As the 2020 campaign kicks off, Democrats scramble to prove their leadership on lowering drug costs

WASHINGTON — As they jostle to position themselves for 2020, many Democratic presidential hopefuls have suddenly zeroed in on a narrow policy target: prescription drug prices.

Sen. Bernie Sanders called his first press conference since the midterms not to discuss President Trump’s quest for a wall or tout universalized health coverage, but to unveil a proposal to lower drug prices that mirrors one of Trump’s own. Sen. Cory Booker dialed up his own rhetoric to campaign-trail levels, decrying high drug prices as “a stain on the very idea of America.” The House Oversight Committee, too, set drug prices atop its own agenda, scheduling a hearing on that issue that will occur more than a week before it calls former Trump lawyer Michael Cohen to testify.

In the Senate, no fewer than six Democrats — including five of the men and women most likely to follow Sen. Elizabeth Warren into the 2020 race — have stepped out on the issue of drug pricing in just the past month, ramping up their anti-industry remarks and attaching their names to legislation that aims to bring down pharmaceutical prices.

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The energy among Democrats on drug pricing is so urgent, in fact, that even the senators representing states with major biopharma concentrations — Warren represents Massachusetts and Booker represents New Jersey — are not hesitating to present themselves as drug industry foes.

Together, it paints an early picture of the race for the Democratic nomination as something of an arms race to determine who can introduce the splashiest bill on drug pricing — or criticize “Big Pharma” most harshly.

“Elizabeth Warren is essentially running on a platform that corporations have taken advantage of Americans,” said Bob Blendon, a Harvard health policy professor. “You can’t say, ‘Oh, I’m from Massachusetts and we have a great deal of biopharma, so I won’t mention them.’ They are really big actors, and her central argument is that corporations have taken incredible advantage of average, middle-class people.”

Candidates hoping to take advantage of the cycle’s progressive enthusiasm will be forced to step out on the issue of drug pricing, Blendon said.

With drug pricing in the spotlight, potential candidates used the first several days of the new Congress to unveil a wide range of drug pricing legislation. Sanders and Booker both used camera time on Thursday to goad Trump into supporting a bill that would tie American drug prices to those in other wealthy countries, a proposal similar to one offered by the Trump administration.

Sen. Amy Klobuchar (D-Minn.), another rumored candidate, this week reintroduced a trio of bipartisan bills she has championed for years. In December, Klobuchar and Democratic Sens. Kamala Harris (Calif.) and Jeff Merkley (Ore.) — both of whom are openly mulling 2020 campaigns — helped roll out legislation that would empower the health secretary to crack down on price gouging.

“Anybody who wants to be successful in 2020, at whatever level in whatever race, is going to have to address this issue,” Sen. Richard Blumenthal (D-Conn.) said at a Thursday press conference. “The political landscape in this country is changing dramatically.”

Warren, for the moment, has been more aggressive than any other candidate, rolling out her most ambitious drug pricing legislation in December two weeks before she announced her presidential run. Just last week, she thrilled many progressives but disappointed much of her home state’s biopharma sector with a proclamation on Twitter that “giant drug companies only care about one thing: raking in profits on the backs of patients.”

The swift reaction highlights a dilemma Warren, Booker, and potentially other 2020 hopefuls face: The very drug companies they are vilifying employ tens of thousands of their constituents in Massachusetts and New Jersey.

But if national campaigns require that a candidate demonstrate his or her independence from home-state interests, Warren appears miles ahead.

“I’ll work with anyone to strengthen innovation,” Warren told STAT in a statement, using the language drug companies often rely on to defend high prices. “But too many Americans are struggling to afford their prescriptions, and we can’t trust giant drug companies to bring down prices on their own.”

Drug companies might dislike her efforts, Warren said, but “I don’t work for them.”

Warren’s words have already caused angst among biopharma types in Massachusetts, who had hoped that she might refrain from specific “Big Pharma” attacks even as her platform zeroes in on outsize corporate influence.

One industry veteran, Gil Bashe, suggested Warren’s words could inspire the quarter-million Americans employed by the biopharmaceutical industry to publicly defend their profession in the face of political attacks.

“The vast majority of people who choose to earn their living in the pharmaceutical industry do so with passion for helping others,” Bashe said. “Her words may prompt a scaled call to action of pride in being part of something important.”

Bob Coughlin, the CEO of the pharma trade group MassBio, was harsher in his appraisal.

“Ironically, these Democrats who are running for president seem to be resorting to Trumpian soundbites and tweets to attack the big pharma boogeyman and grab headlines,” Coughlin said, “at the expense of the patients and constituents in the states they represent where life sciences is one of the biggest employers.”

For now, however, voters appear to have sided with Warren — and while there is no consensus in Washington that Democrats’ drug pricing ideas make for good policy, they without question make for excellent politics. One poll in the run-up to 2018’s midterm elections showed drug company favorability underwater by a lopsided 71-21 margin. Last week, a poll that Blendon orchestrated showed voters view high drug costs as the most important issue currently before Congress.

A left-wing PAC this month even has purchased Facebook ads specifically applauding Warren’s recent drug pricing bill, asking voters whether they’ve had enough of “Big Pharma’s greed.”

Polls like Blendon’s could explain an increasingly common Capitol Hill phenomenon: Democrats in the House and Senate alike are introducing politically appealing drug pricing bills that are nonetheless unlikely to advance in a GOP-controlled Senate.

As drug companies’ reputations have taken an even further hit, several prospective candidates have worked to shed their prior reputation for pharma friendliness.

Booker — who in 2014 received more campaign contributions from the drug industry than any other politician — recently spoke out angrily against the Bristol-Myers Squibb merger with a New Jersey company, Celgene. In an interview Thursday, Booker again expressed frustration that the companies had used savings from a Republican tax bill on stock buybacks instead of lowering drug prices.

In 2017, Booker stopped accepting corporate campaign contributions, including drug companies. He reiterated Thursday that he specifically avoids accepting contributions from executive-level employees at biopharma companies.

Every lawmaker who had attached their name to legislation, Booker said, was doing so because it was good policy and not because it would further a White House campaign. Like every senator STAT interviewed for this story, Booker declined to speculate as to whether lawmakers were using drug pricing bills to bolster 2020 campaigns.

Still, Booker leaned on Trump’s past words in urging the administration to support his party’s market-interventionist proposals that conservatives often shy away from.

“The president of the United States himself has campaigned on this issue, but done nothing,” Booker said at a press conference. “We now are giving him bills that reflect exactly what he said in his campaign.”

While there is talk in Washington of bipartisan compromise on high drug costs, given President Trump’s frequent displays of Warren-like vitriol for biopharma, congressional aides from both parties acknowledge many of House Democrats’ most aggressive ideas are unlikely to gain traction in a GOP-held Senate.

That means the issue is likely to remain salient two years from now for candidates like Klobuchar, who in an interview with STAT declined to speculate on 2020 but said she welcomed the issue’s high profile.

Klobuchar, who has sponsored drug pricing legislation with varying success for years, said she welcomes the new entries to the fold — even if legislation from colleagues might seem duplicative. (Klobuchar introduced legislation to allow drug importation from Canada and a separate bill to let Medicare negotiate drug prices with manufacturers a day before Sanders).

“I don’t care if different people are doing different bills — I’m tired of inaction,” Klobuchar said. “If more people are taking on this issue that I’ve been doing for a decade, more power to them.”