President Donald Trump has issued a fresh threat against pharma, saying a drug price crackdown could be worked in to new healthcare reforms.

Trump says a “fair and competitive bidding process”, will be included in the Republican’s American Health Care Act of 2017, or legislation immediately after it.

The pricing rules could be worked into changes to the bill to repeal and replace former president Obama’s Affordable Care Act.

Trump is trying placate those within his own Republican party who are concerned the new legislation may limit care for older people.

An analysis by the Congressional Budget Office analysis last week found the number of people without insurance under “Trumpcare” will increase from 28 million to 52 million.

Trump criticised the healthcare reforms introduced by president Obama, which he characterised as over-complicated and unwieldy, saying it was a piece of legislation that “no-one read and no-one understood” when it was passed seven years ago.

He said Obamacare was not sustainable financially – and although there are valid criticisms that for some citizens, premiums did increase, many critics say the proposed reforms are likely to weaken the system rather than strengthen it.

Trump linked his attack on drug prices with his campaign pledge to “drain the swamp” of corruption in Washington.

Big pharma has been attempting to make its case, with companies like Johnson & Johnson, Merck & Co and Eli Lilly have been issuing reports outlining price rises and their justification.

But despite meetings with CEOs from the big pharma companies shortly after his election, Trump has continued with his anti-pharma rhetoric.

Speaking at a rally in Kentucky on Monday, Trump said: “The cost of medicine in this country is outrageous, many times higher than in some countries in Europe and elsewhere. Why?”

“Same pill, same manufacturer, identical and it’s many times higher in the United States.”

“You know why? Campaign contributions. Who knows. But somebody’s getting very rich.”

Trump noted that drug prices are far higher in the US than in European countries, and that the legislation he is working on will bring them “way, way down”.

Unlike with previous Trump pronouncements, markets did not react as investors waited to see the detail of the president’s proposals.