Trump's Rx for confusion: How a push for tariffs complicated his pharma plan

When President Trump announced a new deal Friday to lower prescription drug costs, it was the clearest sign yet that he'd paused his commerce secretary's push to slap 100% tariffs on pharmaceuticals that aren't manufactured in the U.S.Why it matters: Prescription drug policy and tariffs are big priorities of Trump's administration. But after the two issues collided in a conflicting series of White House messages recently, Trump set aside the tariffs idea, which could have made drugs more expensive for many Americans."Affordability is the issue. The president gets that," an adviser told Axios.But the road to that decision was rocky, and showed how Trump's uneven management style — particularly surrounding tariffs — shadows a White House in which policies can be made on the fly, change suddenly at the president's whim, and then be fine-tuned as conflicts are resolved in real time.Trump Cabinet secretaries sometimes operate with such independence that they encroach on each other's turf.In this case, it was Commerce Secretary (and tariffs cheerleader) Howard Lutnick on one side initially, and Health and Human Services Secretary Robert F. Kennedy Jr. on the other.Kennedy's department has been negotiating with drug companies as part of Trump's "most favored nation" prescription drug plan to lower drug costs for Americans.Behind the scenes: Within the White House, the conflict came to a head on Sept. 25, during a going-away party for departing senior adviser Taylor Budowich.About the same time that evening, Lutnick was in the Oval Office after a previously scheduled meeting about tariffs on heavy trucks and furniture. Trump and Lutnick then began talking about pharmaceuticals tariffs, a source said. And at 7:24 p.m., Trump posted that he'd impose the 100% tariff on prescription drugs produced outside the country.The fallout: Trump's post caught everyone off guard: Kennedy, Medicare and Medicaid Administrator Mehmet Oz, senior White House officials and drug companies negotiating with them. None had been consulted about the announcement.It prompted White House Chief of Staff Susie Wiles to have a one-on-one meeting with Lutnick to convey their concerns.Wiles — who has tried to prevent the chaos and drama that defined Trump's White House in his first term — reiterated to senior officials that they must work within established processes. "Susie just had enough," a Trump adviser familiar with the discussion told Axios. "There's a process for 'most favored nations' and there's a schedule and there's a plan." "Next thing you know, Lutnick just comes in and doesn't tell anyone this, and Kennedy and Oz see the [Truth Social] post and were like, 'What the f**k?' So Susie had to un-f**k it."The message was received. Five days after the going-away party, Lutnick joined Trump at a news conference to announce a deal with Pfizer in which the commerce secretary made clear that the tariff plan was paused."While we're negotiating with these companies, we're going to let them play out and finish these negotiations, because they are the most important thing to the American people," Lutnick said in response to a reporter's question."We are standing by, helping and working with them," Lutnick said, deferring to the "HHS team" with praise: "We are on their side, helping them."On Friday, Lutnick joined Kennedy in signing the paperwork for a new deal with AstraZeneca, a Britain-based pharmaceutical company that has agreed to build a plant near Charlottesville, Va.Kennedy praised Lutnick for being "key to the negotiations," as did the White House in an official statement crediting the "impactful" secretary as a crucial member of Trump's trade and economic team who helped secure the deals with the pharmaceutical companies.Trump also said tariffs were a "big reason" pharmaceutical companies were coming to the table, although the AstraZeneca agreement actual predated Trump's threat of 100% tariffs last month.Zoom in: Trump's "most favored nation" pharmaceutical plan seeks to force companies to sell prescriptions to U.S. customers at the same price they'd charge people in other countries, where drugs often are cheaper.In some cases, it hasn't lowered U.S. drug prices but has led pharmaceutical companies to hike costs for consumers abroad. The intrigue: Tariffs aside, Lutnick got crosswise with senior aides recently when he told an interviewer about his interactions with the late sex offender Jeffrey Epstein, whom he called "the greatest blackmailer ever."The message was at odds with the White House's efforts to distance Trump and his team from Epstein.Reality check: Lutnick is longtime friend of Trump's and sources say he's still valued by the president.Some see a silver lining in the tariff threat Trump issued at Lutnick's urging because it "got everyone's attention and probably let the other pharmaceutical companies know we mean business," another administration official said."It's fair to say Lutnick got over his skis," the official said. "But in the end, it didn't have a negative material effect on anything except for a few annoyed people."

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