Nov 27, 2019 - Health

Winners and losers from Washington's drug pricing agenda

Illustration of a pill bottle being crushed by a giant quarter.

Illustration: Sarah Grillo/Axios

The Senate's drug pricing bill would likely be better for the pharmaceutical industry than either President Trump's agenda or House Speaker Nancy Pelosi's.

Between the lines: Industry opposes anything that would hurt its bottom line, but of those three proposals, the Senate's "is a positive tradeoff," analyst Ronny Gal of AllianceBernstein wrote to investors this week.

Between the lines: The Senate bill could take some political heat off the industry, while Pelosi's bill and Trump's proposal to tie Medicare's prices to international prices would make bigger changes to the actual system.

How it works: The international pricing index and Senate bill both only focus on Medicare, but would change different parts of Medicare.

  • The international pricing index would lower prices for Medicare Part B drugs, which are things like chemotherapy and eye drugs that are administered in doctors' offices. Regeneron, Roche, Amgen and Bristol-Myers Squibb generate the most revenue from Medicare Part B and therefore are most invested in killing that proposal.
  • The Senate bill would cap some prices for Medicare Part D drugs — the ones patients pick up from pharmacies. Celgene, Novo Nordisk, GlaxoSmithKline and AstraZeneca would feel the most pain to sales, according to Gal.
  • Because the Senate bill proposes the most temperate changes, the industry will push for that as the main political vehicle while mitigating the damage to companies most exposed to Part D.

Both of those proposals pale in comparison to Pelosi's bill, which would limit prices in all insurance plans, including the most lucrative commercial business.

  • Pelosi's bill would "be a fundamental change of business model for the drug industry," Gal wrote, and it's why pharmaceutical lobbyists and Senate Republicans have said it's a nonstarter.
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