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Sarah Karlin-Smith

@sarahkarlin-smith.bsky.social
7.4K followers 2.1K following 3.5K posts

Research Director at Public Citizen's Access to Medicines program. Former journalist covering intersection of pharma, health policy & politics. On Signal at SarahKarlinSmith.34 Views are mine.

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Reposted by Sarah Karlin-Smith
Bayliss Wagner @baylisswagner.bsky.social · 29m
BREAKING: In Nebraska rally, Trump just suggested he would be unbothered to see Iran "take out" LA or San Diego: “They could take out a city,” he said. “Let them take—Let them take out Los Angeles. Let them take out San Diego. That’s—this is a very small price to pay."
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 6h
lowest starting salary here is for pediatrics ($231,000). www.beckershospitalreview.com/compensation...
beckershospitalreview.com
Physicians’ starting salary reaches $419K: A breakdown of 14 specialties
Physicians starting salary reaches $419K in 2025-26, with detailed data on 14 specialties and signing bonuses from AMN Healthcare.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 9h
Federal regulations mandate that farms with 11 or more field workers provide a toilet and handwashing station for every 20 workers, within a quarter-mile walk. But when quotas are in place, advocates say, even a few minutes away from the row can cost workers pay and put their jobs at risk.
northcarolinahealthnews.org
Strawberries in February: The Cyclospora outbreak and the cost of convenience
The 2026 outbreak reveals strains on farmworkers, food inspections and disease tracking in a system where consumers demand fresh produce year-round.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 9h
Many unanswerable questions hung over Bel’s funeral. ...how could the president who made it happen show his face that same day, just miles down the road, not only to defend that change, but to bask in it? www.thebulwark.com/p/a-death-a-...
thebulwark.com
A Death. A Funeral. And the Trump Rally Down the Block.
On the day Springfield held a funeral for Pierre Damas Bel, the president held a rally 25 miles away. We went to both.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 10h
The insight from Hopkin's Anderson in this @bobjherman.bsky.social article that there is a growing openness to regulating hc prices like utilities is notable.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 10h
Drugs have been eating more of the employer’s premium for multiple years now. Rx drugs filled at a pharmacy represented 18% of a worker’s health care premium in 2021, after factoring in any rebates ...By 2026, that figure jumped to 23%, driven in large part by the surge of people getting GLP-1s.
statnews.com
Hospital and pharmaceutical prices are smothering America’s businesses
Workers and employers are drowning in their health insurance premiums. The reason for that deluge: the health care industry’s high and inscrutable prices.
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Reposted by Sarah Karlin-Smith
Max Kennerly @maxkennerly.bsky.social · 01/10/2026
If you're wondering if the US Travel Association blames Trump and Republicans, the answer is "no." As of a month ago, they were still praising him and noting they were "ready to work with the president and his administration to build on today’s momentum." Ok! www.ustravel.org/press/travel...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 01/10/2026
Tomorrow I'll be speaking on this webinar about GLP-1s and access challenges. centerforhealthjournalism.org/our-work/web...
centerforhealthjournalism.org
Who Gets Access to Breakthrough Drugs?
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 01/10/2026
Trump exempted nearly all pharma companies from one of his plans to cut drug prices in Medicare so expected savings dropped from nearly $12 billion to about $440 million. www.citizen.org/news/finaliz...
citizen.org
Finalized GLOBE Part B Model Is Full of Holes - Public Citizen
WASHINGTON, D.C. – The Centers for Medicare & Medicaid Services released its finalized GLOBE Medicare Part B drug price model…
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 30/09/2026
Those losing their health benefits ... include refugees of war, asylees who fled persecution, victims of sex trafficking, and interpreters who risked their lives assisting U.S. service members in Afghanistan — all of whom are in the country with the federal government’s permission.
kffhealthnews.org
US Poised To Boot Legal Immigrants From Medicaid, Including Refugees and Sex-Trafficking Victims - KFF Health News
The Congressional Budget Office estimated 100,000 more immigrants will be uninsured by 2034 because of Medicaid eligibility changes under President Trump’s One Big Beautiful Bill Act that take effect ...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 30/09/2026
So much for MAHA plans to tackle chronic disease eh.. "Task force members were also prevented from voting on a recommendation for preventing cardiovascular disease through healthy lifestyle interventions because of cancelled meetings, he noted." www.medpagetoday.com/washington-w...
medpagetoday.com
Trump Administration Suppressed USPSTF Recommendations, Past Chair Says
Group's recommendations on cervical cancer screening, cardiovascular prevention were blocked
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Reposted by Sarah Karlin-Smith
Jess Piper @piperformissouri.bsky.social · 30/09/2026
If you’re not from Missouri, you may not know that Eric Schmitt got his start in MAGA politics by suing public schools for mask mandates while their teachers died during a pandemic. The really strange thing? He never sued his own kids’ school for their mask mandate. He’s a piece of Schitt.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 30/09/2026
California just passed a new law to make access to Hep C treatment easier. But it's shameful that a DECADE after a cure 400,000 people in the state still haven't gotten access to treatment due to high drug costs and hurdles put in place by insurance companies due to those costs.
yahoo.com
There's a cure for one of California's biggest health problems. Getting it is another matter
California is eliminating a key insurance hurdle for hepatitis C treatment, part of a broader push to get a long-available cure to the hundreds of thousands of patients who need it.
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Reposted by Sarah Karlin-Smith
Annie Waldman @anniewaldman.bsky.social · 30/09/2026
NEW: As Trump’s White House and influencers keep touting the unproven benefits of raw milk, hundreds across the country are falling ill from outbreaks. Some people get severe indigestion. And some nearly die. Here's the story of one toddler who drank it. 🧵👇 www.propublica.org/article/cali...
propublica.org
A Girl Nearly Died After Drinking Raw Milk. The State Did Little to Punish the Unlicensed Farmer Who Sold It.
California is teeming with black-market dairies, propped up by consumer demand fueled by misinformation. With evidence against one raw goat milk farm, regulators could have sought punitive action. But...
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Reposted by Sarah Karlin-Smith
Zach Everson @zacheverson.com · 29/09/2026
Here's a $20 million order, paid for by CBP's Office of Public Affairs, awarded to LMD Agency for a national media campaign starting on Sept. 20. The first pro-Trump ad aired on Sept. 23. www.usaspending.gov/award/CONT_A...
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Blanket Purchase Agreement (BPA) Call
PIID

70B06C26F00001137
In Progress
(11 months remain)
Unlinked Award
Awarding Agency
Department of Homeland Security (DHS)
Recipient
LMD AGENCY, INC.
5950 SYMPHONY WOODS RD STE 500
COLUMBIA, MD 21044-3592
UNITED STATES
Congressional District: MD-03
Related Awards
Parent Award Unique Key
CONT_IDV_70Z02323ACGRC0001_7008
Dates
Today
Start Date
Sep 20, 2026
Current End Date
Sep 19, 2027
Potential End Date
Sep 19, 2027
$ Award Amounts
$20.0 Million
Current Award Amount
$20.0 Million
Obligated Amount
$20.0 Million
Potential Award Amount
Outlayed Amount
$0.00
Obligated Amount
$20,000,000.00
Current Award Amount
$20,000,000.00
Potential Award Amount
$20,000,000.00
View Transaction History
Description

NATIONAL MEDIA CAMPAIGN
North American Industry Classification System (NAICS)Code
54 : Professional, Scientific, and Technical Services
5418: Advertising, Public Relations, and Related Services
541810: Advertising Agencies
Product or Service Code(PSC)
SERVICES
R: SUPPORT SVCS (PROF, ADMIN, MGMT)
R7: MANAGEMENT SUPPORT SERVICES
R701: SUPPORT- MANAGEMENT: ADVERTISING
Contract Activity
$0$5 M$10 M$15 M$20 M$25 MSEP FY '26OCT FY '27DEC FY '27JAN FY '27FEB FY '27APR FY '27MAY FY '27JUN FY '27AUG FY '27SEP FY '27StartTodayCurrent EndPotential End
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Federal Accounts
This award has not been linked to any federal account.
Award History

This section displays the awards:

Transaction History - Displays modification records for an award. Each modification appears as a row in the table below.

Sub-Awards - Displays any sub-contracts reported by this contract's recipient (the 'prime recipient' in the sub-award context). Sub-contracts are contractual agreements that a prime recipient makes with another entity (sub-reci
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Reposted by Sarah Karlin-Smith
Tina Vasquez @tinavasquez.bsky.social · 30/09/2026
Florida Orange Gold is a farm labor contractor (FLC) allowed by the U.S. government to bring hundreds of migrant farmworkers to the U.S. each year to perform dangerous, seasonal agricultural work.
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Reposted by Sarah Karlin-Smith
Tina Vasquez @tinavasquez.bsky.social · 30/09/2026
NEW: H-2A worker Carlos Vargas Moreno experienced a catastrophic heat stroke when his employer, Florida Orange Gold, subjected him to unsafe working conditions. The same company was cited two years prior for the heat-related death of H-2A worker Carmen Sebastian Hernandez Mosqueda.
prismreports.org
Despite farmworker death and another disabled by heat stroke, employer keeps sending people to fields
Florida Orange Gold has exposed workers on H-2A visas to extreme heat, but continues to bring hundreds of migrants to North Carolina
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Reposted by Sarah Karlin-Smith
Juliette Cubanski @jcubanski.bsky.social · 29/09/2026
CMS has just released information about Medicare drug plan offerings for 2027, emphasizing stability. Some quick top-level analysis about the stand-alone Part D drug plan market to follow. ⬇️ www.cms.gov/newsroom/pre...
cms.gov
Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027
Medicare Advantage and Medicare Prescription Drug Programs Expected to Remain Stable in 2027The Centers for Medicare & Medicaid Services (CMS) today announced significant premium savings for millions ...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 28/09/2026
Pharma's business model doesn't work for some of the most needed medical innovation. www.statnews.com/pharmalot/20...
statnews.com
Merck discontinues a crucial antibiotic despite concerns over superbug resistance
Merck discontinued Recarbio, an important antibiotic in the U.S., despite concerns over resistance to superbugs.
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Reposted by Sarah Karlin-Smith
Melody Schreiber @melodyschreiber.com · 25/09/2026
This part is really difficult to understand for people who don't know the intricacies of ACA. Did you know you can be too poor for Obamacare but not poor enough for Medicaid?
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Reposted by Sarah Karlin-Smith
Sarah Tuttle @niais.cryptoanarchy.network · 25/09/2026
IN MINNESOTA.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 25/09/2026
The only explanation I can think of for this, is this guy is so rich everyone does everything for him including getting him home and all his boring paperwork?
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Reposted by Sarah Karlin-Smith
Chanda Prescod-Weinstein 🌌 @chanda.blacksky.app · 24/09/2026
Every villain has a weakness. And occasionally their weakness is turning to the camera and explaining what their weakness is and that their weakness is making themselves stupider
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Reposted by Sarah Karlin-Smith
Aaron Rupar @atrupar.com · 24/09/2026
SANDERS: Trump claims we pay lowest prices in the world for prescription drugs. Wow! Is he telling the truth? OVERTON: There has been immense progress- S: Do we pay lowest prices like POTUS said? You just told us you're gonna stand up to him O: We have seen- S: Is it true? O: *more dissembling*
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Reposted by Sarah Karlin-Smith
Meredith Shiner @meredithshiner.com · 24/09/2026
What is the point of any of this if those who believe so strongly in righteous issues cannot even consider recognizing those who see the political headwinds and demonstrate capacity for change? Politicians are always going to be this way. They can't always be as righteous from the outset as we want.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 24/09/2026
I'm a little overwhelmed at the amount of bad public health news in KFF Health News' morning roundup this am. Most of which seems to be deliberate attempts at harm by Trump team.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 24/09/2026
KFF coming in strong with useful data this week: For five of the 32 drugs, the TrumpRx drug price is the lowest compared to all other comparable countries where the drug is available, while for 13 of the 32 drugs, the TrumpRx drug price is the highest compared to all other countries.
healthsystemtracker.org
How TrumpRx brand-name drug prices compare to other countries - Peterson-KFF Health System Tracker
The analysis focuses on the 39 brand-name drugs listed on the TrumpRx site that do not have generics or biosimilars available in the U.S., of which 32 had publicly available prices in one or more of t...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 24/09/2026
This morning I realized we had put over 4,000 miles on our current ebike in less than a year and a half. While accidentially trying to reset mileage count we use to track miles since last battery charge.. Now do I know how to get screen back to the other mileage ...no
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 24/09/2026
"The pricing details that states would get through GENEROUS, if they do participate, are not publicly available. States had to sign “non-binding participation agreements” in order to get the pricing information, according to officials from California." via @danielpayne.bsky.social
statnews.com
Trump boast on drug pricing policy overstated state-level interest in federal program
President Trump and his aides boasted that every U.S. state wanted to participate in a drug pricing initiative through Medicaid. Several states said they weren't sure yet.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
27% of women 18-64 report they didn’t fill a prescription in the last year because of cost and almost a fifth report they cut pills in half or skipped doses of medicine because of cost. 4/10 women in fair or poor health didn’t fill prescriptions and 1/4 cut pills or skipped doses because of costs.
kff.org
Women's Health Care Affordability Challenges | KFF
As health care costs dominate the national political conversation, our 2026 KFF Women’s Health Survey shows the toll those costs are taking on women. Our new nationally representative survey of women ...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
"Companies have every incentive to cherry-pick [for this program] the products for which they already give Medicaid the best discounts and for which the international price may not be that much lower. So there would be an incentive for companies to try to limit their liability ..."
npr.org
A year ago, President Trump pledged to lower Medicaid drug prices. Has that happened?
The Trump administration's efforts to lower drug prices included promised changes to Medicaid. But it's still unclear which drugs will be affected. And each state has to opt in.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
Vertex's CF drug looks like it may help babies w/ CF if taken in utero. The company charges $27k a month for the drug and it doesn't want to study this indication or provide free drug to others who want to run trials. (cost of drug is also a huge barrier for approved populations)
endpoints.news
In a changed world for cystic fibrosis, a family's fight reveals a new gap in care
Drugs like Trikafta, first approved in 2019, have changed cystic fibrosis from a death sentence to a manageable chronic condition for the vast majority of patients. But the drug is only approved for c...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
Interesting new polling from KFF here that suggests majority of rural voters recognize Trump's drug pricing policies are a failure. www.kff.org/public-opini...
kff.org
KFF/AP Rural Voters Survey | KFF
The KFF/AP Rural Voters Survey examines the views and political priorities of voters living in rural areas across the United States ahead of the 2026 midterm elections. The survey gauges rural voters'...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
One of the highlights of parenthood was during potty training when my children would applaud me for going to the bathroom.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
400k/year is the thanks taxpayers get from industry... "Jobs notes that the recently approved pancreatic cancer drug daraxonrasib from Revolution Medicines — of which Yosemite is an investor — is an example of a discovery that would have been difficult to achieve without publicly funded research."
statnews.com
The NIH budget should be $100 billion per year
“We should be strengthening our investment in the NIH, not dismantling it,” writes Reed Jobs.
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Reposted by Sarah Karlin-Smith
Liz Essley Whyte @lizessleywhyte.bsky.social · 23/09/2026
NEW exclusive from me: Health officials moved money out of the Office of Minority Health to help pay for the ballooning costs of RFK Jr.'s security gift link www.wsj.com/politics/pol...
wsj.com
Exclusive | RFK Jr.’s Enhanced Security Was Funded With Money From Minority Health Office
The cost of the health secretary’s security grew from roughly $10 million in fiscal year 2025 to $17 million in fiscal year 2026.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 23/09/2026
My preker who goes to a public, minority majority public school was just eating a mango. She told me it was a cognate, defined it and then told me how to say cognate in Spanish. I know there is lots on inequality out there but there are pathways to something better.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 22/09/2026
Richard Evans of SSR Health (a former drug exec) expects more co-formulation collaborations between manufacturers whose active drugs used in combo w/ each other to try and avoid Medicare negotiations.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 22/09/2026
Why are list prices dropping? Medicaid AMP cap but also risk of Medicare drug price negotiations, Richard Evans says on Health Affairs webinar.
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 22/09/2026
Lilly pledged to make insulin available at $25/vial for uninsured but it introduced restrictions based on geography and needs, and insulins that are subject to these voluntary price caps are often out of stock at the pharmacy when people go to fill a prescription. via @dylanlscott.bsky.social
vox.com
A shocking number of Americans are still rationing insulin
Insulin still doesn’t cost $35. Here’s what it will take to make it truly affordable.
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Reposted by Sarah Karlin-Smith
PoPville @popville.bsky.social · 22/09/2026
Another Poorly Parked Car Causes Bus Mayhem in Mount Pleasant - Maddening: www.popville.com/2026/09/anot...
popville.com
Another Poorly Parked Car Causes Bus Mayhem in Mount Pleasant - PoPville
Thanks to Terry for sending: "Car in no parking anytime space at Lamont Park. Sign posted no parking g there for a reason. Geesh." Ed. Note: This was a big problem last winter when Meanwhile in Mount ...
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Sarah Karlin-Smith @sarahkarlin-smith.bsky.social · 22/09/2026
new details on Trump's pharma tariffs in federal register late yesterday: public-inspection.federalregister.gov/2026-19498.p...
public-inspection.federalregister.gov
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Reposted by Sarah Karlin-Smith
Dimitri Drekonja, MD, MS @dimitridrekonja.bsky.social · 22/09/2026
They are years late, but this is a good thing and I am glad they found their spines 👍🏻👍🏻💪🏼💪🏼
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Reposted by Sarah Karlin-Smith
Prof Gavin Yamey MD MPH @gavinyamey.bsky.social · 19/09/2026
When healthy young men take testosterone, they risk infertility, erectile dysfunction, severe acne, hair loss, and polycythemia Polycythemia can cause a range of health problems, including heart attacks, clots, and strokes Hegseth’s damaging mandate is terrible science & terrible public health
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Peter Maybarduk @maybarduk.bsky.social · 19/09/2026
We are fighting the redactions in court and still pushing for more documents and disclosures. These FOIA'd documents at least show us the structure of the agreements, in significant part. Read the texts for yourself here: www.citizen.org/article/foia... Thanks @sarahkarlin-smith.bsky.social
citizen.org
FOIA Documents: Trump-Pharma MFN Drug Pricing Deals - Public Citizen
The Trump administration has signed dozens of “most favored nation” (MFN) agreements with pharmaceutical companies, claiming to provide Americans with…
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Reposted by Sarah Karlin-Smith
Peter Maybarduk @maybarduk.bsky.social · 19/09/2026
For some sections of the MFN deals, even the headers are redacted. Trump's HHS won't even tell the American people what it's not telling them. Rules affecting meds access typically are made in public, through legislation or process with public comment. Not Trump's deals. What's being traded here?
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Reposted by Sarah Karlin-Smith
Peter Maybarduk @maybarduk.bsky.social · 19/09/2026
Some drugmakers say they will stop selling new drugs to key countries, in order to keep the most-favored nation price high in the United States. That could mean patients with no route to access. Here, HHS appears to bless that deadly practice:
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Peter Maybarduk @maybarduk.bsky.social · 19/09/2026
Trump claims lower GLP-1 prices from his deals. But Lilly’s deal contains a loophole that insulates it from providing a true MFN price point for its GLP-1 drugs. If the loophole is applied to all GLP-1 drugs, it could cost Medicaid $1.7 billion in savings. Analysis: www.citizen.org/article/publ...
citizen.org
Public Citizen FOIA Reveals That Pharma, Not Patients Are Favored In Trump’s Drug Pricing Deals - Public Citizen
Key Takeaways Copies of Pfizer and Eli Lilly’s “most-favored nation” (MFN) agreements obtained by Public Citizen through the Freedom of…
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Reposted by Sarah Karlin-Smith
Peter Maybarduk @maybarduk.bsky.social · 19/09/2026
We obtained Trump’s confidential drug pricing deals with Pfizer & Lilly via FOIA litigation. The texts are heavily redacted, making it impossible to verify some of Trump's claims. But unredacted text shows Trump exaggerated his drug pricing achievements, which expire anyway at the end of his term.
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Dan Diamond @ddiamond.bsky.social · 19/09/2026
For months, Trump has touted his drug-price deals — saying his work should be enough for the GOP to win the midterms. But Trump and his deputies have declined to release the deals' actual text. @publiccitizen.bsky.social sued to get two deals thru FOIA and shared them with The Post.
washingtonpost.com
Secret contracts reveal undisclosed terms in Trump’s drug-pricing deals
Agreements with Pfizer and Eli Lilly include tariff protections, overseas pricing inducements and broad confidentiality clauses.
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