Sep 8, 2019 - Health

The Trump-Pelosi mind meld on drug costs

Illustration of Trump filling out prescription

Illustration: Sarah Grillo/Axios

Striking a big, bipartisan deal on drug prices is one of President Trump’s last opportunities before the election to make good on a sweeping campaign promise — and Trump himself is the biggest X factor.

The big picture: On policy, Trump and Democrats are aligned — but the Dems may not want to make a deal just before the election. On politics, Trump and Republicans are in agreement — but the drug industry is working overtime to pull rank-and-file Republicans back into line.

Driving the news: House Speaker Nancy Pelosi will release a drug-pricing plan shortly after Congress returns to work this week after its August recess, a House Democratic aide confirmed. And Democrats will try to keep the issue on the front burner for the rest of the year.

  • In the Senate, a bipartisan bill barely passed out of committee just before the recess, with several Republicans clearly torn between the White House’s support and the industry’s strong objections.

How it works: Pelosi’s proposal would direct the federal government to negotiate the price of certain expensive drugs with little or no competition — and, crucially, that would also become the price in the private market, not just the Medicare drug coverage price, according to Democratic aides and lobbyists working on the issue.

  • That’s awfully close to what Trump has endorsed before, but Democrats aren’t eager to share the issue ahead of 2020.
  • People following the legislative debate suspect that normal partisan politics will likely take control over this particular plan — “except if the president is for it. That will change everything,” an industry lobbyist said.

The drug industry is spending record-setting amounts of cash on lobbying, and it's shoveling campaign cash at Republican senators in an effort to remind them that pharma and Republicans have always been friends.

  • “I think this is a real test of that alliance,” the industry lobbyist said.

There are signs it’s working, but congressional and administration sources are deeply skeptical that anything will happen:

  • "Any notion that this will get done easily, if at all, is entirely false," a GOP leadership aide told Axios.
  • Several GOP senators have watered down their own proposals after once talking tough on the issue, and several said they thought the Finance Committee's bill went too far and were supporting it only with the understanding it would change further.
  • On top of that, the trade deal known as USMCA has eclipsed drug pricing as the administration’s top legislative priority, congressional and White House aides tell Axios, and as evidenced by the White House’s public push for the trade agreement.

The intrigue: If something happens on drug prices, it’s unlikely to be in a standalone bill, lobbyists said, but rather wrapped up in a broader year-end package that would include a host of other domestic priorities.

  • That means the politics on drug pricing, unmoored as they are on their own, would be tied up in the politics of everything else in that bill, and also tied up in whatever the general political climate is at that time.
  • It’s easy to see Pelosi denying Trump a win on a critical issue; it’s also not impossible to see Trump applying last-minute Twitter pressure that brings Republicans on board an otherwise fledgling effort.

The bottom line: “We’re a long way from push coming to shove,” the industry lobbyist said.

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