The pharmaceutical industry has relied on Republicans to protect them from Democrats who want to reduce high drug prices, but that may go away if GOP front-runner Donald Trump becomes the Republican nominee.
Trump has strayed from Republican orthodoxy to propose several Democratic reforms to address high prices, including reimportation of drugs from overseas and giving Medicare the power to negotiate for lower drug prices.
Democratic presidential candidates Bernie Sanders and Hillary Clinton have both made such proposals, which means drug companies could be faced with reforms no matter who gets elected.
The industry's main lobbying group, Pharmaceutical Research and Manufacturers of America, refuses to comment on the candidates themselves, but has criticized the various proposals.
When Medicare Part D was created back in 2003, lawmakers gave a key concession to companies: that Medicare would not be able to negotiate for lower drug prices. Medicare Part D is the prescription drug plan for the popular senior healthcare program.
With prescription drug prices rising, giving Medicare negotiating power has been a commonly cited reform from Democrats. It was included in a plan from Hillary Clinton and a Senate bill from Sen. Bernie Sanders, I-Vt. Another common reform is lifting prohibitions against reimporting drug products overseas at lower prices.
Republicans have shied away from giving Medicare such powers and reimportation, and instead argue for faster drug approvals from regulators as a way to increase competition and lower prices. But there is one key exception: GOP front-runner Donald Trump.
"We don't do it. Why? Because of the drug companies," according to an Associated Press report of a Trump event in New Hampshire in January, quoting Trump on Medicare negotiations.
Trump has previously claimed that the U.S. could save $300 billion a year in healthcare costs through Medicare negotiations, even though the entitlement program only spends $111 billion a year on drugs.
Regardless, PhRMA said negotiations are already happening, mainly through pharmacy benefit managers who oversee a prescription drug plan for an insurer. Additionally, the group cites a 2007 Congressional Budget Office report that found negotiations would have a negligible effect on prices because benefit managers already do it.
"There is significant price negotiation that already occurs with the Medicare prescription drug program," according to a January statement from the group.
Drug reimports is another big issue where Trump sides with Democrats. "Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers," according to Trump's healthcare plan.
The practice refers to buying a drug manufactured in the U.S. from a pharmacy overseas because of a cheaper price. Normally people reimport a drug from an online pharmacy in Canada or other countries.
Currently it is illegal under federal law to reimport drugs from overseas, but the Food and Drug Administration essentially looks the other way if it is a consumer buying a drug. However, the FDA warns that pharmaceuticals bought outside the U.S. may be unsafe or ineffective.
Maine approved a state law that allows its consumers to buy pharmaceuticals from state-cleared Canadian online pharmacies. However, a federal judge struck it down because the practice violated federal law.
Reimportation would save about $20 billion in healthcare costs over the next ten years, according to an analysis of Trump's healthcare plan from the nonpartisan Committee for a Responsible Federal Budget.
The pharmaceutical industry has taken a strong stance against reimportation as well, highlighting that this isn't a partisan issue.
"Under both Democratic and Republican administrations, the FDA has stated it cannot assure the safety of imported medicines from foreign countries and they would present a risk to public health," said Holly Campbell, PhRMA spokeswoman.
To be sure, Trump's healthcare plan has several Republican healthcare proposals such as Medicaid block grants and allowing people to buy health insurance over state lines. He also has promised to repeal Obamacare, a common proposal from Republicans.
The committee's analysis of Trump's healthcare plan found that it would add $270 billion to the national debt over 10 years due to repealing Obamacare and would result in nearly 21 million people losing their insurance.