Leaders of the Senate Finance Committee on Friday unveiled an updated version of their bipartisan drug pricing bill, though it’s unclear if the changes will appease skeptical Republican senators.
The renewed push for Republican support by Chairman Charles E. Grassley of Iowa and the committee’s ranking Democrat, Ron Wyden of Oregon, comes ahead of a planned House vote next week on Democrats’ signature drug price negotiation bill.
The Finance bill has been mired in concerns that provisions meant to slow the rise of drug prices paid by Medicare constitute price controls. The updated version, which is in draft form and expected to have a new bill number, contains changes meant to bring more relief to Medicare beneficiaries, but wouldn’t change the penalties for price increases that many Republicans oppose.
The Senate effort got an endorsement Friday from White House Domestic Policy Council Director Joe Grogan, who said President Donald Trump was ready to sign the bill into law — though he appeared to pressure lawmakers with a deadline.
“It is within our grasp to provide a real win for Americans worried about the high price of prescription drugs — if Congress can get it across the finish line before the end of the year,” Grogan said in a Fox Business op-ed co-written with Tom Philipson, the acting chairman of the White House Council of Economic Advisers.
Grassley challenged his GOP colleagues Friday, saying in a statement that Congress “needs to show courage and finally act” on drug pricing. Otherwise, the Iowa Republican said, members “will have to face their constituents and won’t have a believable explanation for why they chose not to act.”
The Congressional Budget Office originally estimated the bill would result in $100 billion in savings over a decade, though Senate Finance aides told reporters Friday that a new estimate to account for the changes was pending. The new version would use the anticipated savings to pay for extensions of numerous Medicare and Medicaid programs and other health grants. The bill would also provide a three-year extension of the Temporary Assistance for Needy Families program.
The changes in the bill are a response to member criticisms that it would save the government money but wouldn’t help average patients.
“What we heard from members is that more actual savings needed to be seen at the pharmacy counter,” a Finance Committee aide said.
One of the measure’s most significant and popular provisions would overhaul Medicare’s prescription drug benefit, Part D. The new version would reduce the amount of cost-sharing that all beneficiaries pay out of pocket after they pay the deductible of their plans, which is currently $415 per year. After that, beneficiaries currently pay 25 percent of their drug costs, but the new bill would lower the cost-sharing amount to 20 percent of costs.
Those out-of-pocket costs, which can reach tens of thousands of dollars for some beneficiaries who take expensive drugs for chronic conditions, would be capped at $3,100. Under the new version, there would be an optional monthly limit to protect beneficiaries who meet the $3,100 threshold quickly, such as after a single prescription.
While Grassley and Wyden said they wanted to address rebates that drugmakers pay to Part D plans in exchange for coverage — a transaction that some say drives up underlying drug costs — the new bill wouldn’t make any changes to the status quo or provide those rebates to beneficiaries at the point of sale, as some lawmakers want.
Instead, more modest rebates related to fees and discounts between pharmacies and drug plans would flow to patients. The new bill would prevent drug plans from imposing retroactive fees on pharmacies after a transaction is concluded, a policy that pharmacists have long been pushing.
The original version proposed increasing the discounts that drugmakers are required to provide once drug spending reaches certain levels. The new version makes tweaks to that provision, though committee aides emphasized that they were meant to protect smaller drug companies and wouldn’t affect the government’s bottom-line savings.
The changes to the bill do not address concerns that many Senate Republicans have expressed, so it is unclear whether it will come to the Senate floor. Majority Leader Mitch McConnell has previously said the Senate would do something on drug pricing but hasn’t specified a timeline or endorsed the Grassley bill. David Popp, a spokesman for the Kentucky Republican, said Friday he had “nothing to add” to the majority leader’s previous statements.
Congress also will be busy with the House’s impeachment proceedings and the effort to keep the government funded past Dec. 20.
The rival drug pricing bill that the House is poised to vote on next week includes some similar provisions as the Senate measure, including the price increase penalties and the changes to Medicare Part D.
But House Democrats’ bill also would require Medicare to negotiate the price of drugs and sets an upper limit on Medicare prices based on lower rates paid in other countries, an approach that Senate Republicans and the Trump White House have rejected.
The House bill is expected to pass with only votes from Democrats, although some liberal members say they have misgivings because they don’t think it does enough to lower prices for those outside of Medicare, such as the uninsured.
The Congressional Progressive Caucus planned to send out a whip question Friday, asking its members if they would be willing to vote against the rule if certain amendments are not in a manager’s amendment or allowed to be put up for votes, said Rep. Mark Pocan, a co-chairman of the group.
“I don’t think the bill will be voted against. I think a rule could be in jeopardy,” the Wisconsin Democrat said. “If you need more time, you could take a rule down in order to have more time.”
An updated version of the bill released by the House Rules Committee on Friday evening stripped down an amendment from Washington Democrat Pramila Jayapal, a Progressive Caucus co-chair, that would have required the Labor Department to issue regulations for drugmakers providing rebates to employer insurance plans when prices increase beyond the inflation rate. The new language requires a report on potential models for such a policy but doesn’t require the regulations.
Some progressive members say this provision was important and object to the way it was changed despite being adopted during an Education and Labor Committee markup. While the change could affect the final vote tally, other members of the progressive group said they expected to support the measure next week, noting the bill must balance priorities of several different Democratic groups.
“I’m sure that I could find fault with a lot of aspects of it, but a lot of us are just committed to making sure we make some progress on this issue,” Michigan Democrat Dan Kildee said. “Being in the majority is great, and being in the majority is really hard sometimes. To find 218 people who are willing to be on the same page on the same day on the same bill is easier said than done.”
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