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House Speaker Nancy Pelosi (D-Calif.) shaking Senate Majority Leader Chuck Schumer's (D-N.Y.) hand during a press conference in September 2021. Photo: Kent Nishimura/Los Angeles Times via Getty Images

One glaring hole in Democrats' drug pricing outline: It says that drug companies that refuse to negotiate with Medicare will be subject to an excise tax. But they don't say what that tax will be.

Why it matters: If the penalty for refusing to negotiate isn't large enough, drugmakers simply won't comply, undermining the entire concept.

What they're saying: "Without knowing the penalties for not complying with negotiation it is impossible to know what this means for incentives facing drug makers. And that is the tip of the iceberg. What does it even mean to not comply?" American Enterprise Institute health economist Ben Ippolito told Axios.

  • "So far we have a very very basic framework. What this saves taxpayers or what it means for the future of the drug market are almost entirely up in the air."

Go deeper: Democrats reach drug-pricing deal

Go deeper

Medicare drug negotiations may not be as limited as we thought

Illustration: Rae Cook/Axios

Here's one wonky but meaningful clarification, at least for us: Democrats' drug pricing bill would allow Medicare to negotiate the prices of up to 20 new drugs a year, but the prices negotiated in previous years would remain in effect until a competitor enters the market.

Why it matters: Which drugs can be negotiated is still much more limited than Democrats' original plan. But this means that, eventually, Medicare will likely be able to negotiate the prices of a lot more than just 20 drugs.

Updated 22 mins ago - Politics & Policy

Omicron dashboard

Illustration: Shoshana Gordon/Axios

  1. Health: Coronavirus variant surveillance varies widely by state — Omicron cases confirmed in 5 U.S. states America probably won't lead the effort to understand Omicron.
  2. Vaccines: Omicron adds urgency to vaccinating world — Omicron fuels the case for COVID boosters — Moderna loses patent battles tied to COVID vaccine — Pfizer could have vaccine data for children under five by end of 2021, CEO says.
  3. Politics: Nevada to impose insurance surcharge on unvaccinated state workers — New Jersey GOP lawmakers defy statehouse COVID policy — Oklahoma sues Biden administration over Pentagon vaccine mandate — Omicron travel bans are sign of what's to come.
  4. World: WHO: Delta health measures help fight Omicron — COVID cases surge in South Africa in sign Omicron wave is coming — Germany approves new restrictions for unvaccinated people.
  5. Variant tracker: Where different strains are spreading.
Updated 5 hours ago - Politics & Policy

Prosecutors charge parents of Michigan school shooting suspect

Photo: Scott Olson/Getty Images

The parents of a 15-year-old accused of killing four students and wounding seven other people at a Michigan high school have been charged with four counts of involuntary manslaughter, according to court documents.

The latest: Lawyers for James and Jennifer Crumbley told the Detroit News they are "returning to the area to be arraigned," after law enforcement officials announced a search for the Crumbleys had been initiated.