When President Trump ran for office four years ago, he said the government could save hundreds of billions of dollars on drug costs -- if it was allowed to negotiate prices with pharmaceutical companies.
That hasn't happened so far. But in his State of the Union speech this week, Trump pledged to take action to lower costs of prescription drugs. His promise pushed Democrats out of their seats to applaud their own ambitious proposal, which they say would do just that.
The bill, H.R. 3, would allow federal officials to negotiate drug prices for people on Medicare based on what the medicines cost in other countries. The savings would be used to expand Medicare to include dental, vision and hearing coverage. But the bill has broader impacts: It would extend those prices to people on private insurance. The House passed the legislation in December with support from two Republicans and every Democrat present, including western Pennsylvania’s Mike Doyle and Conor Lamb.
“I think this might be the most important bill that’s passed since I’ve been in Congress, at least it’s one of them,” said Lamb, pointing to the example of insulin, a drug which has gotten a lot of attention for its skyrocketing price tag.
“Over a million [Pennsylvanians] are living with diabetes, and they could spend up to $20,000 annually on insulin,” he said. “Our bill could cut that to $1,200 -- literally one-twentieth of what people are already paying.”
Lamb’s been targeted in Facebook ads for his vote on the issue, but he says Democrats wrote the bill to match what Trump’s said in the past.
“[Trump’s] talked the talk, so let’s see if he walks the walk. Now is the time: People need this bill to become law. They need to pay less for their drugs,” he said.
But during his State of the Union address, Trump backed a bill that doesn’t go nearly as far as his previous promises.
“I’ve been speaking to Sen. Chuck Grassley of Iowa and others in Congress in order to get something on drug pricing done, and done quickly and properly,” he said.
The Senate proposal sponsored by Grassley takes steps to limit what people pay for medicine, but it does not go as far as H.R. 3 because it does not allow the government to negotiate with drug companies.
Those in Trump’s party may find a less far-reaching plan more appealing. Western Pennsylvania Republican Mike Kelly doesn't support H.R.3, but does support H.R. 19, a Republican bill that would address drug costs for people on Medicare. He also introduced legislation that would create a cheaper generic version of insulin.
Kelly himself has diabetes.
“House Speaker Nancy Pelosi is the only one in the way of bipartisan action to lower prescription drug prices,” he said in a statement, and said giving the government “unprecedented power to dictate prescription drug prices would lead to the discovery of fewer cures and limit access to existing lifesaving drugs.”
“One cure lost is one too many,” Kelly said.
When the Congressional Budget Office assessed H.R. 3, it did note the possibility that the legislation could lead to the loss of around 40 new drugs coming over several decades. But while experts acknowledge the potential downside, they say the actual impact of the measure isn’t clear.
“The industry is obviously concerned that it will limit their ability to profit and generate investors,” said Tricia Neuman, director of the Kaiser Family Foundation’s Medicare policy program. “The extent to which that’s true or will really happen is hard to know.”
Neuman acknowledged that research shows the Democrats’ bill could result in lower revenue for pharmaceutical companies: That in turn could make investing in new drug research and innovation less attractive. But she said “it’s hard to believe that if a drug company came up with a successful treatment for Alzheimer’s that they wouldn’t be able to market and sell that drug at a profitable rate.”
In any case, Neuman said the issue is going to be urgent for voters this year.
“People — whether they’re Democrats or Republicans or Independents — are supportive of having Congress do almost anything to address drug costs,” she said. “This is an issue that affects people no matter how they vote.”
And now that Trump’s re-election campaign is well underway, it remains to be seen if voters still want the kind of solution he offered four years ago.
Clarification: This piece was updated at 10:56 on February 11 to clarify U.S. Rep. Kelly's position on lowering prescription drug prices for people on Medicare.
