Dems struggle to unite behind drug price plan

Divisions are opening up among Democrats as they struggle over how to craft their signature legislation to lower drug prices.

Progressive House lawmakers met this week with Speaker Nancy PelosiNancy PelosiTrump telling aides to look at potential spending cuts if he wins reelection: report Budget talks between White House, Pelosi spill into weekend Trump says he won't watch Mueller testimony MORE's (D-Calif.) top health care staffer, Wendell Primus, to push for a drug pricing bill authored by Rep. Lloyd DoggettLloyd Alton DoggettHere are the 95 Democrats who voted to support impeachment Speaker Pelosi, seize the moment to make history on drug pricing House Democrats sue Treasury to turn over Trump tax returns MORE (D-Texas) that would impose severe punishments on pharmaceutical companies that refuse to negotiate prices with the federal government.

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The concern among liberals is that a competing measure being crafted by Pelosi’s office will go easy on drug companies. They're also wary of Pelosi’s staff holding talks with the White House about drug price reforms.

In an effort to allay those concerns, Primus has been on a reassurance tour of sorts over the past couple of weeks, meeting with progressive lawmakers and outside groups, according to a source familiar with the conversations.

Primus has stressed that any drug pricing bill will move through the committee process, known as regular order, and he has downplayed the White House talks, saying they are not formal "negotiations."

Progressives argue that whatever final bill emerges needs to be tough on drug companies, and they say their legislation is the best way to achieve that.

“We wanted to make it very clear that it needs to be something bold that has teeth in it, and I think that’s what Rep. Doggett's bill has in it,” Rep. Pramila JayapalPramila JayapalHouse Democrats delete tweets attacking each other, pledge to unify House approves bill raising minimum wage to per hour Progressive House Democrats describe minimum wage hike as feminist issue in Teen Vogue column MORE (D-Wash.), co-chair of the Congressional Progressive Caucus, told reporters about the meeting with Primus.

Doggett’s bill, like the one Pelosi's office is working on, would allow Medicare to negotiate drug prices. But its most controversial provision deals with enforcement: The measure would allow the government to strip a company of its monopoly on a drug if the firm refuses to negotiate on pricing.

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Pelosi’s office is working on a different mechanism for negotiating drug prices, one that would use an arbitrator to set a price if the company and Medicare cannot reach an agreement. It also would apply only to a subset of high-cost drugs.

Alex Lawson, executive director of the progressive group Social Security Works, said he is “looking for more of an explanation of the plan” on drug pricing.

“I would like to see us further along on bolder policies,” he said.

Lawson cast doubt on Pelosi’s strategy of entering into talks with the White House, though he stopped short of saying the two sides should cut off discussions.

“Talk to the White House but also remember that Alex Azar is in charge of HHS,” Lawson said, referring to the secretary of Health and Human Services who previously worked at the drug company Eli Lilly. "I just don't think that they are going to be negotiating or even working in good faith on this idea."

Primus expressed optimism about reaching a deal with the White House when he spoke at a health care conference in February hosted by the University of California, Irvine.

“My No. 1 forecast is we are going to do something about prescription drug prices,” Primus said at the time. “I think we will cut a deal with the administration. And I think that, if we do it right in the House, that will give it enough push to get it done in the Senate.”

Asked if she is worried that Pelosi’s office will water down the drug pricing bill to strike a deal with the White House, Jayapal said, “I always have concerns, that’s my job.”

But she also pointed to Primus’s recent assurances that the White House talks are not negotiations.

“Bold, tough prescription drug negotiation legislation is what the American people want, and we're looking at every option to maximize the leverage needed to drive down prescription drug prices,” Henry Connelly, a spokesman for Pelosi, said in an email to The Hill. “Our entire Caucus is determined to confront out-of-control drug prices, and we're continuing to incorporate feedback and ideas from Members and stakeholders about how we can develop the strongest possible bill."

The White House confirmed it is in talks with Pelosi’s office.

“I can confirm that White House officials have been meeting with Speaker Pelosi’s staff on this topic,” said a White House official. “We share the common interest of lowering drug prices and are having ongoing conversations to see where we can work together.”

Jayapal said that while Primus did not take a position on the Doggett bill, “he's trying to work on something that could get the whole caucus there.”

In an interview, Doggett acknowledged that some House Democrats think his bill goes too far, but he attributed that position to the campaign contributions they have received from the pharmaceutical industry.

“They've been generous supporters of people on both sides of the aisle,” Doggett said of drug companies. “I have no illusions.”

Asked about Primus’s proposal on using arbitration to set drug prices, Doggett said, “I don't like it as much as mine, but I'm willing to consider all alternatives, and I think it's important that he do the same.”

A source who has spoken to freshman House Democrats who won in Republican districts last year said many of them have concerns with Doggett’s bill and have expressed more openness to arbitration.

A pharmaceutical lobbyist said Doggett’s measure is worse than arbitration and that the industry has been working hard to reduce House Democratic support for his bill.

Rep. Ron KindRonald (Ron) James KindProtect American patients and innovation from a harmful MedTech Tax increase We should repeal the medical device tax on veterans House panel approves bills on tax extenders, expanding tax credits MORE (D-Wis.), a moderate member of the House Ways and Means Committee, would not say whether he supports Doggett’s measure, but said he wants to work with the pharmaceutical industry.

“What we're hoping is for the industry to be constructive in all this,” Kind said. “Either they're going to be helpful in being able to arrest the rapid growth of drugs, specialty drugs especially, or we're going to do it for them.”