The organizations signing this letter express substantive concerns that the Trans-Pacific Partnership proposal, as they understand it, contains ill-advised provisions that could adversely affect U.S. prescription drug programs. This letter reiterates these concerns in more detail, which center on the direction of the pharmaceuticals annex and how it would impact Medicare, as well as problematic provisions that the U.S. has proposed for inclusion in the intellectual property chapter. It expresses a firm belief that the alteration of our nation’s policies on Medicare reimbursement and patent standards should not be subject to binding provisions in international agreements like the TPP drafted through a process with little public transparency.