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House Democrats are still fighting over provisions of their landmark prescription drug price bill

Progressives argue that the legislation could still stand to be more inclusive.

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Rep. Pramila Jayapal (D-WA) speaks during a press conference held by the House Judiciary Committee on immigration and domestic terrorism at the University of Texas at El Paso on September 6, 2019 in El Paso, Texas.
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Nearly a year into their latest term, House Democrats are still wrestling with internal conflicts as they consider a vote on their landmark prescription drug prices bill.

Although House Democrats have a vote scheduled this week for HR 3, the Lower Drug Costs Now Act, disagreement over specific provisions — including the number of drugs the legislation would cover — threatens to sink an upcoming procedural step, according to The Hill. Members of the House Progressive Caucus, led by Reps. Pramila Jayapal (D-WA) and Mark Pocan (D-WI), in particular, have urged Democratic leadership to expand the scope of the legislation beyond the concessions moderates made earlier this year.

If passed, House Democrats’ proposal would mark a major shift in the way prescription drug prices are set in the US by empowering the federal government to directly negotiate drug prices for Medicare recipients as well as others purchasing the drug. As Vox’s Dylan Scott has written, a Congressional Budget Office analysis found that the measure could curb Medicare spending by $345 billion over the course of a decade, though it could also lead to some reductions in the number of new drugs brought to market.

As things stand, House progressives have suggested that they could tank a procedural vote, preventing the bill from coming to the floor. They’re still taking a whip count of members, to examine the appetite for stymying it, The Hill reports, but the bill would need 216 votes to clear the procedural hurdle if there was a full House vote. Currently, there are 233 Democratic lawmakers in the lower chamber, meaning they could only afford to lose 17 members at most in order to approve this step, a far smaller number than the 98 members who are part of the CPC, assuming that no House Republicans join the Democrats. If progressives were to vote down the rule, Democrats would effectively be forced back to the negotiating table before a vote on the bill.

Democratic in-fighting on the bill has cropped up throughout its development, but this recent disagreement come as time winds down for Congress to approve the legislation ahead of the new year. House lawmakers had made lowering prescription drug prices a cornerstone of their midterm election campaign and have been eager to pass this bill to show voters that they are making progress on the issue in the face of Republican opposition, even as they pursue an impeachment inquiry.

Progressives, however, are trying to send a different message: one about the type of legislation they see as vital to meaningfully lowering prescription drug prices. Since the Senate isn’t expected to take up the legislation any ways, this bill is an opportunity for Democrats to make their mark.

Speaker Nancy Pelosi, in a letter to the caucus on Monday, touted the changes that had already been made to the bill thus far.

“Members’ input has been very important in the construction of this landmark legislation,” she wrote. “Since the beginning of the bill, we moved from binding arbitration to direct negotiations, increased the bare minimum number of drugs negotiated per year to 35, and created a new Emergency Negotiations mechanism to further address potential price gouging in launch prices of new treatments.”

The central disagreement, explained

The crux of the disagreement between progressives and Democratic leadership over the drug pricing bill has centered on two things: the scope of the bill itself and the lack of transparency over how it’s been written.

Earlier this year, members of the CPC suggested that the 25-drug minimum that had been included in the original version of the bill was too low, and they’re still interested in growing this number beyond the current 35-drug floor. It’s one of four areas they’d like to see amended before voting on a final version of the bill. Jayapal laid out some of these demands in a tweet last week:

In more detail, the four areas where there’s ongoing pressure from progressives are as follows:

  • Include uninsured patients: Progressives have called for people without insurance to receive lower drug prices as well. Currently, the bill only offers the reduced prices to people who are covered by Medicare and private insurance.
  • End the existing ban on Medicare drug negotiation: HR 3 would enable the HHS Secretary to negotiate the prices of as many as 250 drugs — and at least 35 drugs — annually.

Under current law, the Health and Human Services Secretary is barred from engaging in negotiations for prescription drugs covered by Medicare, an arrangement established in 2003 as part of the Medicare Modernization Act that set up Medicare’s prescription drug benefit. Presently, private plans that offer Medicare Part D benefits negotiate drug costs independently. But they often lack the leverage to secure the kinds of reductions the government may be able to obtain, given its bargaining power.

Progressives see HR 3 establishing an exception to the original ban, instead of undoing it altogether. They’d like to eliminate the ban completely.

  • Increase the drug minimum in the second year: In order to ensure that more drugs are negotiated on, progressives are pressing for the drug minimum to be increased from 35 drugs to 50 drugs in the second year after the bill’s implementation.
  • Protect patients on private insurance from price hikes: The bill presently requires companies to roll back exorbitant price hikes for drugs covered by Medicare Part B and D if they’ve increased the cost of a drug at a rate higher than that of inflation since 2016. If they have, they can reduce the price or dole out a rebate to the Treasury. An amendment from Rep. Jayapal would push the government to study how such price hikes could be capped — and rebates issued — for patients covered by private insurance, so they do not bear the burden of additional increases. It would also direct the government to implement this regulation.

Although this amendment had previously passed the House Education and Labor Committee, much of it is set to be removed from the final bill, Politico reports.

Progressives are especially concerned these omissions mean that specific patients are being excluded by the legislation.

“I continue to be seriously concerned by who has been left out and left behind by H.R. 3.,” Rep. Lloyd Doggett (D-TX), the author of a more ambitious drug pricing bill, said in a statement. “Currently, there is no relief guaranteed for the most vulnerable—our uninsured neighbors.”

The stakes are significant for Democrats

This bill is important for Democrats for a number of reasons, including its role in helping keep the promise lawmakers made to constituents in 2018. Additionally, the timing of a vote on the legislation comes as Democrats are grappling with the impeachment inquiry and working to talk up their other legislative priorities.

Senate Republicans are not expected to take up the existing version of the legislation or a more progressive one, meaning that Democrats are likely to tout this achievement on the campaign trail as they point to GOP inaction on an issue important to many voters. In the past, over 80 percent of voters have said they think reducing drug prices should be a central congressional priority.

President Donald Trump, too, has emphasized that lowering drug prices is important to his administration, though he’s come out in opposition to this bill and said it would hinder potential innovation too much. Meanwhile, other proposals Trump’s pushed, including a plan to reduce out-of-pocket drug costs for older individuals, have hit roadblocks.

Because the Senate isn’t set to consider the bill at all, progressives see this as a major opportunity for Democrats to pass the most aggressive version of this legislation possible. As a House aide told Vox, this bill is serving as a “values statement” from the Democratic party — and sending a clear message about who exactly lawmakers think should benefit from reduced drug prices.