在11月3日中期选举前夕，总统唐纳德·特朗普越来越频繁地宣传自己在药品定价方面达成的协议，声称美国如今支付的处方药价格已是全球最低。“仅凭这一点，就足以让我们赢得中期选举，”他最近在白宫表示。作为其药品折扣计划公开窗口的TrumpRx.gov，自今年2月上线以来发展迅速。最初只有几十种品牌药，如今已涵盖超过800种品牌和通用名药物，从热门的减肥药到癌症和类风湿性关节炎的治疗药物，几乎涵盖所有领域。
Ahead of the Nov. 3 midterm elections, President Donald Trump has increasingly touted his drug pricing deals, claiming the U.S. is now paying the world’s lowest prescription drug prices. “This one thing alone should win us the midterms,” he recently said at the White House. TrumpRx.gov, the public face of his drug pricing discounts, has grown dramatically since its launch in February. What started as a few dozen brand-name drugs now includes a catalog of more than 800 brand-name and generic medications, offering discounts on everything from popular weight loss drugs to treatments for cancer and rheumatoid arthritis.
不过，特朗普所承诺的“为普通美国人节省巨额开支”是否属实，目前尚不清楚。根据联邦通胀数据，截至7月的年度处方药价格下降了3.1%——但专家认为，现在下结论还为时过早，尚无法确定这一降幅中有多少可以归因于特朗普的药品定价协议。该网站依赖GoodRx的定价数据和技术来支持其大部分药品信息，并将制药公司原有的折扣与最新谈判的价格相结合。
It’s unclear whether the average American has “saved a fortune,” as Trump promised. Prescription drug prices fell by 3.1% over the year ending in July, according to federal inflation data — though experts say it’s too soon to know how much of the drop, if any, can be attributed to Trump’s drug pricing deals. The site has relied on GoodRx’s pricing data and technology to power many of its listings and blends pre-existing discounts from drugmakers with newly negotiated prices.
在上个月举行的共和党中期选举集会上，特朗普表示：“我们从全球最高的处方药价格，一跃到了全球最低的水平。”KFF最近的一项分析发现，对于少数几种癌症和胆固醇药物而言，TrumpRx的价格与其他国家相比具有竞争力。但在许多情况下，美国人的实际购买价格并不比世界其他地区更优惠。以Ozempic为例。对于在美国自掏腰包的普通患者来说，这种畅销的糖尿病药物每月费用可能高达349美元到1000多美元。
At the Republican midterm convention last month, Trump said, “We went from the highest prescription drug prices, by far, anywhere in the world, to the lowest prescription drug prices anywhere in the world.”A recent analysis from KFF finds that TrumpRx prices are competitive with prices in other countries for a small number of cancer and cholesterol medications. In many cases, Americans aren’t getting the best deals compared with the rest of the world. Take Ozempic. For the average patient in the U.S. paying out of pocket, the blockbuster diabetes drug can cost $349 to more than $1,000 a month.
通过TrumpRx购买，价格则为349美元。然而，根据非党派研究机构KFF的数据，在其他几个富裕国家，次高的月均价格仅为190美元。Enbrel的情况则更为明显。
It’s $349 through TrumpRx. Yet in several other wealthy countries, the next-highest price is $190 a month, according to KFF, a nonpartisan research group. Enbrel is an even starker example.
通过 TrumpRx 购买类风湿性关节炎药物，每月费用为 3,354 美元，是研究人员在其他国家发现的价格平均值 641 美元的五倍多。然而，某些药物的价格则明显更优。用于治疗特定血液癌症的药物 Rydapt，通过 TrumpRx 购买 56 粒胶囊的价格为 2,909 美元——低于法国（价格第二低的国家）相同数量 5,901 美元的价格的一半。
A monthly supply of the rheumatoid arthritis drug costs $3,354 through TrumpRx, more than five times the $641 average in the other countries where researchers found prices. Some drugs, however, come out well ahead. Rydapt, a drug used to treat certain blood cancers, costs $2,909 for 56 capsules through TrumpRx — less than half the $5,901 price for the same amount in France, the next-cheapest country.
根据 KFF 的分析，这种价格差异遍布整个网站。这份报告并未比较 TrumpRx 在美国国内的节省幅度，但它提供了特朗普关于药品定价主张的首批大规模全球对比之一。该分析考察了通过 TrumpRx 销售的 32 种品牌药，这些药物没有仿制药或生物类似药可供替代。研究人员之所以关注这些药物，是因为患者无法选择更换为更便宜的版本，这意味着 TrumpRx 提供的折扣对患者的实际支付金额可能产生更大影响。
Those disparities run throughout the site, according to the KFF analysis. The report, which didn’t compare TrumpRx savings within the U.S., offers one of the first broad worldwide comparisons of Trump’s drug pricing claims. The analysis looked at 32 brand-name drugs sold through TrumpRx that lacked generic or biosimilar equivalents. Researchers focused on those drugs because patients don’t have the option of switching to cheaper versions, meaning the discounts offered through TrumpRx could have a greater impact on what they pay.
该组织将这些价格与加拿大、法国、德国、荷兰和英国等另外 11 个富裕国家的价格进行了比较。所列价格截至 8 月 26 日。结果几乎平分秋色：在 17 种药物中，TrumpRx 的价格低于国外平均价格；而在 15 种药物中，其价格则更高。但特朗普曾向美国民众承诺提供全球最低的价格。按照这一标准，结果并不理想：只有 5 种药物的价格确实最低，而 13 种则最高。
The group compared the prices with those in 11 other wealthy countries, including Canada, France, Germany, the Netherlands and the United Kingdom. The prices are current as of Aug. 26. The results were almost evenly split. For 17 of the drugs, the TrumpRx prices were lower than the average prices abroad. For 15, they were higher. But Trump has promised Americans the lowest prices in the world. By that measure, the results were less favorable: Only five were actually the lowest-priced, while 13 were the highest-priced.
KFF 的 Medicare 政策项目副主任、该报告的合著者 Juliette Cubanski 表示：“结果好坏参半。即使制药商在将药物列入 TrumpRx 网站时可能已经同意降价，他们提供的价格即便打了折扣，仍然高于可比国家的价格。”药品折扣差异巨大。这些发现初步揭示了特朗普降低药价方法所蕴含的希望及其局限性。
“It’s kind of a mixed bag,” said Juliette Cubanski, deputy director of the Medicare policy program at KFF, who co-authored the report. “Even with the reductions that may have been agreed to by manufacturers who are listing their drugs on the TrumpRx website, the prices that they’re offering, even at a discount, still continue to be higher than prices in comparable countries.”Drug price discounts vary widely The findings offer an early look at both the promise and the limits of Trump’s approach to lowering drug prices.
美国人购买处方药的费用通常高于其他富裕国家的患者，即使这些药物由同一家公司生产。白宫表示，TrumpRx折扣源于特朗普推行的“最惠国”定价协议，即与制药公司达成协议，以关税减免为交换，让美国消费者享受这些公司向其他国家提供的较低价格。但分析发现，这些折扣存在较大差异，且并未始终达到特朗普所承诺的最低价格。
Americans routinely pay more for prescription drugs than patients in other wealthy countries, even when the medications are made by the same companies. The TrumpRx discounts, the White House says, stem from Trump’s “most favored nation” pricing deals, agreements with drugmakers to charge Americans the lower prices they offer other countries in exchange for tariff relief. But the discounts can vary widely, the analysis found, and they haven’t consistently produced the lowest prices Trump promised.
“我对这些结果并不感到意外，”哈佛大学医学院的初级保健医生兼健康政策研究员本杰明·罗姆博士表示。“只要关注过药品价格的人都知道，TrumpRx一推出，就只涵盖有限数量的药物，而且很明显，其价格并不总是与其他国家的药品价格挂钩或有任何关联。”这与特朗普的前任乔·拜登所采取的做法截然不同。拜登政府利用“医保计划”（Medicare）的权力，每年对数量有限的高价药品进行价格谈判；而TrumpRx则主要依赖与个别制药公司的自愿协议，由这些公司直接向消费者提供折扣价格。
“I’m not surprised by these findings,” said Dr. Benjamin Rome, a primary care physician and health policy researcher at Harvard Medical School. “Any of us who have been following drug prices realized, as soon as TrumpRx was launched, it was a limited number of drugs and it was clear that the prices that were there were not always going to be linked or in any way related to what the prices are in other countries.”It’s a markedly different approach from the one taken by Trump’s predecessor Joe Biden. Rather than use Medicare’s power to negotiate prices for a limited number of costly drugs each year, TrumpRx relies largely on voluntary agreements with individual drugmakers to offer discounted prices directly to consumers. (The exact details of the agreements remain largely confidential, and the White House has declined to disclose them.)
（这些协议的具体细节大多仍属机密，白宫也拒绝公开。）TrumpRx并不直接销售药品。对于许多药物，它会引导消费者参与制药公司的计划，通过该计划获取优惠券或无需保险即可享受折扣现金价。然而，大多数人并非通过这种方式购买处方药。大约十分之九的美国人拥有某种形式的健康保险，这意味着许多人通过私人保险、医保计划（Medicare）或医疗补助计划（Medicaid）支付药费——尽管随着保险费用不断上涨，无需保险的折扣现金支付选项也日益流行。用于TrumpRx的资金不计入患者的共同支付额或自付额。
TrumpRx doesn’t sell the drugs directly. For many drugs, it sends consumers to manufacturer programs through which they can obtain coupons or discounted cash prices without insurance. That’s not how most people get their prescription drugs. About 9 in 10 Americans have some form of health insurance, meaning many pay for medications through private insurance, Medicare or Medicaid — although discounted cash-pay options have become increasingly popular as insurance has gotten more expensive. The money spent on TrumpRx doesn’t count toward a patient’s copay or deductible.
“这些产品都是经过严格筛选的，制造商愿意提供折扣，”罗姆说。“在某些情况下，这些产品可能并非美国消费最高的药品，也可能是他们之前就已经提供过保密折扣的产品，但现在他们将这些折扣变得更加公开透明。”该网站现在也包含一些价格更低的通用名药物。“但这些通用名药物及其低廉的价格在特朗普Rx网站出现之前就已经存在了，”库班斯基说。
“They’re highly selected products where the manufacturer is willing to offer a discount,” Rome said. “Maybe they’re not the products causing the highest spending in the U.S. in some cases or are products where they were already offering confidential discounts, but now they’re making those discounts more public.”The site now includes several cheaper, generic medications. “But those generics and the low prices for those generics pre-existed the TrumpRx website,” Cubanski said.
直接进行价格比较存在困难。KFF的分析并未涵盖特朗普Rx提供的所有药物，因此从中得出的结论也存在局限性。美国药品价格监测机构46brooklyn Research的首席执行官安东尼奥·奇亚恰表示，目前特朗普Rx平台上约有80种品牌药，而KFF仅能比较其中32种的价格。奇亚恰指出，其中一个挑战是，部分在美国销售的药物并非KFF所研究的所有国家都有供应，这使得直接比较变得困难。
Direct price comparisons are difficult The KFF analysis doesn’t capture every drug available through TrumpRx, and there are limits to how much can be concluded from it. Antonio Ciaccia, CEO of 46brooklyn Research, a group that tracks drug pricing in the U.S., counts about 80 brand-name drugs currently on TrumpRx, while KFF was able to compare prices for 32. Part of the challenge, Ciaccia said, is that some drugs sold in the U.S. aren’t available in all of the countries KFF examined. That can make direct comparisons difficult.
“其中一个显著差异是，美国市场的药品种类比国际市场更多，这一点值得注意——我们在这里拥有更多选择，而不是采用一种适用于所有人的治疗方案，”他说。他还表示，国际价格也并非总能完全相互比较。该分析依赖公开可用的价格数据，而这些数据可能并未包含外国政府与制药公司之间协商达成的保密折扣。奇亚恰还指出，KFF用于比较的11个国家，与政府部分国际定价计划所采用的国家并不完全一致。
“One of the big differences is the U.S. market does have more products in it than international markets, so that is noteworthy to the extent we have options here in the U.S. rather than a one-size-fits-all treatment approach,” he said. International prices aren’t always perfectly comparable, either, he said. The analysis relied on publicly available prices, which may not include confidential discounts negotiated between foreign governments and drugmakers. Ciaccia also noted that KFF’s 11 comparison countries don’t exactly match the countries used in some of the administration’s international pricing programs.
白宫尚未立即回应置评请求。验证这一主张。尽管存在上述局限，但这并未改变特朗普主张的核心比较：美国民众所获得的价格是否与国外价格相当，甚至更低。“我们希望通过这项分析来验证这一主张，”库班斯基说。
The White House didn’t immediately respond to a request for comment. Put the claim to the test Those limitations don’t change the basic comparison at the heart of Trump’s claim: whether the prices offered to Americans match or beat those available abroad. “We wanted to put that claim to the test with this analysis,” Cubanski said.
“无论是价格上涨还是价格下跌，整体上都并没有呈现出清晰的规律。”而美国政府则越来越广泛地声称，他们恰恰实现了这一点。“在过去一年里，我的政府与世界26家最大的制药公司达成了前所未有的协议，其余公司也都在迅速跟进，将以60%、70%、80%甚至90%的折扣向美国民众提供药品，”特朗普上个月表示。医疗政策专家希望TrumpRx最终能降低美国药价，但他们认为现在下结论还为时过早。
“There is not a clear pattern across the board for higher prices or no consistent pattern across the board for lower prices.”And the administration has increasingly made broader claims that it has accomplished just that. “Over the past year, my administration has reached unprecedented agreements with 26 of the world’s largest pharmaceutical companies, and the rest are all coming in very rapidly, to provide their drugs to Americans at discounts of 60, 70, 80 and even 90% discount,” Trump said last month. Health policy experts hope TrumpRx will ultimately bring U.S. prices down, but they say it’s too soon to know.
不过，一个令人担忧的问题是，随着更多制药公司达成协议，它们也可能提高海外药价，从而缩小价格差距，却并未真正让美国民众节省开支。“问题不仅在于美国药价可能会下降，另一种实现美国药价更低的方式，是抬高国际药价。因此，如果一年后我们再次进行比较，可能会发现TrumpRx的药价虽然低于国际价格，但差距可能并不大，”Cubanski说道。
A concern, however, is that as more drugmakers strike deals, they could also raise prices abroad, narrowing the gap without delivering Americans savings. “It’s not just that the price in the U.S. might come down, but another way of having a lower U.S. price is by having a higher international price, and so it could be the case that if we do this comparison again in a year, we might find that TrumpRx are lower than international prices,” Cubanski said.