San Antonio Express News: Why the GOP may join Texas Democrat Doggett’s push to limit drug prices
WASHINGTON - Democratic Texas Rep. Lloyd Doggett, who took over a key health-care post in the new Congress, plans to meet with Trump administration officials amid signs of bipartisan momentum to address consumers' desire to stem the rising costs of prescription drugs.
Doggett, who represents Austin and San Antonio, has fought unsuccessfully in the past to end a rule prohibiting Medicare from negotiating with drug companies when buying tens of billions of dollars in prescription drugs for seniors annually. The Veterans Administration already negotiates prices for its drugs.
What could make this year different is President Donald Trump, an industry antagonist who has accused pharmaceutical companies of "getting away with murder." Trump administration officials have held initial meetings with lawmakers, suggesting willingness to sign drug-pricing bills of some variety. And in the run-up to the 2020 presidential election, both major parties are eager to claim success on a matter of overwhelming concern to voters.
As chairman of the Ways and Means health subcommittee, Doggett will play a key role in health-care matters this Congress. He plans to brief members on Medicare issues Thursday and hold a hearing next week on the benefits of competitive drug pricing.
His message to administration officials early next month, he said, "is to follow the advice of candidate Trump" - who endorsed negotiating drug prices.
"We'll be looking for common ground," he said. "I'm seeing an improved awareness of the problem. The question is whether that transfers into votes."
Starting Tuesday, the issue heats up on Capitol Hill when executives from seven top drug manufacturers testify in front of the Senate Finance Committee. The CEOs had sought to meet privately with senators, irritating Republicans and Democrats alike.
Texas Sen. John Cornyn illustrated Republicans' concerns when he referred in a recent hearing to "kickbacks" in the drug industry.
"Can anybody on the panel explain to me why we have a general prohibition against kickbacks — call them rebates — under the Social Security Act, but we nevertheless allow it for prescription drug pricing?" Cornyn asked in a Finance Committee session.
On Friday, the Finance panel announced a bipartisan investigation into insulin prices, citing increases as high as 585 percent in a diabetes treatment that has been on the market for nearly 100 years. Some 30 million Americans suffer from diabetes.
Perhaps more than any other policy issue in Washington, the effort to slow spiraling prescription costs offers potential for bipartisan success, analysts say.
"Everything seems to be aligning for something to happen on drug pricing. Democrats are going to push it and Trump and (Health and Human Services Secretary Alex) Azar are very supportive of doing something on this," said Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.
Campaign issue for Democrats in 2020 — and for Trump
The issue of higher drug costs was a key part of House Democrats' carefully crafted talking points in the midterms, a message that helped them flip 40 seats. Gellad predicts that Democrats seeking their party's presidential nomination will be talking "non-stop" about drug prices on the campaign trail and in the candidate debates, which begin in June.
Ohio Sen. Sherrod Brown, Doggett's partner in drug-pricing legislation, hinted last week that he, too, may join the array of Democrats running for president. Doggett's plan already has one co-sponsor in the field - Minnesota Sen. Amy Klobuchar - and likely will have more.
For Trump, who prides himself on keeping campaign promises, the issue also looks to be important in his 2020 campaign.
The president spoke boldly in his State of the Union message about it being "unacceptable" for Americans to pay more for the same drug than consumers in other countries. "This is wrong, this is unfair, and together we will stop it. We will stop it fast," the president said, asking Democrats to help.
The Trump administration has taken several steps to bring down costs, most of them voluntary for the drug companies, and he took credit in the State of the Union for success. He is planning a bigger initiative with a rule, being written now, that would tie drug prices in a Medicare program to the average costs in several developed, mostly European, countries. But that rule, if it survives, is years away from having an effect; a pilot project wouldn't begin for more than a year.
An array of legislation already is pending, among them minor bills calling for more transparency about prices and more weighty measures that would cap out-of-pocket drug costs for seniors.
Pay-for-delay practice targeted
Doggett also intends to press for legislation that would end the industry's so-called pay for delay practice, in which brand-name drug companies pay to block or slow the arrival to the market of competitive generics.
The mere fact that discussions are taking place has bred optimism. Amid rancorous dealings over the border wall and government shutdown, Trump and House Speaker Nancy Pelosi, D-Calif., have spoken about what might be achieved. Azar has sat down with Democrats in both the Senate and House.
Rep. Peter Welch, D-Vt., a close Doggett ally, was invited to Camp David this month to meet with White House Chief of Staff Mick Mulvaney on the matter, Welch's office confirmed. Last week, Welch introduced still another drug pricing bill, one that would allow diabetes patients to buy cheaper insulin in Canada and elsewhere; importing now is banned.
In 2003, Doggett and Brown, then a House member, worked together to block the provision banning Medicare negotiating with drug-makers. The prohibition was nonetheless included to win support for the Medicare Part D legislation, a significant new social program for seniors and people with disabilities that George W. Bush signed into law.
Allowing Medicare to launch its own effort to tamp down prices could have major consequences. Part D covers 43 million people, making it the federal government's largest drug program. All told, prescription drugs cost taxpayers more than $130 billion annually, about one fifth of all Medicare spending. In a decade's time, Medicare's share of the nation's entire retail prescription market rose from 18 percent to 30 percent, according to the Kaiser Family Foundation.
Yet the 16-year-old law asserts that the government may not "interfere with the negotiations between drug manufacturers and pharmacies" - words that Doggett and Brown seek to strike from the law.
The goal, they say "is a reasonable price that encourages continued innovation and research but does not impose a monopoly price." Winning the argument would require skeptics in the president's party to accept an expanded government role in health care.
New government powers would be invoked if a negotiation with a manufacturer failed. The government then could issue a license allowing other manufacturers to produce a drug - if they compensate the original license-holder.
When Doggett and Brown stood together recently to introduce their legislation, Doggett referred to "rampant prescription price gouging." Added Brown: "The purpose of medicine is to help people, not to line the pockets of Big Pharma executives."