DES MOINES — Rallying nurses and steelworkers in a crowded union hall here this week, Bernie Sanders held nothing back as he laid into the pharmaceutical industry.

The industry, as he put it, is “ripping us off.”

“They are getting away with murder,” Sanders said, “and in some cases they are committing murder.”

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The audience applauded approvingly.

The criticism of drug makers was perhaps to be expected, with Big Pharma taking its place besides Wall Street, the Koch brothers, and climate-change deniers in Democratic stump speeches lately.

But to spend a few days on the campaign trial is to get a palpable sense for just how angry and frustrated American voters have become with the pharmaceutical industry — and how the candidates are tapping into their dissatisfaction. In school gyms and bowling alleys across the first nominating state, Sanders and Hillary Clinton use the specter of a greedy drug industry to help paint their picture of wealthy and corporate interests running roughshod over the American people.

The message is playing well with the base.

At the University of Northern Iowa in Cedar Falls on Tuesday, for instance, Clinton told 500 supporters about a woman she had met last week. The woman had taken the same drug for more than 25 years; it had cost her $200 a month. But the woman told Clinton she had recently gone to her pharmacist and been told that the price had skyrocketed to $14,000 a month.

The attendees gasped. Murmurs of “what” and “wow” rippled through the audience.

The company that had bought the drug and hiked the price was Valeant Pharmaceuticals, Clinton said, which has been widely condemned, including by the pharmaceutical lobby in Washington, for its business practices.

The company had acted “with no regard to need, no regard to fair return,” she said. “The only thing it is is greed.”

Sanders tends to tear into the drug industry, with the sermonic tenor that has come to be a hallmark of his delivery, as he portrays the fight against corporations as part of his “political revolution.” Clinton colors her comments with humor, mocking whispered warnings of side effects in TV drug ads that caution “your nose might fall off” (which always gets a laugh).

But both of them get visceral reactions from crowds — big cheers and muted shock as they relay anecdotes and roll out statistics about the business of medicine in 2016.

The angle for Clinton and Sanders is obvious. Nearly 80 percent of Americans believe that drug prices are unreasonable, according to a recent poll by STAT and the Harvard T.H. Chan School of Public Health. Less than 50 percent of Americans said that drug companies did a good job serving their customers — a figure way down from where it was 20 years ago. Most people thought profits, not the cost of research, were driving prices.

Now the leading Democratic contenders devote almost as much time on the stump to health care and drug costs as they do to the economy and climate change.

Sanders opened his speech to the steelworkers union with a story about nurses he had met “who know what it means to be treating patients who can’t afford prescriptions.” As he bussed across Iowa this week, the Vermont senator repeatedly invoked the same pair of statistics: 1 in 5 Americans can’t afford to fill their prescriptions while the biggest drug companies brought in $45 billion in profits last year.

“We all know tomorrow if you walk into a drugstore to fill your prescription, the price could be doubled or tripled compared to today,” he told the union, “because the pharmaceutical industry is ripping off the American people.”

The crowd whistled and cheered, and grew louder when Sanders proposed his solution: a single-payer health care system.

Clinton says tackling drug prices is the next logical step to build on the Affordable Care Act. In her stump speech, she blames Big Pharma, along with the insurance industry, for the failure of her health care initiative while she was first lady.

She touts her proposals to have Medicare negotiate directly with drug companies — though its potential impact is unclear, according to policy experts — and to do away with tax breaks for pharmaceutical advertising.

Among Democratic voters in Iowa, complaints about greed and corruption in the health care system are ubiquitous. And they often use the same language as their candidates when asked how they felt about the drug industry.

“I think it’s a ripoff,” said Tyrone Scott, 51, who attended Clinton’s Cedar Falls rally. “We’re paying a whole lot for a little. It doesn’t cost that much to make these drugs.”

Dr. Ted Bonebrake, a family physician who attended the same event, overheard a reporter asking about drug costs and offered his own thoughts: “You want to know the problem with the pharmaceutical industry? They give multimillion-dollar kickbacks to insurance companies to get their drugs on formulary. Then the insurance companies tell me which drugs I can give to my patients.”

Again and again, voters said that even if drug costs weren’t a problem for them personally, they knew somebody who was having trouble affording their medications.

Amanda McCord, a high school Spanish teacher in Perry, Iowa, who saw Clinton speak at an overflowing bowling alley in Adel, said that her grandmother, who is on a fixed income, “pays a ridiculous amount for her prescriptions every month.”

“It’s definitely a struggle,” she said. “There are medications that are ridiculously priced for no reason, for no other good reason than greed.”

The pharmaceutical industry is well aware it has a public-relations problem.

The industry argues that the Democratic plans would slow research and drug development — a talking point that Clinton regularly mocks from the stump — and that much of the public outrage is misplaced, driven by high out-of-pocket costs foisted on consumers by insurers, misleading reporting in the press, and a few alleged bad actors.

“For us, we think the only enemy should be disease,” Lori Reilly, executive vice president at PhRMA, the drug lobby in Washington, told STAT last year as Clinton ramped up her public criticism of the group’s members.

Clinton and Sanders both lament the industry’s influence in the nation’s capital — the latter likes to throw out a line about 1,400 lobbyists employed by Big Pharma. But as the candidates make it a focal point on the stump, their supporters clearly want to believe that they might be able to do something about it.

At the Cedar Falls rally, after her husband was asked if Clinton would be able to bring down drug prices, Chris Rediske spun around and said definitively: “She will.”

“She’ll have the best chance…” her husband, Tim, started to say.

“She will,” Chris said.

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