It's not just lower U.S. drug prices Trump wants. He wants the lowest, period

White House
President Donald Trump said on Wednesday that the U.S. government will push for the lowest drug prices in the world.

President Donald Trump is back with more drug-pricing promises. This time, he says he's aiming to push prices lower than anywhere else in the world.

Speaking at a meeting with members of the Congressional Black Caucus (CBC) on Wednesday, the president said U.S. patients pay far too much.

It's "really unfair what’s happened in our country" around pharmaceutical prices, he said, according to a White House transcript, adding that Americans are being "ripped off."

"So we’re going to be instituting a very, very strong bidding process," he said, repeating a plan he's endorsed repeatedly over the last several weeks.

Transforming U.S. drug prices into the lowest worldwide would be quite a feat: Now, they're generally among the highest—if not the highest—on the planet. Bringing them down to the other end of the spectrum would mean pushing them lower than those in India and other developing countries, where drugs can go for pennies on the dollar compared to the U.S.

RELATED: High U.S. drug prices cover pharma's global R&D—and a whole lot more, study finds

Such a shift in prices would gut pharma profits and force a dramatic shift in the industry landscape, likely meaning an end to a great deal of costly research into devastating diseases. Then again, Trump has been known to push the envelope with his public statements only to walk them back later.

The United States currently pays more than any other country for its medicines, Trump pointed out Wednesday, adding that he’s in agreement with Rep. Elijah Cummings, a member of the CBC, that it’s a critical issue.

According to a recent study from several health economists, premium U.S. drug prices pay for Big Pharma’s global R&D and much more. The researchers found that premium pricing in the states created a $116 billion windfall for top drugmakers, compared with a $76 billion R&D spend.

Trump recently met with Cummings to talk drug prices, and the Maryland representative used the meeting to push a proposal that would allow Medicare to negotiate drug prices. Cummings said Trump was “enthusiastic” about the idea, and reports later said the president made two follow-up calls to Cummings.

RELATED: Trump's pushing GOP to put 'competitive bidding' on drugs in healthcare bill

On multiple occasions this week, Trump has promised fast action on drug prices. “We’re going to either do it in healthcare—which I think we’re going to do it in healthcare—or we’re going to do it separately,” he told the crowd at the White House on Wednesday.

And at his Monday rally, Trump said he’s pushing to get “competitive bidding” into the Republican repeal-and-replace legislation set for a vote Thursday. He said “somebody is getting very rich” due to “outrageous” U.S. drug prices.

RELATED: Trump to pharma: You're 'getting away with murder,' and I'm the one to stop it

But as Cummings himself can attest, Trump can be erratic. The lawmaker and Trump got into an argument after the president "made up" a story about Cummings dodging a meeting for political purposes, according to Cummings' take on the situation. Trump had previously spoken with Cummings by phone to suggest the drug pricing talk.

Before that, as president-elect, Trump famously said pharma is “getting away with murder,” resulting in a sector-wide sell-off. Weeks later, in a meeting with biopharma representatives, he backed away from that rhetoric to say the industry has been “terrific” but that the U.S. needs to get prices “way down.”

And so, pharma waits anxiously to see what type of tangible changes will result from the talk in Washington. Reacting to the president’s tweets early this month about a “new system” for drug pricing, Evercore ISI analyst Umer Raffat wondered what that might look like.

Trump has repeatedly said he wants to grow competition, but Raffat pointed out that brand versus generic competition exists and direct brand versus brand competition—particularly with competitive bidding—requires interchangeable meds, which isn’t always possible.