Will Trump’s prescription drug orders bring ‘biggest price reductions in history?’

President Donald Trump signed four executive orders Friday to lower the cost of prescription drugs and provide insulin and EpiPens at a very steep discount to community health centers.

This is just a big day,” Trump said. “I’ve been waiting for this day for a long time. We are ending the sellouts, betrayals and broken promises from Washington.”

A new requirement will allow states, wholesalers and pharmacies to import FDA-approved drugs from foreign countries and sell them in the U.S. Another will allow discounts negotiated by insurance middlemen, called pharmacy benefit managers, to be passed on to Medicare patients. These discounts typically go toward lowering premiums overall.

It includes a section that says that before it can take effect, the Secretary of Health and Human Services needs to confirm that the order won’t cause federal spending, premiums or patients’ total out-of-pocket costs to increase.

“We incredibly and foolishly bear the full cost of all research and development,” Trump said. “You think the world looks at us and says, ‘Where the hell did these people come from?”

The order which has drawn the most skepticism would mandate using the lowest price among other economically advanced countries to set what Medicare pays for certain drugs administered in a doctor’s office, including many cancer medications. This would apply to the most expensive medications covered by Medicare’s ‘Part B,’ which pays for outpatient care. Trump said he is giving the pharmaceutical industry until Aug. 24 to make a deal with him before he implements it.

“We may not need to implement the fourth executive order, which is a very tough order,” he said.

The president also said that the White House would propose a health care bill soon and his aides say Trump will lay out his health care vision in an upcoming speech.

Trump tweeted Saturday, “Yesterday I signed four measures that will massively reduce the prices of prescription drugs, in many cases by more than 50%. Nothing like this has ever been done before because Big Pharma, with its vast power, would not let it happen.”

“Expensive Insulin went from big dollars to virtual pennies. EpiPens went from their incredibly high, jacked up prices, to lower than their original give away bargains,” he continued. “Biggest price reductions in history, by far! Nothing like this has ever [happened] for our citizens, especially our Seniors. REMEMBER YOUR FAVORITE PRESIDENT!”

In a statement, the Pharmaceutical Care Management Association warned the orders would “drastically increase Medicare premiums for America’s seniors and most vulnerable.”

“Reviving a rebate reform proposal now does not address the underlying flaws – that it will drastically increase Medicare premiums for America’s seniors and most vulnerable.” The Pharmaceutical Care Management Association’s members negotiate rebates for health care payers with drugmakers.

U.S. Health and Human Services Secretary Alex Azar said in a Friday press call paying the rebates directly to seniors in the form of discounts could cut their drug costs by as much as $30 billion, or as much as 30%.

Presidential Counselor Kellyanne Conway touted Trump’s record on healthcare Wednesday. “He’s the healthcare President … What the President’s done with vaccines and ventilators, what he’s done in delivering kidney health in a very different way. Also, transparency, surprise medical billing, the list goes on and on. I think he’s the healthcare President,” said Conway.