Trump said what now? 

If President Trump’s recent promise to pen an executive order creating a “favored nations law” for drug prices made your head spin, you’re not alone. I spent Monday chatting with some of the nation’s top drug pricing experts about the alleged proposal, and two things became immediately clear to me: 1. Trump’s remarks caught everyone by surprise and 2. No one knows for sure what the commander in chief meant.

Nonetheless, I’ve done my best to piece together what such a policy could mean — assuming Trump didn’t whiff on the details, that is. Here’s what I learned:

1. The idea really hasn’t been tried before on a national scale. No expert I chatted with could point to another country that uses a “favored nations” clause to mandate they get the best prices on prescription drugs. The closest international corollary experts could point to was so-called international reference pricing, which bases what one country pays for drugs on the average of what other countries pay. But that’s not a perfect comparison and is actually much closer to Trump’s proposal to create an international pricing index for Medicare.

2. Those looking for clues as to how such a system might work may be better suited looking at the Medicaid program rather than looking abroad. Multiple experts pointed to Medicaid’s requirement that the program get the “best price” for drugs as analogous to how a “favored nations” clause might work in Medicare.

3. There’s a disagreement among policy experts as to how penning a "most favored nation" clause would impact America’s already complex drug pricing system. Some, like Johns Hopkins’ Gerard Anderson, told me such an idea would “blow up everything that is in drug pricing today,” while others, like West Health’s Sean Dickson, laid out a system where by the Medicare system could remain largely unchanged.

4. The implementation hurdles are almost unfathomably complex. Experts raised a plethora of questions as to how such an EO would work in practice. Everything from how, logistically, the U.S. would determine what country is getting the best price at any given time, to whether the government has the ability to make such a sweeping change via executive order.

If you want to go deeper on what Trump’s promise could mean for drug pricing, check out my story here.