Blister pack with dollars instead of pills

It was negotiated behind closed doors, with progressive Democrats shut out of the process, so it's an open question how they'll react when House Speaker Nancy Pelosi, D-CA, unveils her drug pricing bill.

Politico reports that the agreement has left progressives in the dark; they fear that it will fall substantially short of their goals to cut drug prices for Americans. Pelosi's goal is to get the legislation passed by Thanksgiving, but with details scarce it's tough to predict how successful that will be.

So what does the bill actually do? Although it could still change in committee, at present it allows the government to tax drugmakers who refuse to negotiate on drug prices, as well as tying the maximum price of those drugs to what's paid for them in other countries.

In addition, it caps what seniors have to pay out of pocket for their drugs under Medicare Part D at $2,000.

Most of the discussion around the legislation this week appeared to focus on technical aspects of the bill rather than substance, and those who have seen it appear to believe it will succeed. However, a number of legislators aren't happy about the process—the close-door meetings and the push for speed.

And the bill does not include a provision that's been key for progressives—that federal officials be authorized to negotiate prices directly on at least 250 drugs. Instead, it set the bar far lower, at 25, with a maximum of 250 per year. Neither does it allow for immediate limits on the price of newly launched medicines, which was another progressive requirement.

Progressives have already registered their objections to the fact that the bill waters down other provisions without even attempting passage; indeed, the Congressional Progressive Caucus has characterized it as Democrats "negotiate[ing] against themselves" in an attempt to woo Republican support.

Politico adds that five CPC members, led by co-chairs Mark Pocan, D-WI, and Pramila Jayapal, D-WA, wrote a public letter to Pelosi in August warning that CPC members might not back the bill if it does not meet their standards.

"Our position has not changed a millimeter," Pocan is quoted saying in the report, adding, "I don't think anyone wants to go back home and say we're negotiating for 25 drugs. It's gotta be something more substantive."

Instant Insights /

Pelosi's drug pricing bill faces progressive scrutiny

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