Mr. Trump is proposing to use prices in 14 other countries as a benchmark or guide in deciding what Medicare would pay. The administration acknowledged that some of these countries, like the Czech Republic and Greece, “have far lower per capita incomes than the United States.”

Several of the 14 countries have a budget for spending on prescription drugs. Many peg their payments to drug prices in other countries, a practice known as reference pricing or international benchmarking. Some of the countries assess the “cost-effectiveness” of drugs and limit how much they will pay for expected gains in the length and quality of life, with some exceptions allowed.

Just seven months ago, the Trump administration criticized the use of reference pricing by other countries, but it has now proposed something similar for Medicare.

What was said

“The president is also going to bring smart negotiation to billions of dollars’ worth of drugs in a part of Medicare where there is currently no negotiation at all.”

— Alex M. Azar II, the secretary of health and human services, in May

What was said

“In Medicare Part B today, the government gets the bill, and we just blindly pay it — oh, plus a 6 percent markup for the provider who administers it. There is no negotiation.”

— Mr. Azar in October

This is misleading.

It is true that the government does not negotiate with drug manufacturers to determine the prices paid for drugs in Part B of Medicare. But the prices paid for many of those drugs do reflect the results of competition and negotiations in the private sector.

Under the Medicare Modernization Act of 2003, the government’s payment for a Part B drug is based on the drug’s “average sales price.” This price, as defined in the law, accounts for commercial discounts, rebates and other price concessions that drug manufacturers negotiate with health insurance plans, pharmacy benefit managers and other private purchasers.

These price concessions, generally treated as trade secrets, may knock 15 to 35 percent off the list price of a drug.

The problem for Medicare and for consumers is that, for some drugs, manufacturers do not give substantial discounts. This may be the case, for example, if a drug has no direct competitors, so doctors cannot prescribe an alternative, or if the market for a drug outside Medicare is small.