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A bitter pill: Biden suffers familiar defeat on prescription drug prices

President Biden at the French Embassy in Rome on Oct. 29, 2021.ERIN SCHAFF/NYT

Sitting in the Oval Office in August, President Biden listened intently as a diabetic patient told him the price of lifesaving insulin had shot up from $39 a bottle in 2001 to $280 today — ‘’the same exact bottle of insulin, with the same exact formula,’’ the patient Gail deVore said.

Biden had long argued for giving the government a stronger hand in curbing escalating drug prices, and he responded that day by vowing to tackle insulin’s cost as part of a social spending bill before Congress. ‘’The only thing that Medicare is not allowed to negotiate a price for is a prescription drug,’’ the president said, ‘’and it’s long past time we changed that.’’

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But the bill Democrats call their Build Back Better Act won’t change how Medicare pays for drugs, at least under the framework Biden unveiled Thursday. The omission of drug-price negotiations blindsided liberal Democrats who are the White House’s allies and infuriated advocates, many of whom argue this is the party’s best opportunity to lower pharmaceutical costs for the foreseeable future.

The apparent inability of even an ardent president and a Democratic-led Congress to achieve that goal is a familiar one. For nearly 30 years, US presidents have tried and failed to contain the price of drugs like insulin. Now Biden appears likely to join a list which includes former presidents Bill Clinton, Barack Obama, and Donald Trump. All of them pledged to tackle high drug costs, and all of them failed at the hands of the deep-pocketed industry, which has spent more than $1 billion on lobbying and advertising over two decades to torpedo initiatives that could rein in its profits, according to data tracked by OpenSecrets, a government transparency group. Which is why, experts say, Americans pay roughly twice as much for their prescriptions as their counterparts around the world.

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‘’Is this hard? Hell yes,’’ said David Mitchell, a cancer patient and the founder of Patients for Affordable Drugs Now, which has tracked at least $26.5 million in spending by pharma lobbyists to influence this social spending bill. ‘’We’re not giving up. We’re going to fight until the last possible minute.’’

Barring a last-minute reversal on Capitol Hill, the United States will continue to be an outlier among wealthy, Western nations, without any government role in determining the prices consumers pay for the medicines they need and, as a result, drug costs are far out of line with those in comparable countries. Among the most expensive medications are treatments for life-threatening conditions such as hepatitis C or cancers, a RAND Corp. report found this year, with some patients saying they must choose between paying for medicine and other necessities.

‘’It’s a remarkable example of how there can be a perfectly common sense piece of legislation — that the government should get its money worth for what it buys, as it does for any other procurement — that has been managed to get . . . demonized by virtue of this massive public relations effort the industry has done so masterfully,’’ said Jerry Avorn, a professor of medicine at Harvard Medical School who specializes in drug epidemiology.

Advocates and some Democrats insist the final bill could still include some form of drug-price negotiations, with House Speaker Nancy Pelosi exploring a more limited, last-minute measure, said several people with knowledge of the talks. Representative Frank Pallone Jr., Democrat from New Jersey, chair of the influential House Energy and Commerce committee, said Thursday that he remains ‘’committed to finalizing an agreement that includes price negotiation, a cap on seniors’ out-of-pocket drug spending, and a penalty for Big Pharma companies that unfairly raise prices.’’

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Proponents also express anger and frustration with Senator Kyrsten Sinema, Democrat from Arizona, Representative Scott Peters, Democrat from California, and a handful of other congressional moderates who opposed progressives’ price-negotiation plan, noting the holdouts received significant drug industry contributions. Just a few defectors are enough to tank the measure with Democrats’ razor-thin margins — a 50-50 split in the Senate with Vice President Kamala Harris as a tiebreaker and only three votes to spare in the House.

‘’The pharmaceutical industry is employing nearly 1,500 lobbyists in D.C. alone,’’ a visibly frustrated Senator Bernie Sanders, Independent from Vermont, told supporters Tuesday night, shortly before the White House conceded it didn’t have the votes and dropped drug negotiation from its framework. ‘’You got that? Nearly 1,500 lobbyists in Washington, including the former congressional leaders of both political parties. That is almost three pharmaceutical industry lobbyists for every member of Congress.’’

‘’It has not been Congress that has been regulating the pharmaceutical industry,’’ Sanders argued. ‘’It has been the pharmaceutical industry that has been regulating Congress.’’

Drug industry lobbyists downplayed the donations, arguing the provision would have harmed patients by depriving drugmakers of money for research that would impede the development of new drugs.

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‘’I can’t speak to why a member of Congress may take a certain position on a certain issue,’’ said Brian Newell of PhRMA, the industry’s main trade group. ‘’Our focus has been educating policy makers about the solutions we are for to lower costs for patients and the concerns we have with proposals like direct government negotiations.’’

Americans have consistently said they back the idea of government drug price negotiations. Some 92 percent of Democrats, 85 percent of Independents and 76 percent of Republicans said they strongly or somewhat support allowing the federal government to negotiate with drug companies to get a lower price on prescription drugs for people with Medicare and private insurance, according to a survey released this month by the Kaiser Family Foundation. More than eight in 10 adults also said the cost of prescription drugs is ‘’unreasonable,’’ and one in five older adults reported trouble affording their medication, according to the poll.