By Noam N. Levey

Tribune Washington Bureau

WASHINGTON — Donald Trump and his congressional allies are making big plans to repeal the Affordable Care Act and make over other government health programs.

But the president-elect appears to have downgraded plans to act aggressively to control rising drug prices — an early victory for the pharmaceutical industry and another illustration of the influence of lobbyists on the new Trump administration, despite Trump’s promise to “drain the swamp” of special interests.

Trump, who once made the cost of pharmaceuticals a central part of his campaign health care pitch, hasn’t mentioned the subject since the election, even though the issue is consistently cited as the top health care problem Americans want fixed.

And Trump’s transition health care agenda makes no mention of drug prices, though it lists six other health care priorities, including restricting abortion, speeding federal approval of new drugs and restructuring Medicare and Medicaid.

“One of the major issues that Americans say they are concerned about is high health care costs, and a key part of that is prescription drugs. It’s a pocketbook issue,” said Nancy LeaMond, executive vice president of AARP.

The Trump transition team did not respond to questions about the new administration’s prescription-drug agenda. But the drug industry’s allies, including lobbyists and senior elected officials who have received hundreds of thousands of dollars in industry money, are taking important roles in the transition and in work on the 2017 agenda.

Vice President-elect Mike Pence’s political career, for example, has long been supported by pharmaceutical giant Eli Lilly, which is based in his home state of Indiana. The drugmaker, through its political action committee and employees, is Pence’s third-largest all-time political contributor, according to the independent Center for Responsive Politics.

Pence is leading the Trump transition. Other key figures in Trump’s circle of advisers have included a former executive at drugmakers Pfizer and Celgene and the chairman of Williams & Jensen, a Washington lobbying firm. According to federal reports, Williams and Jensen’s clients in recent years have included 11 of the world’s largest drugmakers, including Pfizer, Novartis, AstraZeneca, Merck and Bayer.

In contrast to his silence on drug prices, Trump displayed little hesitation blasting them when he was campaigning.

He railed against the political power of the drug industry, which he said was responsible for blocking Medicare from using bargaining power to negotiate lower prices for seniors.

“They have a fantastic lobby. They take care of all of the senators, the congressmen,” Trump said at a Republican primary debate in March.

Trump’s campaign platform included a proposal to give Americans more access to lower-priced, imported drugs, which his campaign said would “bring more options to consumers.”

Though prescription drugs have historically made up a relatively small share of the nation’s total health care bill, prices have risen dramatically, fueled by a combination of expensive new drugs like Sovaldi, a treatment for Hepatitis C, and aggressive price increases by the makers of existing products like EpiPen.

In September, drug prices shot up 7 percent over the past year, the sharpest increase in 24 years, according to the Altarum Institute, a nonprofit research and consulting organization. Overall health care prices were up 2.1 percent.

“Tuesday’s election results are a clear indication that people around the country want change, and one issue that came up again and again on the campaign trail is that Americans are tired of skyrocketing drug prices,” said John Rother, executive director of the Campaign for Sustainable Rx Pricing, a coalition of hospitals, employers, health insurers and others.

For years, millions of dollars in campaign contributions to politicians at the federal and state levels have helped drugmakers beat back efforts to increase price regulation.

In 2016, pharmaceutical companies, through their political action committees and employees, contributed more than $17 million to campaigns, according to the Center for Responsive Politics.

And though Trump received relatively little from the industry, senior Republicans in Congress took in hundreds of thousands of dollars each. The top recipients of industry money were House Speaker Paul Ryan, R-Wis., who received more than $230,000, and House Majority Leader Kevin McCarthy, R-Calif., who got more than $225,000.

Neither was in a competitive political race this year, but both men figure to have important roles in shaping the health care agenda next year.