ASHINGTON — Nancy Pelosi sent Democratic House members home for summer recess with a three-point plan to “own August”: talk about the economy, talk about President Trump, and talk about health care costs — specifically, exorbitant prescription drug prices facing Americans.
It’s easy to see why drug pricing gets such prominent billing. Polls have consistently shown that voters hold a decidedly negative view of pharmaceutical companies, that they trust Democrats more on health care, and that they believe high drug costs should be a top priority on Capitol Hill.
And already, candidates are introducing bills and commissioning studies on the issue, spurred by town halls that feature constituent after constituent demanding action to bring down the bills they face at the pharmacy counter. The bills, the studies, the best town hall sound bites — all get cut into television ads that tout a given candidate’s work.
But it’s more complicated than Pelosi’s push or the rush of new ads might suggest. Some Democrats are closely allied with the the drug industry itself, and the party at large has not yet coalesced around a single, cohesive platform on pharmaceutical costs.
“The Democrats do not have a concise drug plan,” said Robert Blendon, a Harvard political scientist who has commissioned recent polling on drug pricing issues. “Most big plans that help candidates usually come in presidential years where somebody can articulate it. The Democrats would have to agree on a plan, and they would have to have most candidates running on one — that doesn’t exist.”
Since June, the Democratic Congressional Campaign Committee has written nothing on the issue on a campaign blog updated almost daily — focusing instead on health insurance markets and out-of-pocket health costs. And while a spokesman was insistent that party infrastructure viewed drug costs as a signature issue, many of the ads the campaign committee cited in an email to STAT focused far more on health insurance.
In some ways, President Trump is also making it harder for Democrats to find a cohesive message on the issue, as the party has been forced to navigate a string of perceived victories from Trump on pharma issues — namely temporary price freezes announced by Pfizer, Novartis, Roche, and Bayer.
Democrats have a counterpoint, of course: the price freezes, they argue emphatically, are ineffectual PR ploys initiated by the spectre of an angry presidential tweet. Blendon added that it’s unlikely voters will respond to the price freezes — given a recent Politico/Harvard poll that showed few voters were even aware the Trump administration had a drug pricing blueprint.
And it’s not just Trump making it tough for the Democrats to gel around a drug pricing message: Unlike other health care issues that split lawmakers on almost perfect partisan lines, some top Democrats are very willing to accept campaign cash from big-name manufacturers and their lobbyists.
Despite the lack of an overarching strategy, a handful of candidates have already worked to make the issue central to their campaign.
At the top of the heap is Sen. Claire McCaskill, the Missouri Democrat who is among the most vulnerable senators up for reelection this fall. In the past two years, she’s orchestrated numerous investigations into pharmaceutical manufacturers and distributors seen as having contributed to the opioid crisis. And last month, as the top Democrat on the Senate’s chief oversight committee, she released an analysis showing Medicare could save $2.8 billion per year if it directly negotiated drug prices with manufacturers.
All of it is fodder for her messaging on the campaign trail.
“One of the top concerns I’ve heard from Missouri families is the skyrocketing cost of prescription drugs,” McCaskill, who has held 50 town halls in the past year, told STAT. “I’m going after the pharmaceutical companies, and I’m trying to go after a system that’s broken. I don’t care how big and powerful they are.”
Recent polling data shows pharmaceutical companies are deeply unpopular, with voters viewing them unfavorably by a 71-21 margin. Independent voters and Democrats also trust Democrats in Congress far more than Trump on drug pricing issues: a 42-30 spread overall and a 41-12 lead among independents, according to a poll from the Democrat-aligned firm Global Strategy Group.
Another senator in a state Trump won in 2016, Sen. Tammy Baldwin (D-Wis.), used a recent ad to highlight a bill she introduced with Sen. John McCain (R-Ariz.) that would allow for the importation of cheaper drug alternatives from Canada.
Lowering prescription drug costs is such a high-profile issue, in fact, that an outside group has formed specifically to force candidates into discussing it: Patients for Affordable Drugs, which is led by a longtime patient advocate, David Mitchell, and relies on the political savvy of Ben Wakana, formerly the top communications staffer for Barack Obama’s health department.
“Any politician worth their salt would be talking about drug prices, given how important it is to the electorate,” Mitchell said in an interview. “It’s really a kitchen-table issue. People live it every day.”
But Mitchell stressed that drug pricing is not a partisan issue. His group (via its political extension, Patients for Affordable Drugs Action) has already endorsed the reelection bid of an incumbent Republican, Rep. David McKinley of West Virginia, and has planned a half-million-dollar ad campaign on his behalf.
While the group has waded into just two races so far, Mitchell promised his team would become involved in races featuring candidates from both parties, including Democrats who accept pharmaceutical industry contributions and “carry drug companies’ water for them.”
The other race currently on Mitchell’s radar: the New Jersey reelection campaign for Sen. Bob Menendez (D), whose opponent is the former CEO of the drug maker Celgene, Bob Hugin. A recent ad produced by Patients for Affordable Drugs Action tagged Hugin as “the guy who made a killing,” and focuses on his company’s repeated decisions to hike the price of the cancer drug Revlimid. Hugin has struck back by highlighting Menendez’s repeated votes against drug importation.
For many other Democrats, however, campaigning on drug prices is more about making grandiose statements about policies not yet proven to be politically realistic — and it isn’t a central issue.
Several, led by Rep. Lloyd Doggett of Texas, responded to many of the price freezes with the party’s most aggressive bill to date on Medicare negotiation — one that would allow the Department of Health and Human Services to effectively negate patent exclusivity on a drug if the manufacturer could not negotiate an agreement with Medicare.
The main trade group for drug makers, PhRMA, has made it clear that it opposes those aggressive pitches, and pushed instead to get candidates — and Washington more broadly — interested in other targets, like pharmacy benefit managers.
“Unfortunately, many of these proposals would do nothing to address what patients care most about: rising out-of-pocket costs for medicines. Instead, we should pursue reforms to address the misaligned incentives in the system,” Robert Zirkelbach, a spokesman for PhRMA, told STAT.
A few Democrats have found their own ways to speak out against pharma’s influence in Washington — spurred by the DCCC, which has said that specifically tailored strategies tend to prove most effective.
Elissa Slotkin, a former CIA analyst running as a Democrat in Michigan’s 8th Congressional District, has made a pharmaceutical “shield law” a campaign issue. The one-of-a-kind restriction, she said, makes it dramatically more difficult more the state and local governments to sue drug companies for causing public health issues — in this case, namely the opioid crisis.
Slotkin’s opponent, Rep. Mike Bishop (R), blocked attempts to repeal the law when he was the majority leader in Michigan’s state Senate.
“Rep. Bishop refused to allow its repeal here in Michigan,” Slotkin said. “Now that he’s in Congress, he’s giving tax breaks to the pharma industry and taking money from the same drug companies that Michiganders are suing. He has been doing their bidding for the last 20 years.”
Some candidates are even aligning themselves with the Trump administration on pharmaceutical industry issues. Sen. Joe Donnelly (D-Ind.), who is among the senators most likely to lose their seat come November, even ran an ad highlighting his work with the Trump administration on a so-called right-to-try law, a longtime priority for Vice President (and fellow Hoosier) Mike Pence that will give some dying patients a different pathway for accessing experimental and unapproved treatments.
The diverse strategies Democrats are employing on the issue underscore just how intense is the political instinct to find some way — any way — to take on pharmaceutical companies.
Indeed, that instinct is not partisan, nor particularly new. As a candidate, Trump touted the concept of Medicare negotiating drug prices — a concept his administration has not pursued.
One playful ad from Patients for Affordable Drugs even quotes Trump, as a candidate, complaining that Medicare does not negotiate drug prices — then rolls video of Sen. Bernie Sanders (I-Vt.) making the same argument.
“The best proof point in the power of this issue is that Donald Trump ran on a promise to stand up for the forgotten man by reducing drug prices,” said Jesse Ferguson, a Democratic operative who consulted on the Global Strategy Group poll. “The problem is he got to Washington and forgot them.”