ASHINGTON — Republican presidential hopefuls are slowly starting to break up the Democratic monopoly on ideas to rein in prescription drug prices.
Hillary Clinton and Vermont Senator Bernie Sanders have made lowering drug costs a central part of their campaign platforms, but the GOP contenders have begun getting in on the game.
The issue didn’t come up in Tuesday night’s Republican debate in Milwaukee, but candidates have been addressing it on the trail.
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Last month, the former governor of Florida Jeb Bush rolled out a health care plan that included overhauling the Food and Drug Administration; Florida Senator Marco Rubio railed against pharmaceutical “profiteering” in videotaped remarks; and Texas Senator Ted Cruz called for reforming the FDA in an op-ed.
Oftentimes, the candidates admit they’re still figuring out what to do. Former neurosurgeon Ben Carson, in little-reported remarks made in Iowa and posted online by the Campaign for Sustainable Rx Pricing, acknowledged as much.
“As far as Big Pharma is concerned, you know, they’re in it to make money. And I understand that. But we need to have some alternative ways, because we need to be able to take care of our people,” Carson said.
The strategy suggests that Republicans, who have devoted so much energy to promises to repeal the Affordable Care Act, also see a need to address voter worries about drug costs, which rank among Americans’ top health care concerns.
It could be a tricky issue for them. Republican candidates must grapple with the fact that any action to lower drug costs could mean government intervention, typically uncomfortable territory for the GOP.
So far, conservative candidates have stuck to old reliable ideas like reforming the FDA and boosting research funding. But even some on the right say they wouldn’t be surprised to see a Republican take a more interventionist approach before the campaign is over.
“It’s not clear to me that ‘Reform the FDA’ is going to be enough as part of their platform,” said Yevgeniy Feyman, deputy director at the Center for Medical Progress at the conservative Manhattan Institute for Policy Research. “Even the Republican plans are probably going to include a little bit [of] government intervention.”
Conservatives also worry that they will be stepping onto Democratic turf if they talk too much about drug prices, and some are frustrated that the issue has taken on an outsized role in the public discourse.
Nonetheless, engaging on drug costs now seems unavoidable for Republicans. Rubio, during a New Hampshire town hall meeting, initially took a particularly hard line against the pharmaceutical industry, blaming some drugmakers for raising prices so sharply that they are threatening to “bankrupt our system.”
“Part of it is the lack of generic competition. That’s a significant part of it,” he said. “But part of it, guys, is just pure profiteering. These companies decide, ‘We can get away with charging it and so we do.’ ”
In a reminder of the tightrope that Republicans must walk, Rubio’s campaign later sought to soften remarks that otherwise sounded as though they were drawn from a Democratic playbook.
“Marco was obviously talking about specific companies who are gouging consumers,” Rubio campaign spokesman Alex Conant said in an email. “America’s pharmaceutical industry saves countless lives, but it’s no secret that there are some bad actors who put profits ahead of patients.”
Bush has been the most explicit about his proposals, which he included as part of his overall plan to repeal and replace Obamacare. He stuck with some of the GOP’s standard ideas: Change the FDA’s regulatory structure so that new drugs can be approved more quickly to foster competition, and invest more research money into the National Institutes of Health, two policies that congressional Republicans are advancing with the 21st Century Cures legislation that passed the House this summer.
In an Oct. 13 speech detailing his plan, Bush even spoke of setting aspirational goals — akin to President John F. Kennedy’s space-race ambitions in the 1960s — to find new treatments for conditions like autism and Alzheimer’s disease.
“If we started from scratch with the FDA, I promise you we would be a less costly system that would take a lot less time,” he said in the speech, “and it would be more strategic in its efforts, and that’s what we need to do.”
Cruz also set his sights on the FDA. He announced late last month his plan to introduce a Senate bill that would accelerate approval for drugs that have already been approved in other countries and expand a public-private partnership between the NIH, the FDA, and biopharmaceutical companies focused on Alzheimer’s, type 2 diabetes, rheumatoid arthritis, and lupus.
The question is whether that’s enough.
Feyman at the Manhattan Institute cited polling by the Kaiser Family Foundation that found even a large majority of Republicans would support policies like allowing Medicare to negotiate directly with drug companies and setting price caps for expensive medicines that treat cancer and hepatitis C.
It’s hard to imagine a Republican endorsing such direct price controls, but he noted that as a 2008 presidential candidate, Senator John McCain supported allowing prescription drugs to be imported from Canada.
“It wouldn’t be explicit price controls. It even carries this free trade connotation almost,” Feyman said. “But it effectively amounts to price controls because you’re importing price controls.”
During the primary season, there isn’t likely to be much daylight between Republican candidates on drug prices because it isn’t going to be a winning primary issue.
But some sniping is already underway.
Louisiana Governor Bobby Jindal’s campaign believes Bush’s plan “does nothing to address prescription drug costs,” spokesman Henry Goodwin said in an email.
Jindal’s own health care plan was light on details for drug costs specifically, but Goodwin said that its price transparency provisions would apply to pharmaceuticals as well. He would propose making the price that insurers pay to drug companies readily available to consumers.
Whatever place it has in the Republican primary it seems inevitable that the issue of drug prices will play a larger role in the general election, given the emphasis that Clinton and Sanders are placing on it. The Republican nominee will then have to decide how to respond.
The GOP candidate’s best bet would be to tie the drug-cost issue to Obamacare, said Douglas Holtz-Eakin, president of the American Action Forum and adviser to McCain’s 2008 presidential campaign.
“The moment they passed the ACA, Democrats owned the entire health system,” he said. “I’d just blame the prescription drug problem on the ACA. We’ve got to get rid of the ACA. This and all these other inflated cost problems will go away.”
One could hear New Jersey Governor Chris Christie testing that kind of message — deriding Democrats and their support for government regulation — in comments on Clinton’s prescription drug plan last month. He defended drug companies’ right to recoup their investments as necessary for a robust medical industry.
“We’re a capitalist society, they need to make some of that money back, and if we don’t allow them to, they’re just not going to do it anymore,” he said. “They’re not going to explore for the next new cure or the next new treatment, so we’ve got to be smart about the way we do this. And we can’t just put price controls on it, that’s the easy way to do it, and that’s the Democratic, big-government way of doing it.”
Instead, Christie said, “the best way to do this, especially on medical treatments and hospital costs, is to make it transparent and stop paying fee-for-service.”
That sounds like a start to a platform. But Christie, and other Republicans, might need a little more before the campaign is finished.