Of all the ob­sta­cles that the phar­ma­ceu­ti­cal in­dus­try has faced in the first year of Pres­i­dent Don­ald Trump’s sec­ond term, none have struck more fear in ex­ec­u­tives, board rooms and in­vestors than the pres­i­dent’s push to ag­gres­sive­ly cut the price of drugs in the US.

On Tues­day, Trump tout­ed Pfiz­er's wide-rang­ing deal with the gov­ern­ment as a huge win on pric­ing af­ter months of pres­sure and ne­go­ti­a­tion. At the same time, the com­pa­ny ap­pears to have suc­cess­ful­ly met the White House­'s de­mands with­out do­ing too much harm to it­self. And it could pro­vide a road map for oth­er drug­mak­ers, who for years have fought against price con­trols, to make their own deals.

The Trump ad­min­is­tra­tion is start­ing to pre­pare tar­iffs on some phar­ma com­pa­nies, but those levies won’t take ef­fect on Wednes­day, a White House of­fi­cial con­firmed to End­points News.

Pres­i­dent Don­ald Trump an­nounced last Thurs­day in a so­cial me­dia post that be­gin­ning Oct. 1, drug­mak­ers that haven’t start­ed con­struc­tion projects in the US will face 100% tar­iffs on their brand­ed med­i­cines.

But the White House of­fi­cial said Wednes­day that the ad­min­is­tra­tion will on­ly “be­gin prepar­ing tar­iffs” on Oct. 1. The tar­iffs will ap­ply to com­pa­nies that aren’t on­shoring their man­u­fac­tur­ing to the US as well as those that don’t par­tic­i­pate in Trump’s most fa­vored na­tion pol­i­cy, ac­cord­ing to the of­fi­cial.

Since Trump’s post last Thurs­day, a hand­ful of drug­mak­ers have start­ed con­struc­tion on US-based projects.

CMS fi­nal­ized guid­ance this week that the agency says will in­crease trans­paren­cy in the third round of Medicare drug price ne­go­ti­a­tions and “pre­serve crit­i­cal in­cen­tives for rare dis­ease re­search.”

The guid­ance sets re­quire­ments for the first cy­cle of ne­go­ti­a­tions to po­ten­tial­ly in­clude drugs payable un­der Medicare Part B. It al­so de­scribes how CMS is ex­pand­ing pro­tec­tions for cer­tain or­phan drugs in ac­cor­dance with Pres­i­dent Don­ald Trump’s re­cent­ly en­act­ed tax and spend­ing pack­age.

Pre­vi­ous­ly, cer­tain or­phan drugs were ex­clud­ed from Medicare ne­go­ti­a­tions if they were ap­proved to treat a sin­gle rare dis­ease or con­di­tion. Now, or­phan drugs may be ex­clud­ed if they are ap­proved for more than one in­di­ca­tion, as long as it’s an­oth­er rare dis­ease or con­di­tion. If a drug is ap­proved for an in­di­ca­tion that is­n't a rare dis­ease or con­di­tion, it will no longer be ex­empt and CMS will de­ter­mine its el­i­gi­bil­i­ty for ne­go­ti­a­tions based on “the date on which the FDA ap­proves" the non-or­phan in­di­ca­tion.

Bio­gen should pay Genen­tech more than $88 mil­lion in ad­di­tion­al roy­al­ties for us­ing Genen­tech’s patent­ed process to help make the mon­o­clon­al an­ti­body Tysabri, a Cal­i­for­nia fed­er­al jud