While insurer and hospital groups cheered House Speaker Nancy Pelosi’s new drug prices plan, other experts and groups are skeptical of the bill’s chances of ever reaching President Donald Trump.
The ambitious plan released Thursday drew plaudits from hospital and pharmacy benefit manager (PBM) groups and fierce opposition from pharma. But major opposition from Republican members of the GOP-controlled Senate could doom the proposal, some experts and groups said.
“I think it was something that has elements in it that can be supported in a bipartisan manner, but it was clear this was a partisan exercise,” said Joel White, president of the Council for Affordable Health Coverage, an advocacy group that counts insurers, pharma and business groups among its members. “When Republicans control the Senate and Democrats control the House there ought to be a meeting of the minds.”
There also appears to be "little room for compromise between Pelosi's proposal and packages from the Senate Finance and Health, Education, Labor and Pensions Committees," said Lindsay Greenleaf, director of policy at pharma consulting firm ADVI Health.
Republicans have blasted the proposal that calls for the Department of Health and Human Services (HHS) to identify up to 250 brand-name drugs that do not have a lot of competition and aren’t driving up spending.
HHS would then negotiate with the makers of those drugs to determine a fair price that Medicare and commercial payers would pay. The price would be linked to an average paid by several developed countries such as Germany and France.
“This so-called government negotiation idea is more accurately a ‘dictate or destroy’ price control power,” said Rep. Kevin Brady, R-Texas, ranking member of the House Ways and Means Committee, in a statement. Sen. John Thune, R-South Dakota, told Reuters Thursday the proposal would be “dead on arrival” if it reaches the Senate.
However, there are some parts of the legislation that could get through in the Senate, White said. Chief among them is a $2,000 cap on the out-of-pocket limit for Part D plans.
“Lowering the out-of-pocket cap down to $2,000 limit is good,” White said. “The current threshold is too high.”
But even that part could be stymied by congressional opposition. Sen. Chuck Grassley included a similar inflation cap for Part D drugs into a drug prices bill and barely got it through the Senate Finance Committee.
Despite the questions of political viability, hospital and PBM groups were ecstatic with the proposal. The Federation of American Hospitals appreciated Pelosi for taking “meaningful action to address drug costs.”
The American Hospital Association added in a statement that the proposal "takes significant strides toward reducing out-of-control drug prices."
The Pharmaceutical Care Management Association, which represents PBMs, also said it appreciated that the plan addresses prices for prescription drugs that don’t face competition. Top insurance advocacy group America’s Health Insurance Plans was measured in its statement on the plan, calling it a “bold reform proposal.”
Pharmaceutical groups, however, clamored that the proposal would halt innovation in the industry, a common defense against calls for reforming high prices.
“It abandons any pretense of allowing a free and fair market system to determine the value of prescription medicines,” said Jim Greenwood, president and CEO of the Biotechnology Innovation Organization.