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"Donald Trump and Republicans are selling out America's seniors," said one advocate.
A major pharmaceutical industry handout that Republicans—with the support of one Senate Democrat—included in President Donald Trump's signature legislative package is expected to cost US taxpayers nearly twice as much as originally expected, the nonpartisan Congressional Budget Office said in an updated analysis released Monday.
The CBO initially projected that the provision, known as the ORPHAN Cures Act, would cost around $5 billion over the next decade. But the office said Monday that its earlier assessment did not take into account several major, high-priced drugs that will be exempted from Medicare price negotiations as a result of the Trump-GOP law.
The budget office said it now expects the provision of Trump's One Big Beautiful Bill Act to cost $8.8 billion over the next 10 years.
Among the drugs included in the new CBO analysis is Keytruda, a cancer medication sold by Merck that carries a list price of $24,062 every six weeks. The Trump GOP-budget law delays Keytruda's eligibility for Medicare price negotiations by at least a year, postponing significant potential savings for taxpayers and patients.
Merith Basey, executive director of Patients for Affordable Drugs Now, said in response to the updated CBO analysis that "the ORPHAN Cures Act is a wildly expensive handout to Big Pharma that will harm patients, drain taxpayer dollars, and weaken the government's ability to rein in high drug prices."
Basey noted that the "insatiable" pharmaceutical industry is not satisfied with the enactment of the ORPHAN Cures Act, which restricts Medicare price negotiations for drugs that treat more than one rare disease. Big Pharma, Basey said, is "spending record sums this year to advance additional carveouts like the EPIC Act, which would exempt even more blockbuster drugs from negotiation."
"Any support for these bills goes against the will of the 90% of Americans who want Congress to go further to lower drug prices—not facilitate another handout to Big Pharma," said Basey.
"This isn't about helping lower costs—it's about doing the bidding of big drug companies, and Trump and the GOP are all too happy to oblige."
The deep-pocketed pharmaceutical industry has waged war on the popular Medicare price negotiation program since its inception during the Biden administration.
While pharmaceutical giants' efforts to gut the program have been stymied in court, the industry-friendly Trump administration and Republican lawmakers have done pharma's bidding through legislation and executive action. Earlier this year, as Common Dreams reported, Trump signed an executive order aimed at delaying price negotiations for a broad category of medications despite the president's repeated promises to bring down costs.
"Trump and Republicans are selling out America's seniors," said Brad Woodhouse, president of the advocacy group Protect Our Care. "Instead of letting Medicare negotiate lower prices for more drugs, they carved out a loophole to protect the industry's most profitable drugs."
"Not only does the GOP tax bill throw over 15 million Americans off their healthcare and hike costs for millions more, but it also forces older Americans to pay more for life-saving medicines while CEOs and billionaires line their pockets with more money than they know what to do with," Woodhouse continued. "This isn't about helping lower costs—it's about doing the bidding of big drug companies, and Trump and the GOP are all too happy to oblige."
Steve Knievel, access to medicines advocate at Public Citizen, said Monday that "instead of transferring $10 billion from taxpayers and cancer patients to drug corporations that are already extremely profitable, President Trump and members of Congress must work to strengthen and expand Medicare drug price negotiations."
"Instead of gutting the law through bills like the ORPHAN Cures Act, EPIC Act, and MINI Act so Big Pharma can block negotiations on blockbuster treatments," Knievel added, "Congress should pass legislation to empower Medicare to negotiate lower drug prices on all costly medicines and allow all patients to access lower, negotiated prices, even if they don't have Medicare."
"Unlike Trump, I believe we need more than just press releases, polite requests to drug companies, and pilot projects," the senator said.
As President Donald Trump's deadline for large drugmakers to make "binding commitments" to cut prices expired on Monday, Sen. Bernie Sanders released a report showing that the cost of hundreds of prescriptions has risen in the United States since the Republican returned to office in January.
In response to the president's May executive order and July letters giving drugmakers 60 days to act, Sanders (I-Vt.), ranking member of the Senate Health, Education, Labor, and Pensions Committee, "directed his staff to examine prescription drug prices," explains the report, The Art of the Bad Deal: Trump's Failure to Lower Prescription Drug Prices.
The committee staffers documented price increases for 688 medications—310 brand-name drugs and 378 generic ones—during Trump's second term, with a median increase of 5.5% and 25 treatments more than doubling in cost.
"Of the 17 companies that received a letter from President Trump on July 31, 2025, 15 raised the price of at least one product since Trump took office," the report notes. "Since Trump sent letters asking drug companies to lower prices, the prices of 87 drugs have increased."

Overall, the highest hike was 1,555%. Eton Pharmaceuticals increased the price of Galzin, which is used to treat a rare genetic liver disorder called Wilson's disease, from $5,400 to $88,800 per year in the United States—even though it only costs $1,400 in the United Kingdom and $2,800 in Germany.
The report highlights some other examples, such as Novartis' cancer drug Kymriah, which increased by $25,600, or 4.5%, to $594,000 annually. In the UK, it costs $381,000 a year, and in Germany it's $282,000. The report also notes the company's executive compensation last year: $83.3 million.
Vertex jacked up the price of Trikafta, used to treat cystic fibrosis, by 7%, or $23,900, to $365,000 a year, according to the report. Just north of the US, in Canada, it's only $146,000. The company's executive compensation for 2024 was $12.7 million.
Johnson & Johnson increased the price of Xarelto, used to treat and prevent blood clots, by 5% to $7,200—far higher than its cost in Canada ($750), the UK ($880), and Germany ($1,300). The company also hiked the price of Spravato, a nasal spray used to treat depression, by 8% to $28,100, roughly double the cost in those other three countries. Its executive compensation was $64.5 million.
"These price increases are just the beginning. Trump's chaotic across-the-board tariffs will further increase prices," the report warns. "Trump has already imposed a 15% tariff on pharmaceutical products from Europe and Japan, and he has threatened to increase tariffs on pharmaceuticals to up to 250%."
"On September 25, Trump announced that he will impose a 100% tariff on pharmaceutical products starting October 1 unless a product's manufacturer is making or is planning to make the product in the US," the publication details. "Insurers are already reporting that higher drug prices arising from tariffs will result in higher health insurance premiums."
The report continues:
In addition, instead of working with Congress to pass legislation to lower prescription drug prices, the Trump administration spent its first months in office racing to sign a law that makes the largest federal healthcare cuts in history. The cuts will make it harder for millions of Americans to afford prescription drugs as people lose coverage and face ballooning premium bills and rising out-of-pocket costs. In addition, hidden in the administration's One Big Beautiful Bill Act is a multibillion-dollar giveaway to some of the largest pharmaceutical companies in the world.
OBBBA prevents or delays Medicare from negotiating the price of some of the most expensive prescription drugs. Public reporting and analyses have identified several drugs that will benefit from this loophole.
The document stresses that "any real solution to lowering prescription drug prices will require legislation, not just press releases," and points to Sanders' Prescription Drug Price Relief Act, which "would ensure Americans do not pay more for prescription drugs than the median price paid in Canada, the United Kingdom, France, Germany, and Japan."
Although Trump's health and human services secretary, Robert F. Kennedy Jr., "committed to working with Sen. Sanders on this legislation at a hearing in May 2025, HHS stopped responding to staff-level requests to work together to get this bill passed into law after one meeting," according to the report.
Echoing the report, Sanders said in a Monday statement that "I agree with President Trump: It is an outrage that the American people pay, by far, the highest prices in the world for prescription drugs. But unlike Trump, I believe we need more than just press releases, polite requests to drug companies, and pilot projects. We need real action to take on the greed of the pharmaceutical industry and substantially reduce the cost of prescription drugs for all Americans."
"If President Trump is serious about making real change, he will support my legislation to make sure Americans pay no more than people in other major countries for the exact same prescription drug," added Sanders, a longtime advocate of Medicare for All. "Now is the time to end the greed of the pharmaceutical industry."
"Because of you and congressional Republicans, seniors will continue to face astronomical, unaffordable costs for lifesaving cancer treatments," said Sens. Ron Wyden and Catherine Cortez Masto.
Two Democratic senators on Monday tore into their Republican counterparts for "sneaking" a provision into their party's massive budget legislation that they said would provide a "multibillion dollar bailout" for the American pharmaceutical industry.
In a letter sent to U.S. President Donald Trump, Sens. Ron Wyden (D-Ore.) and Catherine Cortez Masto (D-Nev.) pointed out that the budget package "includes provisions that block or delay the Trump administration from using Medicare drug price negotiation to lower the price of certain blockbuster drugs" including "the top-selling cancer drugs in the world, such as Keytruda, Opdivo, Darzalex, and more."
The senators explained that Keytruda was originally due to become subject to Medicare price negotiations starting next year, but that has now been put on ice by the GOP's legislation.
"We see no policy rationale whatsoever for delaying the... ability to negotiate lower prices on these drugs other than handing money over to the industry," they charged. "Because of you and congressional Republicans, seniors will continue to face astronomical, unaffordable costs for lifesaving cancer treatments."
The senators noted the cruel irony of this gift to the pharmaceutical industry was that Republicans offset its cost by slashing roughly $1 trillion from Medicaid over the next decade, a move that's projected to strip health insurance from millions of Americans.
"Republicans were able to find billions of dollars to bailout the pharmaceutical industry in their multitrillion tax bill, but you claimed that fiscal austerity required you to enact the largest healthcare cuts in history, terminating coverage for more than 15 million Americans and hiking healthcare costs for everyone, even imposing a 'sick tax' on the lowest income Americans," the senators argued. "Republicans' budget bill benefited the ultrawealthy and big corporations, like Big Pharma, with tax cuts and bailouts at the expense of working and middle-class Americans' healthcare."
The senators also slammed Trump's decision to eschew Medicare price negotiations of the kind first employed by former U.S. President Joe Biden's administration after the passage of the 2022 Inflation Reduction Act that authorized such negotiations for a limited set of drugs for the first time. Instead, they pointed out that Trump has demanded pharmaceutical companies cut prices on Americans by raising them everywhere else in the world, which they described as a "flashy, empty announcement."
Steve Knievel, access to medicines advocate at Public Citizen, similarly dismissed Trump's recent letters to pharmaceutical companies last week as a completely ineffective approach to lowering prescription drug costs.
"If President Trump was serious about lowering drug prices for Americans, instead of promising to help drug corporations profiteer in other countries, he would work with Congress to pass legislation to lower prices here so Big Pharma can no longer charge U.S. patients and taxpayers the highest prices in the world," he said.
Trump in recent days has been making a number of mathematically impossible promises to lower the cost of drugs for Americans by as much as "1,200%," which would mean that pharmaceutical companies would be paying Americans substantial sums of money in exchange for taking their drugs.