The Health 202: House Democrats must decide whether to work with GOP on drug prices

Democrats celebrating their new-but-narrow control House majority are confronting a hard decision: Whether to work with the Trump administration — and the GOP-led Senate — to lower drug costs.

House Republicans grappled with exactly this kind of question for six years under then-President Barack Obama, as the president and Democrats urged them to help improve the Affordable Care Act. Republicans refused to cooperate on bills that might have bettered its marketplaces and its other benefits, all because the law’s shortcomings were too good a political weapon with which to keep bludgeoning Democrats.

Democrats, who gained at least 26 seats in the House with a handful of races yet to be declared, could very well make a similar political calculation when it comes to drug prices under President Donald Trump. The issue is a top concern to voters, and it’s likely to come up in 2020 when Democrats are seeking to defeat Trump to win the White House.

“They’ve got to make a decision, which is: How far are they willing to go to show they’re willing to work with Republicans and the Donald Trump administration?” Rodney Whitlock, a former health-policy staffer to Sen. Chuck Grassley, R-Iowa, and now a vice president at ML Strategies, told me.

Minority Leader Nancy Pelosi, D-Calif., who is expected to reclaim the House speakership, has said going after the high cost of prescription drugs is a task Democrats plan to take on right away. In July, Pelosi personally visited the Pharmaceutical Research and Manufacturers of America to threaten some specific legislative actions, according to Stat News. Tuesday night she told PBS’s Judy Woodruff it’s “hopefully something we can do in a bipartisan way.”

“I think that we could find common ground on reducing the of prescription drugs if the president is serious about his saying that he wants to do that,” Pelosi said, referring to the administration’s surprisingly bold proposal last month to lower the government’s spending on certain Medicare drugs administered in doctors offices.

But Pelosi, who has given little credit to the administration for the proposal, added a jab to Trump: “He has pulled his punch on it so far,” she said.

Pelosi was referring to a campaign promise by Trump to buck conservative norms and push for allowing Medicare to directly negotiate lower prices with pharmaceutical companies — a policy with huge potential to move the needle on drug prices that would give the government much more influence over the industry. The president has since backed off that pledge as it’s an idea that alienates many in his own party.

Democrats are certainly poised for one type of action: Launching multiple investigations of Trump and scrutinizing his policies on immigration, education, Russia — and health care, as my colleague Karoun Demirjian writes.

But if anything is to get done legislatively in the next two years on drug prices — which are much higher in the U.S. than in other developed countries — it would take House Democrats and Senate Republicans working in tandem with the administration, which has spent the last six months pushing drug costs as a top priority.

Any feasible, bipartisan legislation would likely take the shape of tweaks to Medicare or changes to the laws surrounding the rebates drugmakers give to pharmacy benefit managers, who are widely blamed for putting upward pressure on list prices.

Some House Democrats have introduced more aggressive bills aimed at the drug industry. Reps. Peter Welch, D-Vt., and Lloyd Doggett, D-Texas, have been especially active on the issue. So has Rep. Elijah Cummings, D-Md., who is poised to become chairman of the House Oversight Committee. Cummings has proposed legislation allowing Americans to import drugs from Canada and permitting direct Medicare negotiations.

Health and Human Services Secretary Alex Azar didn’t back either of those ideas in the drug pricing blueprint HHS and the White House released last spring. But the administration did propose an unusually aggressive idea last month, announcing it would experiment with pegging Medicare drugs dispensed by doctors to an index based on drug prices in other countries.

It’s an idea you’d expect Democrats to support since the Obama administration attempted something similar. But as we’ve noted, Pelosi and other leading Democrats expressed only tepid support, appearing unwilling to give any ground to the administration just weeks before the election. Now, on the other side of the midterms and with the House majority firmly in hand, Democrats will be seriously considering how to engage on the issue over the next two years.

Nonetheless, lobbyists are skeptical there will be much bipartisan action on drug prices. “Unlikely,” one GOP lobbyist wrote to me.

Other lobbyists pointed to Grassley — the most likely senator to assume chairmanship of the powerful Senate Finance Committee from retiring Sen. Orrin Hatch, R-Utah — and his longtime, bipartisan work on prescription drugs. A key architect of Medicare’s Part D prescription drug program, Grassley teamed up with Sen. Ron Wyden, D-Ore., three years ago to investigate steep prices for the hepatitis C drug Solvadi.

One could imagine Grassley teaming up with Democratic colleagues on pharmaceutical legislation — assuming, that is, that either party is willing to take actions that would raise the powerful industry’s ire.

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