Pelosi Promised If She Won A Majority, She Would Lower Drug Prices-- So What's The Hold Up?

The problem: Pallone and Pelosi

Back in January, when the new Democratic majority began taking over the reins of power in Congress, there was a hopeful spate of reports on drug prices-- like this one by Maureen Groppe in USA Today: Democrats examine drug prices, a first step in Congress' path to cut prescription costs. Groppe reported that "reducing the cost of medicine is one of the few goals" that both Democrats and Señor Trumpanzee have named a top priority. Even "Republican Sen. Chuck Grassley, the new chairman of the Senate Finance Committee, has said he will try to find solutions... But the initiative is stronger on the Democratic side, said Rachel Sachs, an expert on drug pricing legislation at Washington University in St. Louis. 'The Democrats have advanced an affirmative agenda on what to do on drug pricing,' said Sachs, an associate professor of law. 'Different Democrats have different ideas about how to advance each of those goals, but they are all on board with those goals. Republicans have not really advanced an agenda in the same way.'"

No mention, though of the fact that the Democrat Pelosi has driving the ship, Frank Pallone of New Jersey, Chair of the House Energy and Commerce Committee and a corrupt machine pol who has taken more more in bribes disguised as campaign contributions ($6,288,967) from the Industrial-Medical Complex than any other member of Congress in history. Because of Pallone and his corrupt cronies, the Democrats are stalemated and getting nowhere. Reporting for Vox, Li Zhou wrote yesterday, that the Democrats are supposed to unveil something within a month... but not even they know what it will be yet! "Reducing prescription drug prices was a key plank of House Democrats’ platform during the 2018 midterms. More than six months into their term, however, a concrete bill has yet to emerge from House leadership on the subject, and early excerpts Speaker Nancy Pelosi has floated have spurred progressive concern."

Curbing the rise of prescription drug prices is a problem that Democrats have wanted to solve for some time. Because of the way the industry is currently regulated, many pharmaceutical companies have established a monopoly on certain drugs and have significant leeway when it comes to determining costs for their medications.

As a result, the US boasts some of the highest prescription drug prices of any developed country, leading to shocking costs for thousands of drugs including insulin. Most recently, a gene therapy treatment from Novartis was priced at a whopping $2.1 million.

Despite Democrats’ consensus about the problem and the broad way to solve it (more government regulation), there’s disagreement among lawmakers about the best route to take.

Although Pelosi’s bill is not yet finalized, she has laid out some general outlines at various caucus meetings, including some recent updates that responded to progressive pushback: According to the pieces she’s revealed so far, the bill would enable Health and Human Services Secretary Alex Azar to negotiate on prescription drugs covered by Medicare, but a final price would be decided by the Government Accountability Office if no agreement could initially be reached.

That approach differs significantly from two other bills, one introduced by Rep. Ro Khanna (D-CA) and Sen. Bernie Sanders (I-VT), the other by Rep. Lloyd Doggett (D-TX) and Sen. Sherrod Brown (D-OH). Doggett and Brown’s legislation, which has garnered the support of the Congressional Progressive Caucus, would not include a GAO middle-man in negotiations. Additionally, it would enable a pharmaceutical company’s competitors to produce a generic version of a drug if a firm did not engage in negotiations fairly.

A key difference in the Democrats’ options-- of involving a third party in the negotiations, even if it’s a government body-- has been a point of contention, due to concerns about how this added step might make the process clunkier, while also limiting potential price reductions.

To top it all off, progressives argue that the process for developing this bill has been opaque-- although they’ve been heartened by the latest tweaks by House Leadership, Politico reports. According to a senior Democratic aide, the heads of the two major committees with jurisdiction over the legislation have been making the rounds with different Democratic constituencies as they try to flesh out the proposal.

“We need the same type of transparency in writing drug pricing legislation as for pricing drugs,” Doggett told Vox in a statement.

As lawmakers await the final version of a bill spearheaded by Pelosi, there are still outstanding questions about whether it will be ambitious enough... [T]he contours of the proposal as described during a caucus meeting in late May had spurred outcry from progressives who argued that the legislation didn’t go far enough to hold pharmaceutical companies accountable. Pelosi more recently signaled that she was making updates to the proposal in response to the critiques it’s received... Here’s what we know about the speaker’s plan so far, though these pieces have not been finalized:

• It would enable HHS Secretary Azar to negotiate with pharmaceutical companies on the prices of drugs covered by Medicare.
• If the companies and HHS are not able to reach an agreement, the Government Accountability Office-- an independent agency that conducts research and advises Congress-- would help set a final price. (This is different from a binding arbitration process that had been proposed by the House speaker in an earlier version of the measure.)
• As a reference point for price-setting, GAO would use the median pricing for a particular drug in other countries around the world.
• The plan is calling for negotiations that target roughly 250 drugs, though it does not cap the number of drugs that would be part of negotiations.
• If a company does not comply with the negotiations for a particular drug, it would be penalized with an excise tax of 50 percent of its sales on the drug from the previous year.

While the GAO is seen as a better option than a third-party private arbiter (something that had been floated in prior talks) by critics of the leadership plan, there’s a lot of unanswered questions about how exactly the body would handle this job. The GAO is usually tasked with delivering oversight and other reports on government activities, not managing government negotiations.

...The idea of a drug minimum has also emerged as another point of contention. Previously, Pelosi had suggested a 25-drug floor, though the speaker has since said her plan would aim to target about 250 drugs. Critics had expressed worries that any number set by the legislation would instead become a de facto maximum, and negotiations would peter out once an agreement was reached on a select number of drugs.

Advocates in favor of establishing a drug floor suggest that it would force the HHS secretary to engage in negotiation on a set list of drugs, at the very least, and also argue that it would be very tough for Medicare to start this process without working on a more narrow universe of drugs first.

...Beyond the mechanics of the negotiations, one of progressives’ biggest concerns is whether the bill has an adequate backstop that will ding companies with a financial penalty if they don’t comply with the process.

Pelosi’s proposal does have some safeguards, as HuffPost reports:

Companies that refused to participate would be slapped with a tax equal to 50 percent of their prior year’s sales of the drug. Prices on all drugs covered under Medicare Parts B and D could not be increased going forward, and any company that still did so would have 100% of the price hike taxed away.

Doggett’s bill, however, which has more than 100 125 cosponsors, takes a much more aggressive tack on the matter.

If companies did not treat negotiations fairly, Doggett’s bill would enable HHS to issue licenses to competitors who would be able to produce the same drug as a generic, effectively eliminating a company’s monopoly on a particular drug.

This approach would push companies to approach negotiations around drug pricing more seriously-- and make sure that patients could still access a particular drug even if the company manufacturing it opted out of negotiations.

Pramila Jayapal (D-WA), co-chair of the Congressional Progressive Caucus, spoke for her members, saying "We wanted to make it very clear that it needs to be something bold that has teeth in it, and I think that’s what Rep. Doggett's bill has in it." Pelosi, who laughably claims to be a progressive because she once was, a couple of decades ago, will not allow that. She would rather support the source bribery for her members from the Sickness Industry than fulfill her oath to the voters who put her party in power in the House.

When Doggett introduced the same bill, Medicare Negotiation and Competitive Licensing Act of 2018 (HR 6505), last year, he hard 104 co-sponsors. In February Doggett re-introduced the bill (H.R. 1046) and now has 125 co-sponsors, all the members of the House who are serious about lowering drug prices. Pelosi and her cronies are not among them and even though more than half the Democrats are behind the bill, she refuses to accept that her caucus has moved on and left her in the policy dust.

In 2020, San Francisco voters will have an alternative to Pelosi if she decides to run again. Shahid Buttar is, like she used to be many, many years ago, the real thing. "Prescription drug prices today reflect a broad-based market failure," he told me recently, "and allow pharmaceutical firms to gouge patients forced to secure their medicines at any cost. Too many Americans  ultimately risk bankruptcy or homelessness simply because they fell ill. Arbitration is literally 'arbitrary,' and we need more powerful tools to ensure that medicines remain affordable. HR 1046 is a thoughtful and important proposal to subject companies enjoying regulated monopolies to consider the public interest when setting pharmaceutical prices. San Franciscans deserve a representative who will stand up for their right not to be preyed upon by drug companies instead of throwing us under the bus."

Tomas Ramos is a progressive community activist in the South Bronx, who is aiming to replace retiring Congressman Jose Serrano. Last month he told me that "It's unconscionable to think that there are lawmakers who don't deem it necessary to pass common sense legislation to rein in the reach of big PhARMA. I support the progressive caucus' efforts to clamp down on this industry, and I look forward to joining them once I'm elected."

Aside from Pelosi, others on her craven and disgraceful leadership team who want to feather the drug makers' nests-- and refuse to co-sponsor Doggett's legislation-- are Steny Hoyer (MD), Ben Ray Luján (NM), Jim Clyburn (SC), Hakeem Jeffries (NY), Cheri Bustos (IL), Frank Pallone (NJ), Richard Neal (MA) and Katherine Clark (MA). SHAME! Freshman members who have signed on and are backing their own constituents over Pelosi's allies at PhRMA are:

• AOC (NY)
• Ilhan Omar (MN)
• Rashida Tlaib (MI)
• Ayassa Pressley (MA)
• Joe Neguse (CO)
• Katie Porter (CA)
• Andy Levin (MI)
• Katie Hill (CA)
• Jared Golden (ME)
• Andy Kim (NJ)
• Chuy Garcia (IL)
• Susan Wild (PA)
• Debra Haaland (NM)
• Veronica Escobar (TX)
• Ed Case (HI)
• Josh Harder (CA)
• Joseph Morelle (NY)
• Mary Gay Scanlon (PA)
• Debbie Mucarsel-Powell (FL)
• Tom Malinowski (NJ)
• Antonio Delgado (NY)
• Gil Cisneros (CA)
• Abigail Spanberger (VA)
• Dean Phillips (MN)
• Max Rose (NY)
• Elissa Slotkin (MI)
• Ann Kirkpatrick (AZ)
• Jason Crow (CO)
• Susie Lee (NV)
• Sean Casten (IL)
• Elaine Luria (VA)
• Chris Pappas (NH)

Maybe someone should ask Central Valley freshman TJ Cox if he thinks voters in Bakersfield don't want more reasonable drug prices. Greg Stanton in Phoenix might be asked the same question. Ditto for "ex"-Republican Harley Rouda. Sure, Rouda is very, very wealthy but does he think voters in Costa Mesa and Huntington Beach don't want fairer prices for the prescription drugs they need? Lucy McBath is nuts if she thinks voters in Alpharetta, Sandy Springs and Roswell only care about gun control and not also about high drug prices. Maybe Donna Shalala has been hibernating this summer but voters in Miami want fair drug prices too and if she doesn't wake up and smell the roses she's going to wind up with even more time to sleep after November of 2020. The detestable Republican-lite brigade of Kendra Horn (OK), Sharice Davids (KS), Joe Cunningham (SC), Xochitl Torres Small (NM), Ben McAdams (UT), Chrissy Houlahan (PA), Angie Craig (MN), Jeff Van Drew (NJ), Colin Allred (TX), Mikie Sherrill (NJ) and Anthony Brindisi (NY) can always be expected to oppose anything and everything that's good for working families; so why should fair drug prices be any different? Only primaries can save us from Pelosi and her team and the mindless freshmen who do whatever she says with no regard for the folks back home-- which is exactly why she gave Cheri Bustos the OK to squelch primaries.