A Pharmacist’s (and Technician’s!) Guide to the 2024 Presidential Election
The following table represents the position or track record of each major-party presidential candidate related to key advocacy issues for the pharmacy workforce. Overall thumbs-up/thumbs-down is somewhat subjective but attempts to accurately reflect our professional advocacy positions. Of course, many issues indirectly (but very significantly) pertain to our profession, such as labor advocacy and workplace protections, policies to minimize poverty and other adverse social determinants of health, efforts to minimize global climate change, and more. These policies are omitted for the sake of focusing on pharmacy-specific topics but are certainly relevant to our profession and our patients; they are somewhat reflected in official party platforms in the bottom row of the table.
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Kamala Harris (D) |
Donald Trump (R) |
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340B |
🤷 | 👍 Official position is unclear. However, the Biden-Harris HHS issued a rule to reimburse 340B covered entities $9B of payments dating back 5 years in order to support these essential programs and reverse previous cuts. |
👎👎 The Trump HHS cut prescription drug payments to 340B covered entities by more than 30%. This decision was later overturned by the Supreme Court. Former President Trump also signed the Executive Order on Access to Affordable Life-saving Medications, which aimed to extend 340B cost savings directly to patients. This rule was later rescinded due to “the excessive administrative costs and burdens that implementation would have imposed on health centers.” |
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Drug costs |
👍👍 The Biden-Harris administration asserted the authority to exercise march-in rights, which allows the government to selectively seize the patent for exorbitantly pricey medications. They also signed into law certain drug cost offsets for Medicare recipients, such as a $35/mo max price for insulin, and have called for a $2000 max out-of-pocket for private insurance plans. As the California AG, Harris repeatedly quashed anticompetitive behavior among drug manufacturers. In 2022, the Biden-Harris administration passed the Inflation Reduction Act (for which VP Harris cast the tie-breaking vote in the Senate), which capped out-of-pocket drug costs for Medicare recipients including a $35/month insulin max, allowed Medicare to directly negotiate drug prices, and lowered Marketplace costs to achieve record-setting low rates of uninsured people in the US. In Aug 2024, the Biden-Harris administration and CMS negotiated with drug companies to reduce the price of 10 expensive medications used to manage common chronic disease states, affecting 8.8M people in the US. The Congressional Budget office estimates this will save $3.7B in its first year and when combined with further drug negotiations, $100B over 10 years. |
👎 Frmr Pres Trump proposed that the Most Favored Nation Rule to apply to Medicare Parts B and D. This applied to the top 50 highest-spend drugs in an effort to reduce costs, aligning payment for these drugs to more closely match international pricing. There were legal issues with implementation and the rule was projected to cost $196B over the next 10 years and patient cost-saving was uncertain. The rule was rescinded in 2021. Frmr Pres Trump also signed an executive order that would allow importation of medications from Canada, which was opposed by the Canadian government and Canadian pharmacy organizations as it could exacerbate drug shortages in their country (and is unlikely to significantly help alleviate shortages in the US); the Canadian Health Ministry prohibits parts of this measure. |
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Drug shortages |
👍👍 The HHS under the Biden-Harris administration released a comprehensive white paper aimed at addressing the medication supply chain including adding resiliency into the supply chain, increasing transparency, limiting the power of PBMs, diversifying response to shortages, and aggressively supporting generic product availability. |
👍 | 👎 In 2020, Frmr Pres Trump signed the “Buy American” executive order, which required federal purchases of essential drugs and personal protective equipment to be completed with domestic suppliers. This was feared to be a move that had the potential to disrupt local access to medications and impair the replenishment of the Strategic National Stockpile. The executive order was later fine-tuned by the Biden-Harris administration to close these loopholes. |
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Health equity |
👍👍👍 Health equity is a cornerstone of VP Harris’ healthcare platform and legislative record. The Biden-Harris administration founded the COVID-19 Health Equity Task Force, charged with “government-wide effort to identify and eliminate health and social disparities that result in disproportionately higher rates of exposure, illness, hospitalization and death related to COVID-19.” In 2024, VP Harris announced finalized rules that mandate certain minimum staffing requirements in longterm care facilities and wage allocations for Medicaid home care providers. She has leveraged policy to address disparate Black maternal mortality rates (see “reproductive healthcare” section below) and supports strengthening the Americans with Disabilities Act (ADA). |
👎👎👎 Frmr President Trump opposes health equity efforts related to Medicaid coverage, care of transgender individuals, healthcare for women and pregnant people (see “reproductive healthcare” section below), services for individuals with mental health conditions (favoring a return to institutionalization), protections for people with disabilities, and more. Frmr President Trump also vehemently opposes diversity, equity, and inclusion (DEI) efforts in word and in action. Foundational DEI principles are integral to building equitable healthcare. |
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Medicare for all (or equivalent) |
👍 VP Harris signed Senator Bernie Sanders’ Medicare For All bill, which would eliminate private insurance; she has also advocated for other incremental measures that strengthen the Affordable Care Act (“Medicare For More”). VP Harris reframes health insurance as an economic issue, proposing piecemeal reform items such as a universal maximum $2000 out-of-pocket expense for medications (see also “drug costs” section). This is a more moderate approach than true “Medicare For All.” |
👎👎👎 Frmr Pres Trump opposes the Affordable Care Act (ACA) and has repeatedly attempted to eliminate its provisions, successfully revoking the individual mandate and resulting in higher insurance premium costs. He has not provided any policy proposals for alternative mechanisms to increase insurance coverage for people in the US but does self-report that he has “concepts of a plan” to do so. |
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PBM reform |
🤷 | 👍 The Biden-Harris administration has called for the practices of drug pricing “middlemen” (ie PBMs) to be reformed. Details of proposed reforms are sparse. From an Aug 16 Harris-Walz press release: “[VP Harris] will increase competition and demand transparency in the healthcare industry, starting by cracking down on pharmaceutical companies who block competition and abusive practices by pharmaceutical middlemen who squeeze small pharmacies’ profits and raise costs for consumers.” |
👎 Frmr Pres Trump signed an executive order limiting kickbacks to “middlemen,” but the Congressional Budget Office’s review of this rule found that its elimination of rebates would increase federal spending and insurance premiums. Cost was estimated to be $177B over 10 years and so the rule was rescinded. |
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Provider status |
🤷 No stated position on this topic. Position is likely informed by the candidate’s historical context pertaining to access to healthcare and regard for science/medicine in general. |
🤷 No stated position on this topic. Position is likely informed by the candidate’s historical context pertaining to access to healthcare and regard for science/medicine in general. |
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Reproductive healthcare |
👍👍👍 VP Harris supports federal abortion protections and permanently ended the Global Gag Rule; the Biden-Harris administration signed the Presidential Memorandum on Ensuring Safe Access to Medication Abortion. Introduced the Black Maternal Health Momnibus Act to combat disparate mortality rates. |
👎👎👎|🤷 Frmr Pres Trump often promotes medical misinformation related to reproductive care and his position on this question is often a moving target. The Trump Supreme Court oversaw the overturning of Roe v. Wade and precipitated the ensuing abortion ban in 16 states. |
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Student loan reform (especially Public Service Loan Forgiveness, PSLF) |
👍👍 VP Harris supports student loan forgiveness, particularly among public servants. The Biden-Harris administration has discharged $165B in student loans, predominantly via PSLF. |
👎👎👎 Frmr Pres Trump’s 2020 budget proposal, “A Budget for a Better America,” attempted to eliminate the PSLF program altogether. It also proposed eliminating student loan subsidies, which prevent interest accrual while borrowers are still in school. He has publicly opposed student loan forgiveness programs under the Biden-Harris administration. |
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Telehealth |
👍 The Biden-Harris administration extended telehealth provisions to ensure funding and coverage for telehealth, specifically highlighting improved healthcare access for military veterans and individuals in rural communities. |
👎👎👎 Frmr Pres Trump signed an executive order extending telehealth coverage for Medicare recipients through the end of the COVID-19 public health emergency. The Biden-Harris administration made these provisions permanent. |
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Vaccines |
👍 | 👎 VP Harris received her COVID vaccine on live television, in an effort to promote public uptake of the life-saving immunization. However, the Biden-Harris administration also oversaw the implementation and then revocation of vaccine requirements for healthcare workers. |
👎 Frmr President Trump oversaw Operation Warp Speed, an effort that brought COVID vaccines to market with unprecedented quickness. However, he has also pledged to revoke federal funding for “any school that has a vaccine mandate or a mask mandate.” |
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Whitebagging |
🤷 No stated position on this topic. Position is likely informed by the candidate’s historical context pertaining to regulatory safeguards and attitude toward third-party payors. |
🤷 No stated position on this topic. Position is likely informed by the candidate’s historical context pertaining to regulatory safeguards and attitude toward third-party payors. |
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Pertinent party platforms |
👍 Nine pages of “achieving universal, affordable, quality health care,” including:
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👎 One mention in the 28-page document: “Affordable Healthcare: Healthcare and prescription drug costs are out of control. Republicans will increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options. We will protect Medicare, and ensure Seniors receive the care they need without being burdened by excessive costs.” |
Candidate Robert Kennedy, Jr., has withdrawn from the presidential race. He was formerly running as an independent candidate. The Independent Party Platform states: “While the federal government must honor its commitment to those who have paid into Social Security, health care, or welfare, we favor voluntary participation only, and a gradual phasing out of those systems. We favor free enterprise and competition between practitioners and health care providers. We support the people’s right to choose any modality of health care.”
Candidate Jill Stein is the Green Party Candidate. Her platform includes implementing universal Medicare-for-All, canceling all medical debt, codifying the protections of Roe v Wade, prioritizing health equity, and comprehensively addressing the long-term consequences of Long COVID.
A more comprehensive view of each candidate can be found on Ballotpedia, and a more thorough comparison of health policy positions at the Kaiser Family Foundation.