If there is only 1 company to negotiate with, the government is really the only entity that can threaten to simply create a competitor and give them the IP rights (by legal fiat) to do so. If you tell the existing company that your alternative solution is to compete with them using taxpayer money, they might choose to take the lesson of history and accept the government's negotiating position.

With no legal precedent supporting him but absolutely no resistance from the branches of government meant to keep him in check.

On the side, he may open the door for generic substitutes as well from CAN etc.

A simple price directive would be set at the same time, without any negotiation:

The price US medicare will pay will only be the average price for each drug, in all OECD countries.