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A 30-year campaign to control drug prices faces yet another failure

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WASHINGTON — When a powerful Democratic Senate chairman assembled his special committee on aging to address what he called an “affordability crisis” for prescription drugs, he proposed a new solution: allow the government to negotiate better deals on critical drugs.

The year was 1989, and the idea of ​​that chairman, former Arkansas Senator David Pryor, sparked a government drive for drug price negotiations that was embraced by two generations of Democrats and a Republican president, Donald J. Trump — but now appears to be at risk of being locked out of a comprehensive domestic policy law that is taking shape in Congress.

Senior Democrats insist they have not given up pressure to grant Medicare broad powers to negotiate lower drug prices as part of a once-ambitious climate change and social safety net that is slowly dwindling in size. They know that the loss of the provision, promoted by President Biden during the campaign and in the White House, could be the most embarrassing defeat in the package, as it has been at the center of Democratic congressional campaigns for nearly three decades.

“Senate Democrats understand that after all the commitments you have to deliver,” said Oregon Senator Ron Wyden, the chairman of the finance committee.

“It’s not dead,” said Massachusetts Representative Richard E. Neal, the chairman of the Ways and Means Committee.

But with at least three House Democrats opposing the strictest version of the measure, and at least one Senate Democrat, Arizona’s Kyrsten Sinema, the government’s bargaining power almost certainly appears to be curtailed, if not jettisoned. The loss would be comparable to the Republicans’ failure under Mr. Trump to repeal the Affordable Care Act, after solemn eight-year commitments to dismantle the “root and branch” health law.

And after so many promises on the campaign trail, the Democrats might have a lot to explain next year.

“It 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 fees and spends hundreds of millions of dollars on If we beat this legislation, we won,” Senator Bernie Sanders, chair of the Vermont Independent and Budget Committee, said Wednesday. “And I intend not to let that happen.”

It’s not clear how Mr. Sanders manages to do that. The length of the fight speaks of the permanence and popularity of the problem, as well as the strength of the pharmaceutical industry.

Senator Pryor continued it in the late 1980s, hoping to get through lower Medicaid prices in view of the bigger price, Medicare. President Bill Clinton included price negotiations with the government in his universal health care plan in 1993, and throughout the 1990s, when Democrats pushed to add a prescription drug benefit to Medicare, government negotiations took center stage to keep costs down.

Then, in 2003, a Republican congressional and president, George W. Bush, secured the approval of that drug benefit — but with an explicit ban on the government from negotiating the price of drugs older Americans would buy.

Repealing that so-called non-interference provision has been an important part of Democratic campaigning ever since. Maryland Senator Chris Van Hollen, a former head of the House Democrats’ campaign arm, recalled that “Medicare will negotiate drug prices” was one of six boards in the “Six for ’06” platform that helped Democrats take control to win the House in 2006.

It has passed the House countless times, including in 2019 with yes votes from the three members of the House who now oppose it—Representatives Kathleen Rice of New York, Scott Peters of California and Kurt Schrader of Oregon—and then enter the Senate. to die. Even Mr Trump took over the effort in his 2016 campaign, only to see it lead nowhere.

That futility is why Mr. Schrader said he was against it: “Why do the same thing over and over and expect a different result?” he asked.

For proponents, defeat after defeat only speaks to the power of the pharmaceutical industry and its lobbyists.

But opponents say it reflects the complexity of the issue. Once lawmakers realize they can actually secure government price negotiations, they see how problematic that could be.

“If anyone thinks this is the easy political route for me, that’s just laughable,” said Mr. Peters, who has endured scorn and pressure from his Democratic colleagues but whose district in San Diego includes nearly 1,000 biotechnology companies and 68,000 jobs that directly related to pharmaceutical companies. work.

Mr Schrader and Mr Peters said the House version of prescription drug price controls, tucked into broader social policy legislation, would stifle innovation in one of the country’s most profitable global industries.

The Pharmaceutical Research and Manufacturers of America, known as PhRMA, also claims that government negotiations would severely limit the types of prescription drugs that would be available to Medicare beneficiaries if companies withdraw their products from the program. With the goodwill the industry has built with its coronavirus vaccines and treatments, pharmaceutical companies have pushed their case to key lawmakers and snared larger business.

American Action Network, a conservative group with corporate money, unveiled a new batch of ads on Wednesday targeting vulnerable Democrats like Georgia Representative Carolyn Bourdeaux, rejecting “another socialist health care plan to determine what drugs you can get.”

“We are taking on the greed and corruption of the pharmaceutical industry – I know their power, believe me, I know their power,” said Mr Sanders. “But this is 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 are emerging.

Some simpler solutions would change the formula of the existing Medicare prescription drug to limit out-of-pocket costs, especially in the event of a catastrophic health event.

Mr. Wyden also calls for the reinvigoration of legislation he drafted with Senator Charles E. Grassley, Republican from Iowa, that would force drug manufacturers to offer discounts to consumers on products whose prices are rising faster than inflation. Grassley said he still supports the measure, as does Senator Bob Menendez, a New Jersey Democrat and a traditional ally of his state’s pharmaceutical industry.

Mr. Schrader and Mr. Peters said negotiations are progressing around their proposal, which would give the government the power to negotiate prices under Medicare Part B, which includes outpatient services and some of the most expensive drugs, once outpatient drugs such as chemotherapy reach their full potential. patent have survived exclusivity.

Their bill would also enforce discounts for drug prices that are rising faster than inflation, and limit out-of-pocket drug costs for older Americans. That is expected to save the government $300 billion in 10 years, about half of what the broader measure would save.

“Frankly, based on discussions we’ve had with the White House, senators and other members of our party, this could happen,” said Mr. Schrader. “That would be huge.”

Ultimately, if significant price controls remain, it will be policy logic to overcome lobbying power, said Representative Ron Kind, a Democrat whose district in Wisconsin has been hit by pharmaceutical ads. Mr Kind, an influential centrist, said he has spoken with like-minded Democrats in an effort to resist the attack.

“Of course there’s some advertising,” he said. “But boy, the public sentiment is overwhelming. They just don’t understand why the pharmaceutical industry is the only private industry that the federal government refused to even talk about prices with.”

Kitty Bennett research contributed.

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