Unlike many prior proposals that would have minimal impact in controlling the cost of pharmaceuticals, two recently proposed legislative actions could meaningfully reduce Medicare drug spending. One is aimed at Medicare Part D, which represented $100 billion of the $130 billion spent by Medicare on pharmaceuticals in 2016, and the other, at Medicare Part B. Regarding the Part D spend, by shifting more of the responsibility for payments to the plan sponsor from the government, greater pressure will be placed on the drug companies for more favorable pricing. The Trump administration proposal for Medicare