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The Washington Post: The Health 202: Congress and Trump May Actually Take Action in 2019 to Lower Drug Prices

January 7, 2019
In The News

A divided Congress probably won’t be able to agree on much over the next two years. But that vacuum could bode well for one vexing problem both parties say they want to solve: the high cost of prescription drugs in the United States.

Hope is strong among health-care advocates and lawmakers that 2019 could be the year Congress and the executive branch finally make significant moves against the powerful prescription drug industry, after long acknowledging a need for action but doing little about it.

House Democrats have named lowering drug one of their priorities, with Speaker Nancy Pelosi (D-Calif.) promising last week “to lower health costs and prescription drug prices.” Sen. Chuck Grassley (R-Iowa), the newly minted GOP chairman of the Senate Finance Committee, has vowed to crack down on the “shenanigans” played by major drugmakers to limit lower-priced alternative medicines.

There are signals the industry’s influence is waning, after it recently failed in its bid to reverse steeper payments for drugs in Medicare’s so-called "doughnut hole," the coverage gap for seniors. And overlaying all of this are surprisingly aggressive efforts by the Trump administration to lower prescription drug costs in the Medicare program, some of which were outlined in its drug pricing blueprint.

“I’m very optimistic that the long overdue effort to rein in the price gouging from PhRMA is underway,” Rep. Peter Welch (D-Vt.) who is seen as a leader on the issue, told me on Friday.

Members are eyeing at least two bills with bipartisan support: The Creates Act, which would prevent branded drugmakers from guarding their medications so other companies can’t develop alternatives; and legislation to prohibit “pay-for-delay” deals in which drugmakers pay producers of generic medicines to delay introduction of cheaper versions of them.

These measures attempt to introduce more competition among drugmakers by leveling the playing field — an approach some in theTrump administration (including Health and Human Services Secretary Alex Azar and Food and Drug Administration Commissioner Scott Gottlieb) favor even as they remain suspicious of approaches that smack of government price-fixing. As for Democrats, they’d like the government to play a much more robust role in the prescription drug pricing business, but many feel they shouldn’t let the perfect be the enemy of the good.

“I think it would be a shame … to waste an opportunity if President Trump is willing to work on this issue — or have his people work on this issue — to actually get something done,” said former congressman Henry Waxman, a Democrat from California who served as chairman and then ranking member of the House Energy and Commerce Committee.

Ending pay-for-delay tactics is a priority for Grassley, who has teamed up with Sen. Amy Klobuchar (D-Minn.) on their Preserve Access to Affordable Generics Act. The legislation prohibits the deals not just for generics, but also for newer, pricier products known as biologics and biosimilars. It would “inject a healthy dose of Midwestern, common-sense medicine into Big Pharma,” Grassley said in a November floor speech.

Grassley has also signed on to the Creates Act, whose House and Senate versions are supported by a broad range of lawmakers — so broad, in fact, that they included both Sen. Ted Cruz (R-Tex.) and former Rep. Beto O’Rourke, who nearly beat Cruz in the November midterms. The measure would allow generic companies to sue branded companies for failing to provide them with samples needed to create generic versions of their products (we explained the Creates Act more in this Health 202).

Of course, the partial government shutdown now in its third week is consuming all the oxygen in the room right now. But advocates say they’re still betting lawmakers will come together on an issue that troubles 80 percent of Americans. 

“I am way more optimistic than we’ve ever been before,” said Ellen Albritton, a senior policy analyst at Families USA. “I think a lot of things are aligning in a way that they haven’t aligned before.”

The industry isn't appearing to back down, either. More than three dozen drugmakers began the new year by hiking their product prices an average of 6.3 percent, the Wall Street Journal’s Jared S. Hopkins has reported, although he noted many of the hikes were relatively modest amid pressure on the issue.

The Campaign for Sustainable Rx Pricing launched a new website yesterday to help convince lawmakers to take on high drug prices. “Members of Congress ran and won on the promise to hold pharmaceutical companies accountable and lower drug prices. Our goal with this new website is to provide lawmakers with the information they need to turn their campaign promises into substantive action,” said Lauren Blair, CSRxP communications director. 

The Trump administration has several drug pricing efforts in the works, mostly centered on tweaking the way the government pays for drugs in the Medicare program. But it’s been bold enough to have won some respect — if begrudging — from some of the most liberal Democrats in Congress, including Welch.

“There are promising signs out of the Trump administration,” Welch said. “I think there is a significant potential Trump is going to step up on prescription drug pricing.”

Yet politics remain in play. House Democrats certainly aren’t ignoring the 2020 election, which could of course hand them the White House and open the door wider for pushing priorities Republicans don’t favor.

Consequently, there’s talk in the caucus of passing legislation allowing the federal government to directly negotiate lower prices with drugmakers in the Medicare Part D program — a pie-in-the-sky dream for liberals that is strongly opposed by conservatives. It would be mostly a messaging tactic for Democrats, as it would almost certainly die in the Senate.

Still, Democrats point to the huge support among their own members for the idea. Several Democrats have offered bills requiring Medicare price negotiations, but the most popular — offered by Rep. Lloyd Doggett (D-Tex.) — has 104 co-sponsors. Welch said he holds out hope Trump would sign such a measure (assuming Democrats could somehow get it through the Senate), given the support he expressed on the campaign trail.

A spokesman for House Energy and Commerce Chairman Frank Pallone (D-N.J.) also pointed to Medicare price negotiations, as well as the more likely efforts to lift barriers to generic drugs. “He is hopeful that Democrats can work with the president in a bipartisan way,” spokesman C.J. Young said.