Seniors and their advocates had high hopes for prescription drug pricing reform when President Biden took office with majorities – however slim – in both houses of Congress.  Those were heady days, following four years of obstruction on drug pricing. Democrats (and some Republicans) tried to enact commonsense reforms during the Trump administration, but were obstructed by then-Senate majority leader Mitch McConnell.  Meanwhile, President Trump paid lip service to lowering drug prices, but didn’t lean on Republicans to act.  Today, action to reduce soaring drug costs seems stuck again, to the disappointment of most Americans – who continue pay the highest prescription prices in the world.

Advocates had hoped that drug price reform would be part of President Biden’s American Families infrastructure plan, but it was noticeably excluded. The President’s 2022 budget proposal called for lowering prescription prices – but only as a broad policy goal.  Most Republicans continue to oppose aggressive cost control measures, and some moderate Democrats appear hesitant to directly challenge Big Pharma. After pushing through legislation in 2019, House leadership has not put muscle behind enacting reforms during this Congress.

So what happens now?  There is no lack of conviction on the part of drug price reformers on Capitol Hill.  Democrats re-introduced the House-passed Elijah Cummings Lower Drug Costs Now Act (H.R. 3), which would – among other measures – finally allow Medicare to negotiate prices with Big Pharma (just like the VA does).  Polling indicates that this policy enjoys wide public support, even among majorities of Republican voters.

The Washington Post reports that House Democrats are making an effort to include elements of H.R. 3 in infrastructure legislation this summer:

“House Energy and Commerce Chairman Frank Pallone Jr. (D-N.J.) told reporters yesterday that he’s aiming to get the measure attached to the package — a package that almost certainly represents Democrats’ best shot this year at turning their top priorities into law.” – Washington Post, 6/8/21 

Drug pricing legislation faces considerable challenges in the 50-50 Senate, where most bills need at least 60 votes to pass.  In the last Congress, Senators Ron Wyden (D-OR) and Charles Grassley (R-IA) offered a bill that did not include Medicare negotiation, but would have imposed penalties and controls to try to contain Big Pharma price hikes. That legislation was blocked by then-Majority Leader McConnell and failed to win support from most Republican senators.

Reformers now hope that an infrastructure package including drug pricing provisions might be pushed through the Senate using the budget reconciliation process (similar to the American Rescue Plan relief act earlier this year).  Interestingly enough, Senator Joe Manchin (D-WV), who opposes eliminating the filibuster and forcing additional legislation through the Senate via reconciliation, has himself sponsored legislation allowing Medicare to negotiate drug prices.

Dan Adcock, Director of Government Relations and Policy at the National Committee, characterizes reconciliation as the best and only chance of enacting prescription pricing reform during this Congress.  “Amending Medicare to include prescription drug price negotiation is totally fair game,” he says.  President Biden would likely sign any prescription drug pricing legislation that manages to work its way through the House and Senate.

Of course, Medicare price negotiation may not survive the legislative process this time around, but other measures similar to the Wyden-Grassley bill (such as tying drug price increases to inflation or to what other countries pay) might make it through.  “We would like to get something as comprehensive as H.R. 3,” says Adcock. “But politics is the art of the possible, and it may be possible to get something less than that which still could help limit price gouging.”