Voters’ Guide: 2020 Presidential Candidates on Prescription Drug Costs and More

Casting a presidential vote is among the most meaningful actions the average American will take in their lifetime. The stakes are high, as the winning candidate gains the chance to influence American politics and public life for years to come.

Karl Williams, R.Ph., J.D., faculty member of the Wegmans School of Pharmacy at St. John Fisher University, said the first election he remembers was in 1968, involving a pharmacist named Hubert Humphrey, who lost the presidential race to Richard Nixon that year.

“Folks viewed it as a high-profile decision, and this [election] isn’t any different than that,” Williams said. “But with a 2020 set of problems to overlay on top of the decision.”

The list of challenges in 2020, particularly in health care, is long. The coronavirus pandemic and the race to create a safe, effective vaccine continue. Unemployed and underemployed Americans are losing their health care coverage, and those managing chronic conditions may struggle to pay for treatment.

One particular challenge highlighted by both presidential campaigns is prescription medication prices in the United States, which continue to increase. The list prices for 460 prescription pharmaceuticals were set to rise 5.2%, double the rate of inflation in 2020, according to a report on prescription drug costs from AARP.

The list prices for 460 prescription pharmaceuticals were set to rise 5.2%, double the rate of inflation in 2020, according to a report on prescription drug costs from AARP.

The Democratic and Republican nominees, former Vice President Joe Biden and President Donald Trump, each have proposals to help lower costs to consumers. Carefully considering their approaches can help voters make a thoughtful decision on election day.

Glossary of Pharmaceutical Terms

Executive Order: Signed, written, and published directive from the president of the United States. Though not legislation, an executive order has the force of law.

International Reference Pricing: A system of pricing pharmaceuticals in which a government sets a medication’s price based on the price in other countries. Also called international price comparison, external price referencing, or cross-reference pricing.

Know the Lowest Price Act of 2018: Legislation signed by Trump in 2018 that prohibits a prescription medication plan under Medicare or Medicare Advantage from preventing pharmacy providers from informing enrollees of any difference between the price, copayment, or coinsurance of a drug under the plan and a lower price outside the plan. In other words, providers can tell patients when a medication costs less out of pocket than on insurance.

Medicare Parts Explained Simply

Medicare Part ACovers

  • inpatient hospital care
  • care in skilled nursing facilities and nursing homes
  • hospice care
  • home health services

Medicare Part B: Covers

  • medically necessary tests
  • medical equipment
  • outpatient care
  • home health services
  • some preventive services

Medicare Part C: An alternative to original Medicare offered by private companies. Also called “MA Plans,” or “managed care.”

Patient Right to Know Drug Prices Act: Legislation signed by Trump in 2018 that prevents health insurance issuers and pharmacy benefit managers from prohibiting pharmacy providers from informing enrollees of any difference between the out-of-pocket cost of a medication with and without health insurance coverage. In other words, this law allows pharmacists to tell patients when paying out of pocket is less expensive than paying through insurance, similar to the Know the Lowest Price Act of 2018

Pharmacy Benefit Manager: Public, for-profit companies that manage prescription medication benefits on behalf of health insurance companies, Medicare Part D drug plans, large employers, and other payers.

President Trump Drug Prices Executive Order: Refers to the president’s executive orders on July 24, 2020, and September 13, 2020. All five are aimed at lowering prescription medication prices.

Rebate: Discount off the list price paid by reduction, return, or refund on funds already paid.

2020 Presidential Candidates’ Views on Pharmaceutical Costs

International (or External) Reference Pricing


Proposes using international reference pricing to target specialty pharmaceuticals, a specific driver of high costs.

Biden supports limiting launch prices for specialty medicines that have no competition. Under Biden’s health care plan, the Secretary of Health and Human Services (HHS) would create an independent review board to determine the medication’s value and recommend a “reasonable price, based on the average price in other countries.”


Has issued executive orders aimed at using international price referencing to lower prescription medication costs broadly.

In an executive order issued on July 24, 2020, Trump introduced the “most favored nation” proposal, which would compel pharmaceutical manufacturers to sell Medicare Part B medications (drugs given in outpatient settings) at the lower price offered to other countries.

On September 13, 2020, the president followed up with an executive order directing the HHS secretary to test models for paying for both Medicare Part B and D medication at the often lower rates that Europe and other developed nations pay.

Inflation-Based Price Limits


Proposes this limit on all brands, biologics, and some generics.

As a condition for participation in Medicare and public option programs, Biden’s plan would prohibit pharmaceutical manufacturers from increasing the price of all brand, biologic, and “abusively priced” generic medications more than the general inflation rate. Those that do would face a tax penalty.


Supports this limit for Medicare Part B pharmaceuticals.

Only Medicare Part B drugs, those given in an outpatient setting, would be subjected to an inflation-based limit under Trump’s proposal, according to the Kaiser Family Foundation’s update on candidates’ prescription medication proposals.

Government Price Negotiation


Supports allowing Medicare to negotiate prices with pharmaceutical corporations.

As enumerated in the Biden-Sanders Unity Task Force Recommendations (PDF, 833.21 KB), the Biden campaign proposes allowing Medicare to negotiate lower prescription medication prices for “all public and private purchasers—for families and businesses, as well as older Americans—no matter where they get their coverage.”


Does not have a proposal, as of October 2, 2020.

On July 24, 2020, the president said he may support government negotiations of pharmaceutical costs but has not endorsed legislation or released a proposal to do so, according to the Kaiser Family Foundation’s update on candidates’ prescription medication proposals.

Banning Medicare Rebates


Does not have a proposal, as of October 2, 2020.


Proposes eliminating Medicare Part D rebates.

One way pharmacy benefit managers (PBMs) make money is prescription medication rebate programs. In this complex system, PBMs help promote a company’s product. When consumers purchase that drug, the PBM receives a rebate from the drug’s list price. However, the consumer (or their insurance) would still pay the list price—and the PBM either keeps the rebate or shares it with insurance companies to help lower premiums. 

President Trump’s July 24, 2020, executive order on eliminating kickbacks directs the HHS secretary to act to ensure patients “directly benefit” from these rebates through new regulations.

Questions to Ask About Candidates in Any Election

Both candidates favor a more nationalized approach to health care and pharmaceuticals, and the policies created by the next president will affect all Americans in the coming years. But the presidential race is not the only one happening this election season.

Elected officials at all levels of government influence health policy, and their views will help shape the well-being of their communities. Below are three questions to ask about any candidate to better understand their approach to health care.

What is the candidate’s strategy for lowering prescription medication costs?
Williams said Americans are recognizing “that health care is something that the private sector cannot deliver on. It’s a market that has failed, and we need government intervention to provide health care to everyone.” What tools would each candidate use to lower costs and better manage pharmacy care nationwide?

Does the candidate support policies that allow pharmacists to practice at the top of their license?
“In the United States, pharmacy is a highly regulated and rule-based profession that varies in every state,” said Williams. States regulate their pharmacists’ scope of practice, often to patients’ detriment. When pharmacists can practice to the full extent of their training, outcomes improve.

What is the candidate’s plan for addressing the pandemic?
The coronavirus pandemic will be the most pressing issue that elected officials in every community take on. “We need some assurances that our citizens will be able to engage in normal American domestic pursuits without having to worry about these infectious diseases that have gone out of control,” said Williams. He encourages voters to consider candidates who support scientists and utilize their expertise in creating public policy.   

Citation for this content: St. John Fisher University’s online Pharm.D. program from the Wegmans School of Pharmacy