Democrats weigh changes to drug pricing measure to win over moderates

Democratic leaders are discussing changes to a signature bill to lower prescription drug prices in a bid to win over a handful of moderate Democrats needed for passage.

House and Senate leaders have discussed a proposal that would remove one of the provisions moderates find most objectionable in Speaker Nancy Pelosi’s (D-Calif.) bill, a cap on prices based on what other wealthy countries pay for drugs, and have pitched the proposal to moderates, sources say.

But some moderates who voted against the drug pricing measure last month in a House committee are still not signing on, illustrating the difficult path forward for a key piece of Democrats’ agenda that is intended to help pay for President Biden’s sweeping Build Back Better package.

Rep. Scott Peters (D-Calif.), one of the three House lawmakers who voted no last month, said he spoke with White House staff and Speaker’s office staff on a call last week about ways to bridge their differences on drug pricing, but that there has not yet been a resolution.

“I think it’s great that they’re talking to me, but I also don’t want to overstate, I don’t want to suggest that they proposed something yet that I think will work or will pass,” Peters told The Hill.

“I didn’t expect it to come to a resolution in one meeting, and so we’ll continue those conversations,” he added.  

House and Senate leaders have discussed a proposal that would use domestic prices to help set a cap on drug costs, rather than using the lower prices paid in other countries, a move to somewhat scale back the legislation.

That proposal would also allow Medicare to negotiate lower drug prices, but would not extend those lower drug prices to people with private insurance plans, sources say. That would significantly scale back the scope of the measure, in a move that stems from what is allowed under the complicated Senate rules used to bypass a Republican filibuster in the Senate.

Peters, as well as a handful of other moderates, have concerns about the impact on drug companies’ ability to innovate and develop new treatments.

Advocates for action on the issue have expressed frustration with Peters and other moderates, saying they are simply doing the bidding of the pharmaceutical industry. Drug companies are lobbying hard against the legislation, and have launched a seven-figure ad campaign against it.

In addition to Peters, Reps. Kurt Schrader (D-Ore.) and Kathleen Rice (D-N.Y.) voted against the drug pricing measure last month. Reps. Stephanie Murphy (D-Fla.) and Lou Correa (D-Calif.) also cosponsored a scaled-back, alternative drug pricing measure from Peters and Schrader that they say would address their concerns about innovation.

Democrats can only lose three votes in the House and still pass the package. And in the Senate, they cannot lose a single vote, given unified Republican opposition.

Asked about progress on drug pricing, a senior Democratic aide said the provisions “remain under discussion.”

In the Senate, Sens. Robert Menendez (D-N.J.) and Kyrsten Sinema (D-Ariz.) are question marks on the drug pricing measures.

Menendez said Wednesday that he has had “discussion” with Senate Finance Committee Chairman Ron Wyden (D-Ore.), who is taking the lead on crafting the legislation in that chamber, but that he had not seen enough specifics to form a view.

“Show me a proposal and I’ll tell you how I feel,” he said.

A Sinema spokesperson said the senator “is carefully reviewing various proposals around this issue — and, as always, does not negotiate those policy specifics through the press.”

In a sign of the frustration with the handful of Democratic lawmakers expressing resistance on the issue, Sen. Bernie Sanders (I-Vt.) told reporters on Friday he would “begin calling out some of those members of Congress,” throwing up roadblocks on drug pricing, and pointed to pharmaceutical industry lobbying and campaign donations. 

“You’ve got lobbying firms led by former Democratic leaders, Republican leaders working overtime to try to defeat this legislation,” he said.

The Democratic group Protect Our Care is also putting pressure on both Sinema and Menendez to support drug pricing action, including ads in Arizona and a mobile billboard outside Menendez’s office in New Jersey.

Backers point out that action on the issue is extremely popular in polls. A Kaiser Family Foundation poll earlier this year found that 88 percent of the public supports allowing the government to negotiate lower drug prices.

Many Democrats in competitive districts also favor action.

In a meeting between Biden and such “frontline” members this week, “almost every member who was on that Zoom call mentioned Medicare negotiation as a top priority for them,” Rep. Susan Wild (D-Pa.) said on a call hosted by the group Lower Drug Prices Now.

Some employer groups are also pushing for action on drug prices to lower their costs, but are watching to see if the measure will apply to private insurance and not just Medicare. A provision in the measure to limit drug price increases to the rate of inflation could apply to private insurance, sources say.

Getting substantial savings from drug pricing provisions is also key for paying for other health care priorities in the package, like extending enhanced financial assistance under ObamaCare, expanding Medicaid in the 12 GOP-led states that have so far refused, and widening Medicare benefits to include dental, hearing and vision coverage.

Rep. Peter Welch (D-Vt.) acknowledged that changes could have to be made on a variety of fronts, including drug pricing, to win enough votes.

“We’ve advocated for it, now how do we get the votes to pass it?” he said. “We’re just transitioning from advocacy to legislative negotiation.”