Sen. Mike Crapo. Photo: Bill Clark/CQ-Roll Call via Getty Images
The Inflation Reduction Act's Medicare drug price negotiations will be a prominent target for repeal next year if congressional Republicans have their way.
Why it matters: Although former President Trump and his running mate, Sen. JD Vance, have expressed support for lowering drug prices in some form, many GOP lawmakers are openly discussing killing a process they've widely condemned, saying it hinders innovation and artificially sets prices.
What they're saying: Some well-placed congressional Republicans told Axios that they, at a minimum, want to repeal Medicare drug price talks, though plans for any replacement are less concrete.
- "I would try to remove that and replace it, but I can't tell you the exact, you know, what it would be yet," Sen. Mike Crapo, who's in line to be the next chair of the Senate Finance Committee if Republicans flip the chamber, told Axios.
- Rep. Buddy Carter said the IRA drug pricing provisions are "the worst legislation I've ever witnessed in 10 years in Congress and 10 years in the state legislature" and he "absolutely" wants to repeal them.
- Sen. Thom Tillis said he "100%" wants to repeal the negotiation provisions, while other drug pricing sections of the law would need to be evaluated based on whether they have "a positive impact on business."
The big picture: Trump hasn't clarified exactly how he would approach the IRA drug pricing provisions. He has criticized the pharmaceutical industry but opposed what Democrats eventually put forward on Medicare negotiating prices.
- His own plan envisions using executive action to have Medicare pay no more than the lowest price that select other developed countries pay for drugs — a proposal that never was realized during his presidency.
Between the lines: No congressional Republicans asked by Axios said they wanted to keep the Medicare negotiation provision. But some indicated repeal is not their priority.
- Sen. Ron Johnson said he was focused on tax issues. "We have this looming massive tax increase in 2026," he said.
- "I'm probably more primarily focused on the energy provisions in the IRA," said Rep. Scott Perry, a Freedom Caucus member.
- Senate HELP Committee Ranking Member Bill Cassidy called the question a "total theoretical," adding "Ask me that question then" if there really is a GOP sweep.
- Sen. Ted Cruz, a conservative facing a competitive reelection in Texas, said to "call our press office" when asked about repealing the IRA drug pricing sections. His office did not respond to request for comment.
By the numbers: The Congressional Budget Office found that the negotiation provisions would save about $100 billion over 10 years.
- That poses an obstacle for any repeal efforts, given that repeal would cost money, as opposed to other health care changes that could potentially be used to pay for tax cut extensions.
- Republicans also may not be eager in general to reopen a grinding health care debate, given that Medicare negotiating drug prices is popular with voters.
Vice President Kamala Harris has called for expanding the negotiations and making more drugs subject to price talks, if she's elected.
- Congressional Democrats are trying to showcase how the talks are already yielding savings for seniors and working-class Americans. Senate Finance is due to have a hearing on the drug price negotiations Tuesday.
The other side: Republicans argue that the IRA provision is not a real "negotiation," because companies that opt out would be hit with a steep tax for nonparticipation, and that the process amounts to price setting.
- They also say it harms innovation that leads to new cures and have warned of potential premium increases in Medicare Part D.
- Crapo and other Republicans put forward a more modest alternative drug pricing plan in 2021 that did not include negotiation but had other elements similar to the IRA, like an out-of-pocket cap on drug costs.
- "The problem with price fixing is that it inevitably leads to scarcity, so it's kind of a conundrum," Sen. John Cornyn, the possible next Senate GOP leader, told Axios when asked about repeal. "But I think the thing where there seems to be consensus is to do some work on reforming the PBMs."
