Donald Trump and his congressional allies are making big plans to repeal the Affordable Care Act and overhaul other government health programs.
But the president-elect appears to have downgraded plans to act aggressively to control rising drug prices, handing the pharmaceutical industry an early victory and providing another illustration of the influence of lobbyists on the new Trump administration, despite Trump's promise to "drain the swamp" of special interests in Washington.
Trump, who once made the cost of pharmaceuticals a central part of his campaign healthcare pitch and included the issue on his campaign website, hasn't mentioned the subject since the election, even though the issue is consistently cited as the top healthcare problem Americans want to see fixed.
And Trump's transition healthcare agenda makes no mention of drug prices, though it lists six other healthcare priorities, including restricting abortion, speeding federal approval of new drugs and restructuring Medicare and Medicaid.
"One of the major issues that Americans say they are concerned about is high healthcare costs, and a key part of that is prescription drugs. It's a pocketbook issue," said Nancy LeaMond, executive vice president of the influential AARP.
"People are looking to see what the president-elect and his team are ready to do."
The Trump transition team did not respond to questions about the new administration's prescription drug agenda.
But already the drug industry's allies, including lobbyists and senior elected officials who have received hundreds of thousands of dollars in industry money, are taking on important roles in the transition and in work on the 2017 agenda.
Vice President-elect Mike Pence's political career, for example, has long been supported by pharmaceutical giant Eli Lilly & Co., which is based in his home state of Indiana. The drug maker, through its political action committee and employees, is Pence's third largest all-time political contributor, according to calculations by the independent Center for Responsive Politics.
Pence is now leading the Trump transition.
Other key figures in Trump's circle of advisors have included a former executive at drug makers Pfizer and Celgene and the chairman of Williams & Jensen, a leading Washington lobbying firm. According to federal lobbying reports, Williams and Jensen's clients in recent years have included 11 of the world's largest drug makers, including Pfizer, Novartis, AstraZeneca, Merck and Bayer.
Shares of many pharmaceutical companies' stock rose after Trump's election last week.
In contrast to his silence on drug prices, Trump displayed little hesitation blasting them when he was campaigning.
He railed against the political power of the drug industry, which he said was responsible for blocking Medicare from using its bargaining power to negotiate lower drug prices for seniors.
"They have a fantastic lobby. They take care of all of the senators, the congressmen," Trump said at a GOP primary debate in Miami in March.
Trump's campaign platform included a proposal to give Americans greater access to lower-priced, imported drugs, which his campaign said would "bring more options to consumers."
Though prescription drugs have historically made up a relatively small share of the nation's total healthcare bill, prices have risen dramatically, fueled by a combination of expensive new drugs like Sovaldi, a treatment for Hepatitis C, and aggressive price hikes by the makers of existing drugs like EpiPen.
In September alone, drug prices shot up 7% compared with last year, the sharpest increase in 24 years, according to the Altarum Institute, a nonprofit research and consulting organization. By comparison, overall healthcare prices were up 2.1%.
The price spikes are stoking public anxiety. Polls consistently show that large majorities of Americans — including Democrats and Republicans — want the next president and Congress to make drug prices their top healthcare priority.
"Tuesday's election results are a clear indication that people around the country want change, and one issue that came up again and again on the campaign trail is that Americans are tired of skyrocketing drug prices," said John Rother, executive director of the Campaign for Sustainable Rx Pricing, a coalition of hospitals, employers, health plans and others.
In one recent national survey, more than eight in 10 Americans favored allowing the federal government to negotiate with drug makers to get lower prices on medications for people on Medicare.
And more than seven in 10 Americans favor allowing Americans to import less expensive drugs, according to the poll by the nonprofit Kaiser Family Foundation.
But the pharmaceutical industry has vigorously opposed such steps, calling drug importation unsafe and price negotiation unnecessary.
And for years, millions of dollars in campaign contributions to politicians at the federal and state levels have helped drug makers beat back efforts to increase regulation of their prices.
In 2016 alone, pharmaceutical companies, through their political action committees and employees, contributed more than $17 million to campaigns, according to the Center for Responsive Politics.
And though Trump received relatively little from the industry, senior Republicans in Congress took in hundreds of thousands of dollars each. The top recipients of industry money were House Speaker Paul Ryan (R-Wis.), who received more than $230,000, and House Majority Leader Kevin McCarthy (R-Bakersfield), who got more than $225,000.
Neither was in a competitive political race this year, but both men figure to play pivotal roles shaping the healthcare agenda in 2017.
Drug prices "are clearly one of the key drivers of healthcare costs that we need to get our arms around," said Peter Lee, head of Covered California, the state's insurance marketplace, which has pioneered efforts to cap how much consumers must pay for prescriptions.
"But it's a very tough issue to address.… The pharmaceutical industry is a phenomenally powerful political lobby."
In response to questions about potential future regulation, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, or PhRMA, provided a statement from CEO Steve Ubl.
"We look forward to working with the new administration, as well as members of Congress on both sides of the aisle to advance pragmatic solutions that enhance the private market, improve patient access to care and foster the development of innovative medicines," Ubl said.