President Trump signed a stunning set of executive orders on Friday. He fundamentally restructured drug pricing and availability. He used his pen, apparently after years of legal and administrative review, to do what the congressional Republican’ts and Democrats have only postured about for decades. The president spoke with commonsense and indignity on behalf of ordinary Americans against Washington and global elites. At the same time, he characterized the big drug companies as great innovators, key to beating the Chinese virus, who are just stuck in the system. This is a negotiating posture, as those CEOs have been part of the rigged game.

President Trump is massively driving down the outrageously inflated prices of insulin and EpiPens. He is ending the crooked practice of middlemen pocketing large manufacturer discounts, leaving the retail pharmacy and the consumer with much higher prices. Note the manufacturers had already given the discounts; the discounts just were not getting to the pharmacy counter.

Not only did the president speak, he had others drive home the points. An insulin-dependent senior citizen spoke powerfully. A dental hygienist, widowed years ago with twin 4-year olds, spoke of the “unaffordable care act.” She spoke of a 15-year-old EpiPen, which had gone from perhaps $20 copay to $750 per EpiPen. She spoke of $75,000 in medical debt and praised President Trump for saving a single mother hundreds of dollars a month.

Within this presentation, President Trump successfully blended solid scripting and emotionally connecting ad-lib, marked in italics in this excerpt, transcribed by me from the live event:

The four orders I am signing today will completely restructure the prescription drug market, in terms of pricing and everything else, to make these medications affordable and accessible for all Americans.

The first order will require the federal community health centers to pass the giant discounts they receive from drug companies, on insulin and EpiPens, directly to their patients. You know, insulin became so expensive people weren’t able to use it. They desperately needed it. We have it to a level that you’re not going to believe. EpiPens likewise. You’ve been reading horrible stories about EpiPens over the last . . . six, seven years. Horrible, horrible, horrible increases where they went from almost nothing to massive amounts of money. We’re changing that right now. These providers should not be receiving discounts themselves while charging their poorest patients massive full prices. Under this order, the price of insulin for affected patients will come down to just pennies a day, pennies a day from numbers that you weren’t even able to think about. It’s a massive cost savings.

The second executive order I’m signing this afternoon will allow states, wholesalers, and pharmacies to do something other politicians have promised for decades and decades, but never done. They never delivered. We will finally allow the safe and legal importation of prescription drugs from Canada, and other countries, where the price for the identical drug is incredibly lower — It is a difference like you wouldn’t believe. 70%, 80%, 90%, 30%. But massively lower. — than the identical drug, made in the same plant, the same factory, the same exact drug, the same everything. Same box. Same pill. And yet, it’s 50, 60, 70 percent lower. And this is something that [Florida Governor] Ron [De Santos] and I have been discussing from the time Ron got elected. And I’ve been wanting to do it, and it takes a long time from a legal standpoint. And, uh, we’ve got it all worked out. So, we are going to be getting massive drug savings in Florida and other states. And we’ve had numerous states that wanted to do it. Ron really was at the forefront, I will say that, but you have other states that have caught on, and it’s caught on very quickly. Didn’t take them long to figure that one out, Ron, it’s too obvious. We pay for all of the research and all of the development, and foreign countries pay absolutely nothing, and our consumer gets charged. This has been going on for decades. The American people pay an average of over three times more for medicine than the Canadians. Many people go to Canada. I see it all the time. They go to Canada to buy drugs and then they come back, prescription drugs, because they save so much money. The trip is well worth it. The Obama-Biden administration pledged to end this unfairness, and allow drug importation, but they never got it done. They were unable to det it done. They didn’t get a lot of things done. But under my administration, we’re standing up against the lobbiests and the special interests, and fighting back against a rigged system. Rigged system, you’ve heard that word before. I am unrigging the system, that is many decades old. We’re doing something that should have been done a long time ago.

The third revolutionary order I’m signing today will prevent middlemen — and women I guess, but you’ve heard about the middleman, right? The middleman that makes so much money. Nobody knows who they are. Nobody has any idea who they are. They make more money, perhaps than even the drug companies themselves. The drug companies, in all fairness to them, Big Pharma, they’re doing a great job on the vaccines, they’re doing a great job on therapeutics. I can tell you, because I deal with them a lot. But I thing the middlemen make more money than they do, and they don’t do much. Maybe they don’t do anything. Some people say they don’t do anything. Nobody even knows who they are. But the middlemen are making a fortune. — and pharmacy benefit managers, people are just bilking Medicare patients with these high drug prices, while they pocket gigantic discounts. Gigantic discounts. The amount of money they have made over the decades is too incredible even to speculate or say. It’s massive. Some very rich people are not going to like me today, I can tell you. {audience laughter} I probably know them well, I probably see them in Palm Beach. {laughter} But nobody ever talks about who they are. I hear “the middlemen” for years, “the middlemen,” right Alex [Azar]? And he doesn’t know who they are either. But he knows they are rich. {audience laughter} And they’re not going to be so rich any more, because the money is going down to reduce the price of prescription drugs. So, that’s a big thing, that’s a tremendous step. It should have been taken a long time ago, but they have a great deal of power. And I don’t have to tell you how many phone calls I’ve had in the last few days, when they heard I was going to be doing this. I’ve heard from people that I haven’t heard from in a long time. {audience laughter} Frequently drug companies give these middlemen discounts of up to 50 percent on the price of prescription drugs. But too often, those discounts are not passed on to the pharmacy counter. Meaning the people. This rule will pass those billions and billions of dollars a year, I mean many, many billions a year, in discounts on to patients, directly on to patients, saving Americans with high drug costs thousands of dollars a year. Individual people will save thousands of dollars a year. You’re not going to believe the impact that the things we are talking about today are going to have. Mark Meadows, our Chief of Staff . . .

The fourth and final order I am signing today, is the granddaddy of them all, will end global freeloading on the backs of American patients and American seniors. For decades, our citizens have paid the highest prices for drugs, prescription drugs, anywhere in the world. And it’s not even close. Foreign nations have paid vastly less for the exact same drug, and the exact same box, from the exact same plant, from the exact same company. They would pay 10 percent, 20 percent, 30 percent, what our people are paying. A pill that would sell for one dollar in certain countries — I won’t name them, they are all allies. They call them allies. I call them so-called allies. But a pill that would cost a dollar — could be seven, eight dollars in our country. Same exact pill. We pay 80 percent more than nations like Germany, Canada, and others, for some of the most expensive medicines, identical in all respects. This means that Americans are funding the enormous cost of drug research and development for the entire planet. We are bearing the entire cost, they pay none. They say this is what we are going to pay. In some cases it is a socialist country. So, we are paying to reduce drug prices in a socialist country. How does that work? How does that work? And these are things that should have been done a long time ago. And even from our standpoint, we would have done it more quickly, but we have to go through vast amounts of waiting periods, waiting times, and this is just an incredible day, I’ve been waiting for this day for a long time. We incredibly and foolishly bear the full cost of all research and development. In all fairness to the drug companies, it can take 15 years to get something approved, billions of dollars for a simple drug. It also means that the U.S. taxpayers are effectively subsidizing the socialist healthcare systems of foreign welfare states and many other countries. We will end that abuse and restore the principles of free enterprise, but this does not even have to do with free enterprise. This has to do with commonsense and courage, to be honest, and courage. Under this transformative order, Medicare will be required to purchase drugs at the same price as other countries pay. So we would pay four, five times more for a drug, if somebody else pays one dollar, we now pay one dollar. Now, what’s going to happen is their number will go up and our number will come very substantially down, and we’ll all agree on two and a half or two, or whatever the final number is. But if some country is paying, wherever it may be in the world, because they had a better negotiator, because they had smarter people than we have, and that’s what it’s all about. Maybe more honest people, who knows? Could be a lot of things going. But we have, we get now the lowest price anywhere in the world. And no more will we have to suffer by saying “gee, why is it so much cheaper for some drug in another country?” We will determine what other medically advanced nations pay for the most expensive drugs, and instead of paying the highest price, Medicare will pay the lowest price, and so will lots of other U.S. buyers. Medicare is the largest purchaser of drugs anywhere in the world, by far. Medicare, largest purchaser of drugs in the world. And we’re finally going to use that incredible power to achieve a fairer and lower price for everyone. Everyone will get a fairer and much lower price. This is not talking about one-half of a percent. This is big stuff. Under our ridiculous system, which has been broken for decades, we aren’t even allowed to negotiate the price of drugs. Can you believe it? I said when are we going to negotiate? “We’re not allowed to negotiate. We’re restricted by Congress from negotiating the price of drugs.” Can you imagine? You say I want to get a better price. “I’m sorry, sir, you’re not allowed to that. That’s illegal.” What kind of system is that? You thing the world looks at us and said “Where the hell did these people come from?” {audience laughter} “But they treat us very nicely.” It’s going to end, OK? I see you’re a fan of what we’re saying. You must be a doctor, are you a doctor? Yes. Doctors know. You’ve known that for years. We’re not allowed to negotiate, can you believe it? We just have to take whatever it is. 

I’m pleased to announce that, as a result of the orders I’m signing today, the heads of the major drug companies have requested a meeting to discuss how we can quickly and significantly lower drug prices and out of pocket expenses for Americans. They want to do what is right. Look they’re going to do what is right. Look, I think it is so important what they are doing on therapeutics and vaccines, and we’re going to see them on Tuesday and see if we can do something here. But, this could have been done a long time ago. The drug company executives will be at the White House on Tuesday. And they have some ideas how to significantly drug prices. We’ve already given them to you. I don’t know if they can possibly do something to substitute for what is called “favored nations.” Favored nations, that means you get the lowest price anywhere in the world. Whoever gets the best price, congratulations. Thank you very much for being a good negotiator because we now get the lowest price, too. Should have been a long time ago. If these talks are successful, we may not need to implement the fourth executive order. Which is a very tough order for them, very tough, and I understand that. And we have a lot of respect for our great pharmaceutical companies, drug companies. So, we’ll see what they have to say on Tuesday. Maybe they have another idea that is good. But it’s got to be very substantial. They actually are in favor of the rebate rule, the roll-back, because they say that’s people getting money that aren’t even doing anything. If they are not, the order will be implemented. . . .

I will add the links to the executive orders, and the official transcript as they post. Three of four are up already. This Friday was a truly significant one for many Americans.

• Executive Order on Access to Affordable Life-saving Medications
• Executive Order on Increasing Drug Importation to Lower Prices for American Patients
• Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen