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The blueprint does not include a proposal allowing Medicare to directly negotiate drug prices, a promise Trump campaigned on in 2016.

"Everyone involved in the broken system - the drugmakers, insurance companies, distributors, pharmacy benefit managers and many others - contribute to the problem", Trump said.

The president was accompanied by Health and Human Services Secretary Alex Azar, who played a major role in developing the plan.

Trump also denounced foreign countries that he said "extort unreasonably low prices from US drugmakers" so that their citizens often pay much less than USA consumers for the same drugs.

Senator Chuck Schumer, Democrat from NY, said the president's blueprint offered "little more than window dressing". It would aim to increase competition by ending "the gaming of rules" by brand-name drug manufacturers that stymies the introduction of cost-saving generic and biosimilar drugs.

One thing Trump did not propose was allowing Medicare, the government health care program for the elderly, to directly negotiate lower drug prices for its beneficiaries.

Lowering drug prices may be almost as complicated as bringing peace to the Middle East.

"Think about all the time everybody spends watching drug company ads, and how much information companies are required to put in them", Azar said. "Most of them would do very little for the 100 to 200 million Americans who are on private insurance".

Speaking in the White House Rose Garden, Trump said the current system has been corrupted by greedy businesses and middlemen who have made "an absolute fortune" through "dishonest double-dealing" at the expense of USA consumers who need medicine to extend or improve their lives. What if we said, "No rebates, just a flat price", which would disincentivize drug companies from having higher list prices.

Because of the lack of transparency in the system, it's impossible to tell exactly who benefits from rebates.

The administration may also revise how it pays for drugs administered in doctor's offices, clinics or hospitals through Medicare's Part B program.

In his speech, Gottlieb appeared to raise the possibility of eliminating rebates.

"They refuse to take meaningful action on skyrocketing drug prices, broke their promise to allow Medicare to negotiate lower drug costs, and all while showering drug companies with record tax breaks", Woodhouse of Protect Our Care concluded. "It's all legally sanctioned, but it's not transparent to the consumer. We hope the administration can bring some transparency - and relief - to patients".

But experts question whether tougher negotiation strategies will lower drug prices in the USA, and Trump's plan was light on specifics.

The US Trade Representative Robert Lighthizer said the Trump administration will use "every tool available" to ensure other nations use fair pricing practices.

The president did say in his speech that his proposal gives Medicare plans "new tools to negotiate lower prices for more drugs". Some consumers could potentially pay more for drugs because of how co-pays and coinsurance work in the prescription drug plans. That's why we have developed and supported innovative solutions to lower health care costs and we look forward to partnering with leaders to continue to do so. "But the problem - one of the problems with moving them over - is it's tricky".

Regarding forcing other countries to pay more for drugs, Richardson said: 'We don't really have the policy levers to get that to happen'. Senior administration officials did not explain how the government could achieve its goal. However, although several of the administration's proposals will help lower costs, "We are concerned that some proposals would actually lead to higher costs for Americans, because they would weaken the ability of plans to negotiate lower prices". Those changes include a maximum limit on out-of-pocket costs that would help people on very-high-priced specialty drugs.

Critics said the policies pointed to the influence the pharmaceutical industry wields with the administration. For seniors who are sometimes on fixed incomes, the pain is real. It has also been projected to drive premiums up. "If they don't address the cost that patients see at the pharmacy counter it's not going to be seen as responsive".

His proposals did not scare the system he criticized. "They're thinking of the price to the patient, or - more cynically - they're thinking about the price to the voter".

Trump calls his plan the "most sweeping action in history to lower the price of prescription drugs for the American people".

Democrats pounced on Trump for not pursuing direct Medicare negotiations, an idea he championed before reaching the White House.

On Wall Street, shares of major pharmaceutical companies appeared unfazed by the announcement, with Merck closing up 2.81%, Pfizer gaining 1.31%, Bristol Myers up 1.39% and Eli Lilly - where Azar was a top executive - ahead 1.97%.