Battle over drug prices is shaping up
Doggett, other congressional Dems plan quick action
WASHINGTON — After tapping election season outrage over rising prescription drug costs, Texas Rep. Lloyd Doggett and victorious House Democrats intend to move quickly in the new Congress with proposals to protect consumers from price spikes and ease the financial crush on Medicare.
President Donald Trump and Senate Republicans say they’re open to drug-price legislation, but Democrats face the twin obstacles of a potent drug industry lobby and fear of putting the gov- ernment deeper into the health care business.
With Democratic takeover of the House in the new Congress, Doggett will be in position to influence health care policy as he did in 2010 in helping engineer passage of the Affordable Care Act.
Doggett, whose district stretches from San Antonio to Austin, chairs a House Democratic task force on drug pricing and is in line to take over the Ways and Means health care subcommittee next year.
He’s chief sponsor of far-reaching legislation giving Medicare au- thority to negotiate directly with drugmakers and is moving swiftly to consolidate support.
The law would allow the government to negotiate on behalf of veterans. The Medicare prescription drug benefit in place since the George W. Bush administration forbids such negotiations.
Doggett is hoping Trump, who has accused the pharmaceutical industry of “getting away with murder,” will be an ally in lifting the prohibition.
“As much as I disagree with President Trump on just about everything, I’m hopeful that we can
find some common ground. I’m hoping that on this issue he will begin acting more like candidate Trump,” Doggett said.
Doggett will be joined by fellow drug-industry antagonists. Maryland Democrat Elijah Cummings, who once spoke of “very expensive champagne popping in drug industry board rooms,” will chair the House Oversight and Government Reform Committee.
It was that committee that summoned Mylan’s CEO to explain the company’s six-fold rise in the price of the EpiPen, an injector that wards off allergy attacks.
The industry also can expect a less hospitable Senate, even though it remains in GOP hands.
Utah Republican Orrin Hatch, known for diverting drug-pricing proposals to the legislative graveyard as chair the Senate Finance Committee, is retiring. He’ll be replaced by no-nonsense Sen. Chuck Grassley of Iowa, who coauthored an investigation of Gilead’s decision to sell its hepatitis C drug for $84,500 per treatment.
In the House, Doggett’s Medicare negotiation bill has emerged as the Democrats’ main plan of action thus far, attracting 100 cosponsors and scores of endorsements. Projected revenues of more than $350 billion in 2018 for the top 10 drug manufacturers help to make his case.
Studies show prescription prices in the United States are more than twice as high as in other developed countries, according to comparisons published by Health and Human Services. One-fourth of Americans say they have a hard time paying for their medicine, the Kaiser Foundation’s Health Tracking Poll found.
Per capita drug spending grew at a slower rate recently after increases of up to 11.5 percent annually when an array of new specialty drugs came on the market.
But the announcement by drug giant Pfizer last week that it will raise prices of 41 of its medicines Jan. 15 likely will renew concerns and add pressure on Congress to act
For Medicare, the price boosts are draining.
Medicare’s share of national health spending leapt from 2 percent to 29 percent over a decade, making Medicare the nation’s second biggest spender on drugs, behind private insurance.
Deploying government purchasing power would reduce prices, save taxpayer dollars and lower seniors’ out-of-pocket costs, Doggett and his allies contend.
The challenge is finding a price. What happens if that negotiation fails is what likely will trigger debate.
The government then could issue a license allowing other manufacturers to produce the drug for Medicare with the goal of lower prices through competition.
The legislation would give protection from “price gouging,” as Doggett puts it, by preventing Medicare from paying more than the average price in countries that resemble the United States economically.
That provision resembles an election-eve plan spelled out by Trump that raised eyebrows given his criticisms of health care systems in foreign lands.
Calling it a “revolutionary change,” the president announced Oct. 25 that an “international pricing index” will be used in a demonstration project to determine how much will be paid for drugs covered by Medicare Part B — the original Medicare part that covers services and supplies.
Trump’s proposal wouldn’t take effect for more than a year, and only as a demonstration project, rather than a regulation that prescribes policies.
Nonetheless, it generated cries of “price controls” from the Pharmaceutical Research and Manufacturers of America (PhRMA), the industry’s trade group in Washington.
The industry is certain to wage an all-out effort against the Doggett plan.
PhRMA has spent $21.8 million this year on lobbying, about 10 percent of the $216 million lobbying expenditures of the pharma- ceutical and health products industry, according to the Center for Responsive Politics.
A PhRMA spokeswoman, Holly Campbell, said by email that “we can’t speculate on what Congress may or may not do, but we remain focused on advancing marketbased reforms” that lower costs.
She added that medicine prices increased just 1.9 percent last year, even though patients’ outof-pocket costs continue to rise.
Dan Mendelson, a consultant who oversaw health care issues in the Clinton administration’s Office of Management and Budget, sees a difficult road for the Doggett bill.
More likely, he said, are modest changes aimed at boosting competition among drugmakers and requiring more transparency in how they set prices.
“There is not consensus about the government setting limits on the cost of drugs and there is not consensus that government can do better than the private sector in negotiating the cost of drugs,” he said.
Mendelson also sees the electoral politics playing a role as Democrats lay the groundwork for wresting the White House from Trump in 2020.
“They’re not going to want to put the question to bed,” he said, referring to the likelihood of drug prices remaining a potent campaign issue in two years.
Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, is less certain that Doggett faces insurmountable odds.
“A lot of people are writing it off. I’m not so sure I would do that,” he said. “It would have a lot of trouble in the Senate. But you never really know these days with this administration and what might happen in a deal.”
U.S. Rep. Lloyd Doggett, center, and his fellow House Democrats aim to move quickly on the issue of drug prices.
Alexandria Garcia talks with state Rep. Diego Bernal, from left, U.S. Rep. Lloyd Dogett and state Sen. Jose Melendez about the problems she’s had with the price of prescription drugs.