Advocates frustrated over pace of drug price reform

Washington has seen a flurry of activity and bipartisan interest in passing drug pricing legislation this year, but with the August recess approaching and the 2020 elections ahead, advocates for reform worry time is running short.

Congress has two weeks until the August recess, and lawmakers must handle a number of other pressing issues. And despite early momentum, House Democratic leaders are divided with progressives over their drug pricing bill, while in the upper chamber Republicans are balking at some measures backed by Senate Finance Committee Chairman Chuck GrassleyCharles (Chuck) Ernest GrassleyFalling investment revives attacks against Trump's tax cuts Overnight Health Care: CDC links vitamin E oil to vaping illnesses | White House calls Pelosi drug price plan 'unworkable' | Dem offers bill for state-based 'Medicare for All' White House says Pelosi plan to lower drug prices 'unworkable' MORE (R-Iowa).

Some are already lowering expectations for what Congress will do.

“As we creep now into it being mid-July and without either chamber passing a larger package than what they’ve been able to do so far, I’m starting to think that we may very well end up with just the lower-hanging fruit this year,” Julie Allen, senior vice president of the District Policy Group at Drinker Biddle, told The Hill. "Bills that focus on generic and biologic competition and not other provisions that would truly affect drug prices."

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Allen said groups were keeping up pressure on lawmakers.

“Everyone is still working under the mindset of let’s keep pushing this month. Moving a bill through a chamber is key, and everyone is very serious about trying to do that," she said.

President TrumpDonald John TrumpFive landmark moments of testimony to Congress Lindsey Graham basks in the impeachment spotlight Democrats sharpen their message on impeachment MORE and lawmakers from both parties vowed to make legislation to lower drug costs a priority this year. And groups pushing for changes were hopeful measures would move quickly with both parties looking for a legislative win ahead of 2020.

The issue has been a boost for K Street, with both sides in the debate, including Big Pharma, which is fighting back on many of the proposals, spending big.

But with the administration's own efforts to tackle drug costs faltering amid court challenges and pushback and both parties facing internal divisions in Congress, advocates for reform are expressing frustration.

“We are certainly concerned about Congress getting some movement on drug pricing legislation as soon as possible," said Claire McAndrew, director of campaigns and partnerships at Families USA, a nonprofit addressing the concerns of health care consumers. "The clock is ticking, so we need to see some serious discussions in the public eye, some hearings and legislation move forward as soon as possible."

Lawmakers have faced numerous hurdles.

In the House, Speaker Nancy PelosiNancy PelosiDemocrats sharpen their message on impeachment Congress hunts for path out of spending stalemate Siren song of impeachment lures Democrats toward election doom MORE (D-Calif.) agreed to changes to a drug pricing plan after progressives argued that a provision to allow Medicare to negotiate lower prices covered too few drugs. Progressives have argued that they have not been given enough input on the plan. And any House Democratic bill will also need to pass muster with Trump.

Over in the Senate, one bill, the Affordable Prescriptions for Patients Act, which would limit drug companies from using the patent system to extend monopolies, was approved by the Judiciary Committee. But it is still awaiting a floor vote.

The Senate Finance Committee, meanwhile is drafting a more sweeping bipartisan package to limit drug price increases in Medicare. Grassley is working closely with his panel’s top Democrat, Sen. Ron WydenRonald (Ron) Lee WydenFalling investment revives attacks against Trump's tax cuts Overnight Health Care: CDC links vitamin E oil to vaping illnesses | White House calls Pelosi drug price plan 'unworkable' | Dem offers bill for state-based 'Medicare for All' White House says Pelosi plan to lower drug prices 'unworkable' MORE (Ore.), and is aiming for a markup by mid-July.

But it is unclear if those bills will get a floor vote. While Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellLindsey Graham basks in the impeachment spotlight Biden not ruling out Senate voting to impeach Trump: 'It will depend on what their constituency says' Congress hunts for path out of spending stalemate MORE (R-Ky.) is eager to deliver Trump a legislative victory, he must still address concerns within his own caucus. Some Republicans senators have likened the Grassley plan, which would force drug companies to pay back Medicare if prices rise too quickly, to setting government price controls.

Lawmakers also must deal with spending issues and reach an agreement on raising the debt limit by early September, limiting the time for drug price legislation. And advocates worry that the approaching 2020 elections will narrow the time frame for bipartisan work as well.

Allen said that some smaller measures from drug pricing bills could end up getting pulled into end-of-year budget negotiations to offset other costs.

“Under that scenario, a larger package of reforms likely struggles, and the easier go-to items where there’s long been consensus end up being what is able to go through,” she said.

Publicly, groups are urging lawmakers to press on.

“There is unprecedented momentum to hold Big Pharma accountable with market-based solutions to crack down on the industry’s anti-competitive practices and price-gouging,” said Jon Conradi, a spokesman for Campaign for Sustainable Rx Pricing, a coalition of health care professionals and hospitals.

He said lawmakers should not let the moment pass.

"With so many Americans demanding action and rare bipartisan consensus, Congress simply can’t squander this opportunity to deliver lower prescription drug prices,” said Conradi.

Lobbyists worry that the lack of consensus in Congress could lead to scaled-back legislation that just tackles low-hanging fruit instead of broader changes.

“Ultimately, each side will have to compromise on some of their priorities,” Emily Felder, senior policy adviser and counsel at Brownstein Hyatt Farber Schreck, told The Hill

Michael Werner, co-head of Holland & Knight's Health & Life Sciences Group, pointed to the support on both sides of the aisle for getting more generic drugs on the market.

“I think for a lot of Republicans, they’re more comfortable with that than they would be with we’re going to directly regulate the price of a drug. I think a lot of Democrats like that too because they believe generic drugs are a good option for people and often lead to reduced prices,” he said.

Allen said lawmakers are in a critical stretch.

“Watching which chamber is able to move things forward and how things progress as we get another week into July is going to be important,” Allen said.

Matthew Lane, director of the Coalition Against Patent Abuse (CAPA), which includes health care providers and consumer groups seeking drug patent reforms, said the White House was also likely to raise pressure on lawmakers in the weeks ahead.

“I know from what we have been hearing, the president’s very upset about not having enough movement on drug prices, which was a big issue for him and they want something through,” he said.

“I think a lot of this is going to depend on continued pressure from the White House into the Senate that this is something they want on his desk to run for reelection,” said Joshua Lamel, a spokesperson for CAPA.

Lane struck a more optimistic note, arguing that the attention on the issue would not fade.

“We're not especially concerned about the time pressure because I know that there's a lot of attention on the drug pricing right now, but we don't see that changing anytime soon,” Lane said. “This is very much about starting the process and getting the wins on the board as we lead to a bigger solution.”