Democrats working to regain control in Congress this fall are making the cost of prescription drugs a centerpiece of the party’s message. The path to a majority, however, runs through some places where the pharmaceutical industry employs a lot of potential voters.

Southern California, New Jersey, and the Philadelphia suburbs are among the areas where Democrats have the strongest chances to turn red House seats blue. Yet since these states are some of the biggest pharmaceutical hubs in the United States — the industry estimates it directly employs 44,000 people in Pennsylvania, 65,000 people in New Jersey, and 131,000 in California — candidates there tread a little more cautiously on the issue of drug prices.

Tom Malinowski is running against Republican incumbent Leonard Lance in New Jersey’s 7th District, home to outposts for companies including Bayer, Merck and Roche.

“They wake up every single morning and go to work because they want to make people better and want to help people suffering,” Malinowski said of the constituents he is courting. “At the same time, many people have legitimate questions about what’s happening to drug prices.”

Compare that with Sen. Bernie Sanders, the Vermont independent campaigning on behalf of left-leaning Democrats around the country.

“At a time when corporate America has unprecedented wealth and power, the pharmaceutical industry distinguishes itself as perhaps the most greedy and irresponsible corporate entity,” Sanders said at a May event on drug prices.

Beneath the rhetoric, however, Democrats’ policy proposals are fairly measured. A party document circulated to members before the August recess stressed three points: allowing Medicare to negotiate drug prices, creating a federal investigator to crack down on “price gouging,” and requiring transparency for drug price increases.

Balancing act

Democrats seeking to win over voters who might work for the industry hope they see that the party is trying to focus on bad actors and not criticize the entire field.

For example, in the New Jersey Senate race, incumbent Democrat Robert Menendez is being friendly to industry-linked voters while at the same time characterizing his Republican opponent, a former pharmaceutical executive, as a greedy price gouger. Republican Bob Hugin used to run the drugmaker Celgene, which is under fire for raising the price of its blood cancer treatment Revlimid by 20 percent in 2017, to more than $18,000 per bottle.

“You had a guy who is a greedy pharmaceutical executive who made a killing on the back of cancer patients,” Menendez said of his opponent. “That’s not necessarily the truth of all of the pharmaceutical industry.”

The Hugin campaign didn’t respond to a request for comment. His website emphasizes that experience as a drug executive would help “promote policies that incentivize bold experimentation and innovation that can find cures and lower costs.”

In California’s 49th District, which stretches from south of Los Angeles to north of San Diego, there are dozens of smaller biotech companies. Mike Levin, a Democrat running to replace retiring Republican Darrell Issa, endorses importation of lower-cost drugs from other countries, an idea the industry oppose, but also argued for the need to balance price and innovation.

“It’s really about keeping prescription drugs affordable and accessible while also ensuring that our local companies can continue to thrive and innovate,” he said, noting that he thought that support for innovation was still in step with being progressive.

In three races in the Philadelphia suburbs, where companies like GlaxoSmithKline, Janssen and Teva have a presence, newly-drawn districts are much more favorable to Democrats than before a judge earlier threw out the gerrymandered districts drawn by a Republican legislature.

Even so, Democrats there are still careful.

“We must make sure that there is a healthy balance in consumer protection, prescription access and costs, and support for practices that allow us to continue to be at the cutting edge of medical advancement,” said Madeleine Dean, the Democrat running in the new 4th district.

Ben Wakana directs Patients for Affordable Drugs Now, a political action committee devoted to making drug prices a campaign issue. He says candidates should go all in on taking on the pharmaceutical industry, even in districts where drugmakers create jobs. Most voters, he said, care a lot more about lowering prices.

“You shouldn’t have to tailor your message because you are in a state where a fraction of the population is employed by the industry,” Wakana said. “Even if you are employed by a drug company, that does not insulate you from the high costs of prescription drugs.”

The group contributed money to Rep. David B. McKinley, a West Virginia Republican who doesn’t pull punches with the drug industry. It’s also putting up money to oppose Hugin, though not directly endorsing Menendez.

To some extent, Republicans also have to walk a fine line, given that the party’s leader, President Donald Trump, accused the pharmaceutical industry of “getting away with murder.” While candidates tend to go easier on the industry than Trump, they often echo his statements, particularly how other countries often pay less for drugs that the United States subsidized.

“Many hard working people in Montgomery and Berks Counties earn a living in the pharmaceutical industry and they should proud of the good work they do,” Dan David, the Republican running in Pennsylvania’s 4th District, said through a spokesman in an email. But David, like Trump, endorsed drug importation.

Lance, who has represented his New Jersey district since 2009, said his constituents want “reasonable prices to the same extent as anybody else,” and cited another Trump talking point: “We have to do a better job to share the cost of research and development, which is borne by the American people to a greater extent than other nations,” he said.

But in most cases, even if the candidates aren’t going after Big Pharma, the industry seems to prefer the people they know: incumbents.

In some races, pharma money is barely a factor. In California’s 49th District, neither candidate has financial support from industry groups, compared to 2016, when Issa’s last re-election campaign received $48,000.

Pennsylvania Democratic Rep. Brendan F. Boyle, who represents the area that is becoming the 4th District and is running in a neighboring district this year, received around $59,000, according to Federal Election Commission filings compiled by the Center for Responsive Politics. In the new 4th, neither candidate has substantial industry support.

Across the Delaware River in New Jersey’s 7th District, industry-linked campaign groups provided Lance with $156,750, while Malinowski isn’t accepting corporate contributions. In the Senate race, on the other hand, Menendez received $187,000 from the pharmaceutical industry, compared to $19,200 for Hugin, the Center for Responsive Politics found. Hugin, however, has received a major cash injection from one industry donor — himself, in the form of a $15 million loan to his own campaign.