WASHINGTON — Presidential candidates in both parties face growing pressure to explain what they'd do about a burning health care issue that has little to do with President Obama's politicized insurance law: high prescription drug costs.
The issue is rising fast on the agenda of Americans, with large majorities saying the government should take action to lower drug prices. Polls show Democrats and Republicans, and independents, too, want the government to step in.
Lobbying groups and health care professionals are pressing candidates to talk about how they would rein in the prices of medications — not just the most expensive new drugs for chronic conditions but also those that have long been available but have become much more costly.
Advocates for government intervention point to eye-popping examples: a new drug for hepatitis C that costs $84,000 for 12 weeks of treatment, cancer drugs that now average more than $100,000 a year, and a commonly used antibiotic known as tetracycline whose price tag shot up nearly 70-fold in one year.
Other health care initiatives, especially Obama's Affordable Care Act, have deteriorated into partisan shouting matches about the proper scope of the government's role in medicine. This issue could be different.
One poll, released last week by the Kaiser Family Foundation, found that 93 percent of Democrats, 83 percent of independents, and 74 percent of Republicans want the federal government to negotiate drug prices for Medicare — even though the Republicans in the survey were skeptical the approach would actually work.
On the campaign trail, most candidates have shied away from the subject, but there are signs that might not last. Senator Bernie Sanders of Vermont, Hillary Rodham Clinton's main challenger from the Democratic left, raises the issue of drug prices in nearly every speech. Clinton has mentioned it on the campaign trail. And Republican Senator Marco Rubio of Florida wants to bring down prices as well, though aides say his plan is based on overturning Obama's health care law, which isn't one of the main factors the drug industry blames for high prices.
In addition to lobbying for lower prices by powerful industry groups, including America's Health Insurance Plans, there have also been pleas from those on the front lines. More than 100 cancer doctors this summer called for stronger regulation of prices. Insurers and hospitals are pushing for drug costs to become a 2016 issue.
Their argument: It will take a broad public discussion about the causes of high drug costs to develop a solution — the kind of debate that is made possible by a presidential campaign.
"I do believe this will become not just a side issue, but a central issue in the campaign," said John Rother, president of the National Coalition on Health Care and the leader of the Campaign for Sustainable Rx Pricing, a project that's trying to draw attention to the cost pressures of the most expensive drugs.
Drug industry officials say appeals for lower prices are understandable but overlook the benefits of new medications.
"Medicines that are coming out on the market today would have been considered science fiction 10 years ago," said Robert Zirkelbach, a spokesman for Pharmaceutical Researchers and Manufacturers of America, the main trade group for the companies. "They're also incredibly difficult to develop.
"We have to have a system that incentivizes and rewards innovation so companies will go after the hardest-to-treat diseases," Zirkelbach said.
Democrats have signaled they see the political potential in the issue. At a town hall meeting in Iowa in April, Clinton declared "we need to drive a harder bargain with drug companies about the cost of drugs."
In his speeches, Sanders usually notes the bus trip he organized from Vermont to Canada years ago so people could buy cheaper drugs there, spokesman Michael Briggs said. And former Maryland governor Martin O'Malley is planning to talk more about "bold, progressive ideas" on health care later in the campaign, including how to bring down costs across the board, spokeswoman Haley Morris said.
Despite this attention, advocates for lowering prices have had only limited success getting other presidential candidates to tackle the issue, especially Republicans.
Republicans might find it challenging to address drug costs, in part because they remain most focused on repealing the Affordable Care Act.
But there's another challenge, policy analysts say: Republicans, who are speaking to conservative primary voters, have to be careful not to sound as though they're suggesting price controls. And any suggestion of stronger regulations would contradict the message of Republican candidates such as Wisconsin Governor Scott Walker: Health care should be regulated by state and local leaders, not Washington.
Robert Blendon, a health care public opinion expert at Harvard University, said the issue of drug costs is only going to become more urgent in the coming years as new cures and treatments become available — many of which could be painfully expensive.
"It may make sense to the manufacturer how it was priced, but to the public, it won't make much sense," Blendon said. "The question is, if there are new cures, can people even afford them?"
Many oncologists say the problem is that there's no real oversight for prices. Medicare is legally banned from negotiating drug prices, patients want the full course of cancer treatments, and no one is about to tell them they can't have it — not the insurance companies, and certainly not the doctors.
"That's what has to be a part of the campaign: You can't have a benefit where you can't control the price, and whether it works for one year or one week, I have to pay whatever the drug companies want to charge," said S. Vincent Rajkumar of the Mayo Clinic, one of the 100-plus oncologists who published a joint letter about rising prices this summer.
There are other problems in the health care system, Rajkumar said, but "it doesn't mean we shouldn't highlight a problem that's easily fixable."