What Happened to Trump's Drug Price Promises?

But it would be a radical shift to the system marking a dramatic redistribution from middlemen to individuals and drugmakers with unknown consequences. And Secretary Azar has yet to provide substantial details about how it would actually be enacted.

Similarly, Azar didn't use his testimony to provide any fresh detail about proposed shifts in Medicare coverage that could help ease prices.

Trump once advocated for using the government's negotiating power as custodian of Medicare to squeeze price cuts out of drugmakers. But in a previous hearing, Azar specifically rejected the notion of a government-set drug list that could be used to do exactly that. Instead, the administration's plans have been downgraded to theoretical actions that would boost the negotiating ability of fragmented private insurers that run Medicare Part D plans.

Azar has proposed bringing physician-administered medicines covered under Medicare Part B into Medicare Part D. Part B drugs aren't subject to negotiation and are reimbursed more generously than Part D drugs. But the impact of that shift would be muted without other changes to increase negotiating power.

Part D plans must currently have at least two options available for any disease state, and are required to cover essentially all drugs in certain classes. HHS is looking into easing these restrictions, which make it tough for Part D plans to get favorable pricing. But there's little detail on a possible timeline or on what specifically the agency wants to do.

Azar hasn't been clear about exactly which changes HHS could do make its own, and which would require Congressional action. Ones involving the latter seem unlikely anytime soon, especially with midterms approaching, given the likely strenuous objections of drugmakers, providers, and beneficiaries to various parts of these policy shifts.

In the hearing, Azar noted that drugmakers often increase prices around July 1 and that he hopes they'll show some restraint. That's a rather notable rhetorical step-down from more grandiose claims by his boss — and a rather tidy encapsulation of how the administration's drug-pricing efforts have delivered so far.

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Max Nisen is a Bloomberg Gadfly columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.