Speaker of the House Nancy Pelosi’s September embrace of a “transformative” prescription drug plan on which “we do hope to have White House buy-in” sparked hearings, renewed hopes for legislation during this first year of a sharply-divided Congress, and was widely lauded as at least a “good first step” toward relieving the burden on consumers. The Lower Drug Costs Now Act (H.R. 3) is sponsored by the chairs of the key Ways and Means, Energy and Commerce, and Education and Labor committees and would: 

• Allow Medicare to negotiate prices with drug companies each year on “as many as possible” but at least 25 of the 250 most costly drugs, specifically including insulin.
  
• Set negotiated prices at no more than 1.2 times the average in Australia, Canada, France, Germany, Japan, and the United Kingdom.
  
• Require drug companies to offer those negotiated prices to all other insurers,  thus benefiting 70 million Medicaid recipients and 150 million enrollees in employer-sponsored plans.
• Impose escalating penalties beginning at 65% of annual gross sales on companies that refuse to enter negotiations.
• Cap annual out-of-pocket prescription drug costs for Medicare beneficiaries at $2,000.
• Mandate rebates on Medicare Part B and Part D covered drugs whose prices increase faster than inflation.

Praising the bill, retired Congressman Henry A. Waxman, long-time champion of affordable health care access:

• Highlights prescription drug prices in which the U.S. has  “dubious distinction,” averaging 3.7 times higher than in 11 similar countries, seven times what the Japanese pay for the same drug, and rising 2.5 times the inflation rate. 
  
• Calls authorizing price negotiation ”one simple, common sense solution” to the “primary reason” for these “appalling” disparities.  All in all, it’s estimated to save at least $100 billion in spending for Medicare-covered drugs over 10 years (based on estimates for the narrower Senate Finance committee bill).  “All it takes is a small dose of political courage.”
• Rebuts claims that H.R. 3 will discourage developing new medicines, pointing out that industry spends on advertising, marketing and stock buybacks than on R&D and benefits “enormously” from taxpayer-funded research, to which part of the savings from the bill will be devoted.
  
• Views the bill as “a vital step further” building on legislation he sponsored over 40 years for providing affordable access to prescription drugs while encouraging innovation.  And “unlike most issues in Washington, D.C., this has bipartisan support and the potential for achieving positive change.” 

The Coalition for Fair Drug Prices, which includes consumer, labor, and health care provider organizations says that H.R. 3 an “important step forward,”  and hopes during the legislative process to lower drug initial “launch prices,” expand which drugs are covered, and empower the government “ to achieve fair prices when there are too few competitors or international reference prices are too high.”

What are the prospects for this bill that Kaiser Health News calls “tailor-made for an election year”? On the one hand, its approach is appealing because It focuses on seniors, it draws from Senators Grassley and Wyden’s Finance Committee approach (which most Senate Republicans don’t support), and it appeals to President Trump’s avowed support for curbing drug prices. But some progressive Democrats say that requiring negotiation only on 25 drugs per year is too modest. 

Here are some viewpoints on the bill’s chances offered by media and members of Congress at different points over the politically volatile recent weeks: 

• On the day that H.R. 3 was unveiled, The New York Times compared the bills, described them so far, and commented on political prospects.
• Ten days later, the Associated Press offers another comparison and political handicapping, adding that the growing impeachment inquiry “could suck the air out of the room.” 
• But House Speaker Nancy Pelosi, appearing on October 8 at Seattle’s Harborview Medical Center with Representative (and Ways and Means member) Suzan DelBene (D-WA 1st District) to promote the bill still said of prescription drug reform, “In my view, it could happen this year.”

– Charlie Mitchell, NoHLA Senior Staff Attorney