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Democrats are planning a major push to lower drug prices as part of a coming infrastructure package, seeing an avenue to move forward on a long-held goal for the party.
House Democratic leaders are intent on including a measure that would allow the secretary of Health and Human Services to negotiate lower prices for prescription drugs, sources say.
That bill, first passed by the House in 2019, would provide about $450 billion in savings that in turn could help fund a spending package with a price tag as high as $3 trillion.
The drug pricing measure, H.R. 3, is a Democratic priority in its own right, with the party lamenting for years how Medicare is prohibited from negotiating lower prices.
But the bill is fiercely opposed by Republicans and the powerful pharmaceutical industry, with executives warning it would harm innovation that leads to new drug development. The 50-50 split in the Senate is also raising questions about whether it could get through that chamber without losing any moderate Democrats.
Speaker Nancy Pelosi (D-Calif.) gave a vote of confidence to the idea of including the drug pricing measure in the infrastructure package last week.
"If we were able to do that, we could save almost a half a trillion dollars,” Pelosi said. “We would be missing an opportunity if we did not include lowering the cost of prescription drugs."
Some House Democratic committee staff recently told outside groups that while the House is working on H.R. 3, they are unsure if the measure can get through the Senate, according to a source familiar with the conversations.
“There is an urgent need to address drug prices, and Democrats are united on this front,” a spokesperson for Democrats on the House Ways and Means Committee said when asked about those comments. “H.R. 3 is urgent, unfinished business from last Congress, and we are working hard to get this done for the American people.”
Still, questions loom in the Senate. Spokespeople for moderate Democratic Sens. Joe Manchin (W.Va.) and Kyrsten Sinema (Ariz.) did not respond when asked if their bosses supported including the measure in an infrastructure package.
Sen. Bob Menendez (D-N.J.), who represents a state that is home to many big-name pharmaceutical companies, voted against a measure to allow Medicare to negotiate drug prices in the Senate Finance Committee in 2019.
His office was noncommittal when asked about including H.R. 3 in an infrastructure package.
“While we haven’t seen any final language, I can tell you that the senator supports efforts that will create actual savings for consumers and not just for the health care system or government,” said Robert Julien, a Menendez spokesman.
He declined to comment when asked if Menendez views H.R. 3 as a bill that meets that standard.
“We have a fight on our hands to get this passed,” said Rep. Peter Welch (D-Vt.), one of the House’s main proponents of drug pricing legislation. “We've got a Senate with a razor-thin margin that we hope will pass it.”
He noted, though, that Democrats have a very small margin in the House as well. Asked if he is worried about the Senate, Welch said, “That’s a Schumer problem,” referring to Senate Majority Leader Charles Schumer (N.Y.).
In the other direction, several progressive lawmakers would like to see the 2019 measure go even further, by expanding the number of drugs that are subject to negotiations.
The White House has been in touch with some progressives in the House about potential changes they would like to see to the bill, according to a source familiar with the conversations.
The specifics of the White House plans for drug pricing legislation, or how strongly they will push for it, remain unclear. A White House spokesman declined to comment.
Including the drug pricing measure in a larger infrastructure package could help smooth its passage, if other priorities in the bill were enough to win over some reluctant lawmakers.
But there are some other options on drug pricing in the Senate if the House bill proves too far-reaching.
Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) reached a deal on bipartisan legislation to lower drug prices in 2019, which Grassley has portrayed as a compromise approach. The agreement does not include the ability for Medicare to negotiate lower prices, but it does allow limiting price increases for Medicare drugs to the rate of inflation. Still, that approach goes too far for many Republicans.
“There's no reason why in one week we couldn't get that bill passed and we don't have to wait until several weeks down the road to do something like that,” Grassley said on the Senate floor Wednesday. "It's bipartisan, we ought to move on that."
Sen. Amy Klobuchar (D-Minn.) recently introduced her own measure to repeal the ban on Medicare negotiating drug prices, which was co-sponsored by Manchin, among others.
That measure is less far-reaching than the House bill, though, in that it does not have a penalty for drug companies if they do not come to the table in negotiations. The House bill would impose a steep tax on drug companies that declined to negotiate. The Congressional Budget Office has previously said measures without such an enforcement mechanism would produce only “negligible” savings.
On another health care front, Democrats have also long pushed for a government-run “public option” for health insurance to compete alongside private insurers. Compared to drug pricing, though, discussions on a public option are much less far along, and that measure is much less likely to be included in the upcoming package, sources say.
Pelosi also downplayed that possibility last week. "Obviously it is something that we want to do," she said when asked about the related idea of lowering the eligibility age for Medicare. "I want a public option, I don't know that we get that in this bill, but this is an ongoing conversation."
At the same time, Sen. Bernie Sanders (I-Vt.) said in an interview with Politico that he will push for including a proposal to lower the Medicare eligibility age to 55 or 60.
On drug pricing, advocates are hopeful the breakthrough moment has arrived.
“Certainly this is the best opportunity to enact reforms that will lower prices and protect innovation that we have had maybe in the past two decades,” said David Mitchell, founder of Patients for Affordable Drugs Now. “We think we're going to get it done this year.”