has led to significant price reductions for drugs like Apixaban and Sitagliptin, with reductions exceeding 50%. However, following these negotiations, Bristol-Myers Squibb (BMS) projected that Apixaban's sales in the U.S. market would remain stable at $8.5 billion to $10.5 billion, indicating that substantial reductions in WAC do not significantly affect actual net prices [1][2][3]. 7. **Conclusion on Trump's Claims**: The assertion of reducing drug prices by 30-80% as stated by Trump is likely to apply primarily to Medicaid. Even if expanded to Medicare, the existing price buffers suggest that the negative impact on the market would be limited [1][2][3].