Democrats vow to continue fight on drug pricing in budget bill

White House framework calls only for repealing rule requiring benefit managers, insurance companies to share rebates

Sen. Ron Wyden, shown Tuesday, says he is still committed to the issue of allowing Medicare to negotiate prices for some prescription drugs. “We’re staying at it,” Wyden said. “This is too important.” (Tom Williams/CQ Roll Call)
Sen. Ron Wyden, shown Tuesday, says he is still committed to the issue of allowing Medicare to negotiate prices for some prescription drugs. “We’re staying at it,” Wyden said. “This is too important.” (Tom Williams/CQ Roll Call)
Posted October 28, 2021 at 4:15pm

Democrats on Capitol Hill say they are continuing to work toward allowing Medicare to negotiate prices for some prescription drugs in their social spending package, although the provision was left out of a $1.75 trillion framework agreement the White House released Thursday.

For weeks, Democrats have been at odds over how to address drug pricing, a longtime party priority, in a budget reconciliation package. While it’s been clear that any effort to allow Medicare to negotiate drug prices would likely be more narrow than the policy advanced by House committees last month, the framework only calls for repealing a Trump-era rule requiring pharmacy benefit managers and insurance companies to share drug manufacturer rebates with patients at the pharmacy counter.

Senate Finance Chair Ron Wyden, D-Ore., whose committee oversees the bulk of the budget bill, said he was still committed to the issue. Senate Democrats had an all-caucus meeting over Zoom with White House officials around midday to discuss the framework, according to a senior Democratic aide.

“We’re staying at it,” Wyden said. “This is too important.”

Wyden added that an agreement exists on two pieces of a drug pricing deal — a rebate when drugmakers raise prices faster than inflation in the Medicare and commercial markets, and a redesign to cap patient costs under the Medicare Part D drug program. But he stressed that any negotiation deal must include retail drugs in the Part D program and physician-administered drugs in the Part B outpatient program.

“The way I would put it — if you want you know, my bottom line — it is non-negotiable that negotiation become a part of Medicare now,” he said, although he did not say he would vote against the bill.

Energy and Commerce Chairman Frank Pallone Jr., D-N.J., evinced frustration with other industry friendly lawmakers after a meeting of House Democrats with President Joe Biden on Thursday morning.

“I still feel confident that we’re going to get a drug pricing initiative, but I just want you all to know that pharma is doing whatever they can to try to prevent any drug pricing provision being in this bill,” he said. “And if it doesn’t get in the bill, it’s totally because of them and their lackeys here in the House and the Senate.” 

A senior Energy and Commerce Committee aide said a competing proposal to allow negotiations only for physician-administered drugs covered by the Medicare Part B outpatient program would only cover “an incredibly small universe of drugs and would do functionally nothing to lower prescription drug prices for the American people.” The proposal would allow negotiations only for drugs with expired patents and no generic competition.

The aide said Pallone doesn’t think the package could pass the House without a “meaningful” provision to lower prescription drug prices. 

But Reps. Scott Peters, D-Calif., and Kurt Schrader, D-Ore., who opposed drug pricing proposals during the Energy and Commerce Committee markup and offered the competing physician-administered drug proposal, both said they thought a more narrow deal could be had. 

“The logic of coming to an agreement is just too strong for me to think that it won’t be in there at some point, even if it’s not in there today,” Peters told reporters. 

Peters rejected any blame for drug pricing not being in the plan.

“I offered a very reasonable answer to this problem, I think. I don’t know why anyone wouldn’t want to put it in if we had that choice,” he said.

Critics of the proposal from Peters and Schrader argue it would allow pharmaceutical manufacturers to keep drugs in patent exclusivity periods for up to 21 years, during which Medicare could not negotiate the price for that drug. 

Sen. Christopher S. Murphy, D-Conn., said his colleague Sen. Kyrsten Sinema, of Arizona, had reached a tentative agreement with the White House on drug pricing, a provision she had voiced reservations about. The agreement, which reportedly contained elements that were similar to Peters' bill, was omitted from Thursday's framework in an effort to extend negotiations, Murphy said.

"I think there was a desire on behalf of some members to continue those discussions, that I think it’s a strong agreement but it can be stronger, and so that’s the reason it was left out is there's still some more work to do on it and we’ve been working on it over the course of today," he said.

Longtime drug pricing advocate Sen. Bernie Sanders, I-Vt., touted everything that Democrats were able to include in the framework, saying it would be “the most significant piece of legislation ever passed in the world.” But he added he was still pushing to include drug pricing provisions, which were originally estimated to save as much as $700 billion over a decade.

“Whether we got to that level or not, I don't know,” he said. “But we've got to do something significant.”

Sen. Bob Menendez, D-N.J., whose state is home to a number of drugmakers and who is one of the chief holdouts in the Senate, was also still hopeful an agreement could be reached on Medicare negotiation.

"I have been desirous of finding a way to lower prescription drug prices. I just didn't agree with the House process," he said. "That's why I was negotiating with Chairman Wyden, and I still hope it can be done."

Advocates immediately released a string of sharply worded press releases. Nancy LeaMond, the executive vice president and chief advocacy and engagement officer at AARP, said in a stinging statement that the organization was “outraged” that the framework released Thursday did not take further steps to lower drug prices.

“It would be a monumental mistake for Congress not to act on an historic opportunity to improve the lives of virtually every American family,” she said. “Voters 50+ are a major force in every election and they expect the President and Congress to keep their promises and let Medicare negotiate for lower drug prices. They need to include these provisions in the package before they can expect seniors to support it.”

Speaker Nancy Pelosi, D-Calif., was pushing to finalize a deal in order to pass a separate but linked bipartisan infrastructure bill this week. Pelosi wanted to vote on the infrastructure bill as soon as Thursday, but it’s unclear whether it has enough support just yet. Congressional Progressive Caucus Chair Pramila Jayapal, D-Wash., told reporters after the meeting with the president that there were “too many no votes” in her caucus to pass the infrastructure bill Thursday. 

“However, we are committed to staying here until we get this Build Back Better Act done, get the legislative text,” she said, referring to the budget bill that includes the health policy provisions. “We enthusiastically endorsed the framework that the president laid out today for the Build Back Better Act.”