Prescription drug price reform at stake in social spending bill |


WASHINGTON – Among the most potentially transformational changes in the Democrats’ massive social and climate bill pending in the Senate is a long-sought set of changes aimed at curbing the rapidly rising cost of prescription drugs.

The $ 2 trillion spending program would ensure Americans don’t pay more than $ 35 when they buy a new vial of insulin at their drugstore and penalize drugmakers if they raise drug prices faster than the rate of inflation.

It would also, for the first time, allow Medicare to negotiate the prices of some of the more expensive drugs it provides to seniors.

But it is not clear whether several of the provisions aimed at finally taking substantive action on skyrocketing drug prices will remain in the final version of the bill, known as “Build Better.” “

That decision will rest with the Senate parliamentarian, who has met privately with senators from both parties to issue directives on whether certain elements of the massive bill comply with the rules of the chamber.

The way forward is logistically delicate, as Democrats use the reconciliation process to move the measure forward with just 50 votes instead of the required 60. This means they can push through legislation without gaining the support of any Republican.

The odds of going through reconciliation recently waned when Senator Joe Manchin III, a Democrat from West Virginia, said he planned to vote against the Biden administration’s latest spending plan.

The closed-door discussions were not relayed publicly by lawmakers in the room. But reports from Politico and other news outlets have suggested that opponents of the GOP are contesting whether aspects that apply to private insurance plans comply with a Senate rule requiring that the provisions of a bill of reconciliation directly affect federal spending or revenue.

Democrats have said they are cautiously optimistic that the provisions will survive and have championed them as a long overdue help for those struggling to afford health care.

“They’re out of step with the American people if they somehow think that a $ 35 insurance copayment (for insulin) … is sort of not something. that the American people approve, “said Senator Ron Wyden, an Oregon Democrat and top lawmaker. to the finance committee, which is heavily involved in developing the proposal.

If the drug pricing provisions were to survive, experts say the proposed set of policy changes would start to reduce prices, although the effort does not fully resolve the drug price crisis.

“The pharmaceutical industry is perhaps the most powerful lobby of any lobbies in the country,” said Paul Ginsburg, professor of health policy at the University of Southern California and non-resident senior researcher at the Brookings Institution. “He’s a formidable opponent. Some people are pleasantly surprised that anything can be done to bring down the prices of drugs. “

Some proposals are recycled from previous legislation, such as the cap on out-of-pocket drug costs for people enrolled in Medicare Part D, and the inflation cap, which was previously not submitted to the Senate finance committee but did not come before the Senate finance committee. ‘has never been taken over by the prosecution.

The spending cap for Medicare Part D would start at $ 2,000 in 2024. Drug makers would also be required to pay discounts to patients if they increase prices faster than inflation.

On drug price negotiation, the Democrats’ package doesn’t go as far as a recent House measure, HR 3, which Ginsburg called a change of mind on what the federal government could do to implement price reforms.

This earlier measure would have resulted in larger price cuts, linking prices to cheaper prices overseas, and more drugs would have been reviewed. Still, the version in Build Back Better, which would begin in 2025, would start with negotiations on 10 high-priced drugs, and increase the number over time, reaching 100 in six years.

“I think that will be a building block,” Ginsburg said, noting the strong public support to continue to find ways to keep rising costs down.

House Democrats bragged about the pending provisions when they recently released a scathing report denouncing the business practices of drugmakers that have led to soaring prices.

“The evidence overwhelmingly supports the need to pass the Build Back Better Act, which will allow Medicare to negotiate lower prices, restrict price increases, and cap out-of-pocket expenses for insulin and others. drugs, ”wrote the chair of the House Oversight Committee. Carolyn Maloney, DN.Y.

The bill would not address some practices criticized in the House report, such as manufacturers making small adjustments that allow them to avoid competition for longer periods of time.

Still, the spending program drew strong opposition from the pharmaceutical lobby, which said it ignored the role of insurance companies in driving up prices and would reduce the research investment needed to break through on new treatments.

“The bill puts the government’s heavy hand into the American medicine cabinet, and we know that when government bureaucrats set the price of drugs, patients ultimately have less access to treatments and cures,” Stephen Ubl, Chairman and CEO of Pharmaceutical Research and Manufacturers of America. , the largest lobbying group for drugmakers, said.

It is unclear when Senate MP Elizabeth MacDonough will be able to provide advice on the drug pricing provisions.

MacDonough, who is impartial and provides advice and assistance on Senate rules and procedures, has already excluded a set of immigration proposals from the bill. This section aimed to provide temporary protections to undocumented migrants.

“The parliamentarian is the arbiter,” Wyden told reporters during a recent scuffle in the halls of the Capitol. “We’ll wait for an appeal, and then we’ll make decisions. “

President Biden urged the Senate to lay the bill on his desk, hosting a recent White House event with a young woman who struggled to afford insulin.

“We can agree that prescription drugs are shockingly expensive in this country,” Biden told the White House. “It doesn’t have to be like that.”

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