WASHINGTON – When a powerful Speaker of the Democratic Senate convened his Special Committee on Aging to address what he called a prescription drug “affordability crisis”, he proposed a new solution: to allow the government to negotiate better deals for essential drugs.
It was 1989 and the idea of that president, former Senator David Pryor of Arkansas, sparked a campaign of government drug price negotiations that was embraced by two generations of Democrats and a Republican president, Donald J. Trump – but now seems to risk being left out of a sprawling domestic policy bill taking shape in Congress.
Senior Democrats insist they haven’t given up on giving Medicare broad powers to negotiate lower drug prices under once-ambitious climate change and safety net bill social whose reach is slowly diminishing. They know the loss of the provision, promoted by President Biden during the election campaign and in the White House, could be the most embarrassing defeat of the package, as it has been at the heart of Democratic campaigns in Congress for nearly three decades.
“Senate Democrats understand that after all the commitments you have to hang in there,” said Sen. Ron Wyden of Oregon, chairman of the finance committee.
“It’s not dead,” said Representative Richard E. Neal of Massachusetts, chair of the Ways and Means Committee.
But with at least three House Democrats opposing the harsher version of the measure, and at least one Senate Democrat, Arizona’s Kyrsten Sinema, against, the government’s bargaining power seems almost certain to be reduced or even abandoned. The loss would be akin to the failure of Republicans under Mr. Trump to repeal the Affordable Care Act, after eight-year pledges to dismantle the “root and branch” health law.
And after so many campaign promises, Democrats could find themselves next year with a lot of explaining to do.
“This would mean that the pharmaceutical industry, which has 1,500 paid lobbyists, the pharmaceutical industry, which made $ 50 billion in profits last year, the pharmaceutical industry, which pays its executives huge salaries and who is spending hundreds of millions of dollars to defeat this legislation will have won, ”Senator Bernie Sanders, chairman of the Vermont Independent and Budget Committee, said on Wednesday. “And I intend not to allow that to happen.”
It is not clear how Mr. Sanders can get away with this. The length of the fight is a testament to the durability and popularity of the problem, but also to the power of the pharmaceutical industry.
Senator Pryor put it in place in the late 1980s, hoping to bring down the prices of Medicaid, with an eye on the biggest price, Medicare. President Bill Clinton included government price negotiations in his universal health care plan in 1993, and throughout the 1990s, as Democrats pushed to add prescription drug coverage to Medicare, government negotiations were essential to keep costs low.
Then, in 2003, Congressman and Republican President George W. Bush got the drug benefit passed – but with an explicit ban on the government negotiating the price of drugs older Americans would buy.
The repeal of this so-called non-interference clause has since been a centerpiece of Democratic campaigns. Senator Chris Van Hollen of Maryland, a former leader of the House Democrats’ campaign arm, recalled that “Medicare will negotiate drug prices” was one of the six prongs of the platform. Six for 2006 ”that helped Democrats take control of the House. in 2006.
It has been passed the House several times, including in 2019 with the yes of three House members who now oppose it – Representatives Kathleen Rice from New York, Scott Peters from California and Kurt Schrader from Oregon. – to die in the Senate. Even Mr. Trump embraced the effort in his 2016 campaign, only to see it going nowhere.
This futility is why Mr. Schrader said he opposed it: “Why do the same thing over and over and expect a different result? He asked.
For supporters, defeat after defeat speaks only of the power of the pharmaceutical industry and its lobbyists who go with it.
But opponents say it reflects the complexity of the issue. Once lawmakers realize they could actually get price negotiations with the government, they see how problematic that could be.
“If anyone thinks this is the easy political route for me, it is just laughable,” said Peters, who has faced contempt and pressure from fellow Democrats but including the San Diego District includes nearly 1,000 biotechnology companies and 68,000 jobs directly related to the pharmaceutical industry. job.
Mr Schrader and Mr Peters said the House’s version of prescription drug price controls, embedded in broader social policy legislation, would stifle innovation in one of the world’s most profitable industries in the world. country.
The Pharmaceutical Research and Manufacturers of America, known as PhRMA, also argues that government negotiations would significantly limit the types of prescription drugs that would be available to Medicare beneficiaries as companies withdraw their products from the program. With the goodwill the industry has accumulated with its coronavirus vaccines and treatments, pharmaceutical companies have taken their case to key lawmakers and joined the broader business community.
American Action Network, a conservative, commercially-funded group on Wednesday unveiled a new round of announcements targeting vulnerable Democrats such as Rep. Carolyn Bourdeaux of Georgia and denouncing “another socialist healthcare plan to control drugs you can get “.
“We are tackling the greed and corruption of the pharmaceutical industry – I know their power, believe me, I know their power,” Sanders said. “But it’s a fight we have to win.”
Mr Wyden insisted that any legislative effort to tackle rising drug costs must include government bargaining power, but alternatives emerge.
Some simpler solutions would change the existing Medicare prescription drug benefit formula to limit out-of-pocket expenses, especially in the event of a catastrophic health event.
Mr Wyden is also pushing to resurrect legislation he drafted with Iowa Republican Senator Charles E. Grassley that would force drugmakers to offer discounts to consumers on products that are rising in price more quickly. than inflation. Mr Grassley said he still supports the measure, as does Senator Bob Menendez, a Democrat from New Jersey and a traditional ally of the pharmaceutical industry in his state.
Mr Schrader and Mr Peters said negotiations were advancing around their proposal, which would grant the government the power to negotiate prices under Medicare Part B, which covers outpatient services and some of the most expensive drugs, a once ambulatory drugs like chemotherapy have passed their patent. exclusivity.
Their bill would also force discounts for drug prices to rise faster than inflation and limit direct drug spending for older Americans. This is expected to save the government $ 300 billion over 10 years, about half of what the larger measure would save.
“Frankly, based on the discussions we have had with the White House, senators and other members of our party, it could be done,” Schrader said. “It would be huge.”
Ultimately, if significant price controls survive, it will be the logic of politics that triumphs over power over the lobby, said Representative Ron Kind, a Democrat whose district of Wisconsin is plagued by the publicity of the. pharmaceutical industry. Mr Kind, an influential centrist, said he spoke to like-minded Democrats, trying to defend them against the onslaught.
“Obviously there is publicity,” he said. “But boy, the public sentiment is overwhelming. They just don’t understand why the pharmaceutical industry is the only private industry the federal government has refused to discuss prices with.
Kitty bennett contributed research.