On Nov. 2, 2020, days before that year's presidential election, then-candidate Joe Biden said he would "lower prescription drugs by 60%, and that's the truth."

He advanced toward that goal throughout his presidency, but didn't lower prescription drugs by that much across the board.

In 2022, Congress adopted and Biden signed into law the Inflation Reduction Act, part of which targeted prescription drug costs. It passed with no Republican votes.

One of the law's drug provisions, effective October 2023, increased payment incentives for physicians to prescribe what are called biosimilars — lower-cost alternatives to expensive brand-name drugs. Drugmakers now, under the law, must rebate Medicare if their prices rise faster than inflation. The law also included a provision that caps the annual out-of-pocket cost for Medicare Part D prescription drugs at $2,000 starting in 2025.

KFF estimated 1.4 million Medicare members enrolled in Part D had out-of-pocket drug costs that exceeded $2,000 in 2020, averaging about $3,355 each.

The legislation also capped Medicare enrollees' insulin prices at $35 a month in 2023; the U.S. Department of Health and Human Services estimated this would yield an annual savings of about $500 per person. After the law passed, some pharmaceutical companies — including Eli Lilly and Co., Novo Nordisk, Sanofi and Civica Rx — self-imposed price caps for all insured insulin users, not just Medicare patients.

Lastly, the law has allowed Medicare, for the first time, to negotiate prices with drug manufacturers, starting with 10 drugs in 2026. More will be added to the list each year.

The Department of Health and Human Services said in August that Medicare negotiated savings from 38% to 79% off the 2023 list prices of the 10 drugs. The reduction will yield an estimated $6 billion in savings for the federal government and a $1.5 billion reduction in out-of-pocket costs for older Americans when the lower prices take effect in 2026, according to the Biden administration. The $6 billion in savings for Medicare represents a 22% reduction in total net spending on the medications, which factors in the rebates and discounts.

Biden promised a 60% reduction, but whether that was aimed at drug costs for individuals, lower prices across many drugs, or total national spending on drugs is unclear, experts said.

"The promise of a 60% reduction is fairly vague, though there have been some improvements that might be close," said Stacie Dusetzina, a health policy professor at Vanderbilt University who studies drug pricing. "The Inflation Reduction Act does reduce what Medicare beneficiaries pay for high priced drugs and — in some cases — those reductions are even more than 60%."

For example, she said, before the law, someone with cancer could spend more than $10,000 out-of-pocket on those drugs and will pay only $2,000 in 2025. "Now, that's not everyone," Dusetzina said, "but the more someone was spending on drugs under Medicare Part D, the more they will save with that policy."

Although Biden accomplished significant changes that will substantially lessen costs for some people, health policy experts said, it falls short of a 60% reduction when applied across the U.S.' pharmaceutical marketplace.

"Has the administration taken big steps on prescription drugs that will substantially reduce prices? The answer is yes," Matthew Fiedler, a senior fellow at the USC-Brookings Schaeffer Initiative for Health Policy previously told us. But Fiedler added that it would take time before the price reductions meaningfully cut what the U.S. pays for drugs.

We rate this Compromise.

Much has happened since President Joe Biden, then a candidate, made a campaign-trail pledge to lower drug costs. He said in a Nov. 2, 2020, speech that he would "lower prescription drugs by 60%, and that's the truth."

He followed up on that promise early in his term, with a July 2021 executive order that gave a road map of how his administration planned to do it. At the time, drug pricing experts said these actions might help, but they warned that legislation was necessary to move closer to keeping that campaign promise.

Then, last summer, following a long partisan fight, Congress adopted wide-ranging legislation called the Inflation Reduction Act, part of which targeted prescription drug costs. It passed with no Republican votes. Biden signed it into law Aug. 16. But has any of this moved the needle toward Biden's promise?

Experts say the new policies could move closer to the 60% mark, but with caveats.

Through this law, "there are people who are going to save thousands, either because they are taking many drugs or certain high-cost drugs," said Matthew Fiedler, senior fellow at the USC-Brookings Schaeffer Initiative for Health Policy. Unless the law is repealed, "those reductions in prices will eventually happen."

But the big picture is murkier, he and other experts said.

It isn't clear, for example, whether the 60% reduction Biden promised was aimed at drug costs for individuals, lower prices across many drugs, or a spending drop of that size in the overall national prescription drug tab.

If Biden was aiming for a 60% reduction in the cost of drugs across the U.S., then the inflation reduction measure "is not going to meet that target," Fiedler said. "This is a big change in government policy. But it's not a 60% change."

What else does the law do?

Its drug provisions are varied. One, which went into effect in October, increases payment incentives for physicians to prescribe what are called biosimilars, which are lower-cost alternatives to expensive brand-name biologic drugs. And, as of January, Medicare enrollees' insulin prices are capped at $35 a month.

But what's gotten much more attention are the changes to Medicare. In addition to the insulin cap, the law allows Medicare for the first time to negotiate prices with drug manufacturers. It starts small — with 10 drugs that don't have generic or biosimilar competitors — in 2026. More will be added to the list each year. No one knows yet which drugs' prices will be the first to be negotiated, though they must be selected from among the 50 drugs with the highest Medicare spending.

"It starts slow, but it does accumulate fairly rapidly," said Benedic Ippolito, a senior fellow in economic policy studies at the American Enterprise Institute.

Those provisions are estimated to save $98.5 billion over 10 years for Medicare, according to the Congressional Budget Office.

A provision that goes into effect this year requires drugmakers to rebate Medicare if their prices rise faster than inflation, with an estimated government savings over 10 years of $63.2 billion.

Another change affects how much Medicare enrollees must pay out-of-pocket annually toward their drugs. Those changes start to take effect in 2024 — and let's just describe them as complex. Bottom line: Medicare beneficiaries who use a lot of drugs or very expensive drugs will see their share of the costs lowered and capped, to $2,000 a year by 2025, and rising after that by a specific index.

KFF estimated 1.4 million Medicare members enrolled in Part D of the program had out-of-pocket drug costs that exceeded $2,000 in 2020, averaging about $3,355 each. Likely more will benefit from the provision by the time it goes into effect, the September report noted. (Kaiser Health News is an editorially independent program of KFF.)

Unlike some other provisions in the Inflation Reduction Act, the CBO estimated that the Medicare out-of-pocket-cap will cost the federal government — about $30 billion over 10 years.

A few other provisions also affect drug costs and access. All told, the CBO said, the legislation will reduce the federal deficit by $237 billion over 10 years.

So how to rate Biden's promise?

"Congress passed a law, and the president signed that piece of legislation, which will significantly lower prices of some drugs for some people in the future," said Ippolito.

But it isn't just what people pay as their share of the cost of some drugs, he emphasized. Biden seemed to promise a 60% reduction, but whether that is for some individuals, the prices manufacturers set in the first place, or total national spending on drugs is unclear.

"One of the specific things about Biden's statement was the 60% reduction, and we don't know if that's going to be the case or for how many drugs because we don't know how the agencies will implement the law," Ippolito said.

That's one reason he considers the promise as "a work in progress." It's also uncertain just how Medicare will set the maximum prices allowed in the program for those drugs that will be selected for the effort.

Fiedler, however, thought Biden's promise was partly achieved,  in that significant changes have been accomplished that will substantially lessen costs for some people or for some prescriptions, but fall short of a 60% reduction when the number is applied across the pharmaceutical marketplace.

"Has the administration taken big steps on prescription drugs that will substantially reduce prices? The answer is yes," said Fielder. But he also said it would take time before "these price reductions fully materialize" and there is "a meaningful reduction in what the U.S. pays for drugs."

Some provisions are just now taking effect, and the groundwork is set for more.

Savings will start to be seen by some Americans this year under the insulin out-of-pocket cap and potentially through the incentives for doctors to prescribe lower-cost biosimilars. Several big-ticket items — the out-of-pocket spending cap for enrollees in Medicare, and the drug price negotiations — will play out over the next three years. Those changes may lead to consumers and the federal treasury saving hundreds of billions of dollars over the next decade.

Still, because it will take time to see how these reductions come to fruition, and whether they reach a 60% mark, our rating on the promise remains In the Works.

President Joe Biden's executive order issued July 9 marked an official step toward making good on a key campaign-trail promise.  

"I'm going to lower prescription drugs by 60%, and that's the truth," Biden said during a November 2, 2020 speech. 

The recent executive order outlined the president's vision for how he wants to proceed.  

The order included an initiative designed to shore up the approval framework for generic drugs and biosimilars, working with the Federal Trade Commission to address efforts to impede competition for these types of drugs and to help Medicare and Medicaid incorporate new payment models to cover them. 

It also calls for a report to be issued within 45 days outlining the specific efforts that should be implemented to reduce prescription drug prices. More details will emerge when that document becomes available.

Experts so far have offered measured reactions. 

The administrative actions outlined in this executive order do have the potential to reduce prescription drug prices, said Matthew Fiedler, a fellow with the USC-Brookings Schaeffer Initiative for Health Policy. But it's dependent on more than just what the executive order says. 

"In each of these areas, whether prices actually fall will depend on the details of the proposals the administration ultimately puts forward," Fiedler wrote in an email. "However, these are all areas where there are opportunities to make changes that would have a meaningful impact."

It's also important to note that the FTC is an independent agency, so Biden's principle means of influencing drug policy would come from his appointments to the agency, said Fiedler. It does seem likely, though, he added, that the newly appointed FTC chair would be sympathetic to cracking down on market conduct that delays the entry of generic drugs or biosimilars. 

Still, to actually reduce drug prices by 60% would require legislation, said Benedic Ippolito, senior fellow in economic policy studies at the American Enterprise Institute. 

"And the most disruptive drug pricing reforms — those that could even sniff that kind of price reduction — are also the most unlikely to pass," Ippolito wrote in an email. "In short, I suspect that this executive order isn't going to make much headway in achieving this goal." 

Former President Donald Trump also promised that he would lower drug prices by 60% last year on the campaign trail, after repeatedly promising to reduce medication costs during his four years in office. However, little progress was made toward accomplishing the overarching goal despite issuing several, drug-pricing executive orders in 2020. 

While Biden's executive order has a different focus than most of the Trump-era drug-pricing orders, the Biden administration has signaled they may still be open to embracing some of those policies. 

Trump's directives focused on rebates paid to pharmacy benefit managers being rerouted to beneficiaries, reducing the cost of insulin by compelling federally qualified health centers to make the drugs available at low prices to low-income people, importing drugs from Canada and tying the prices of drugs to the prices of those drugs in other countries. 

Three of the Trump-era proposed rules that are a result of his executive orders are still being kept around by the Biden administration — at least for the time being. One is called the "Most Favored Nation Model." This rule is supposed to match U.S. prices for a certain class of drugs with the lower amount paid in countries which negotiate drug prices. 

According to Politico, the Biden administration's regulatory office received the rule last week, which means there may be a new public comment period and finalization of the rule — though it's likely this would take some time to complete. 

Another rule that was finalized during the Trump administration would allow states to import drugs from other countries with the Food and Drug Administration's permission. But Pharmaceutical Researchers and Manufacturers of America sued the Trump administration to get it overturned and it is still tied up in court. 

No other Trump drug-pricing efforts made much headway. Instead, they drew a fair amount of industry pushback. 

And it remains to be seen whether Biden's directives will fare any better. His executive order is just the first step in a long line of steps to try to reduce the cost of prescription drugs. When the prescription drug pricing plan comes out, more will be known. Plus, issuing rules and allowing time for public comment takes time. 

But experts agreed that most likely congressional action would be needed to achieve a 60% reduction in drug prices. With over three years left in office for Biden, who knows what could still happen on this issue. 

For now, we rate this promise In the Works.