WASHINGTON — Democrats here have, of late, been making far more noise about high prescription drug prices.
But at two dueling hearings on Tuesday, the most powerful Republicans on each committee made their own mark.
Rep. Jim Jordan of Ohio, the ranking member of the House Oversight Committee and a former chairman of the ultra-conservative Freedom Caucus, kicked off his panel’s hearing by offering his support for a controversial proposal that would inflame drug makers: to potentially cut the lucrative exclusivity periods the government grants drug makers for their products.
And Iowa Sen. Chuck Grassley, the chairman of the Senate Finance Committee, used part of his own speaking time to blast some of the pharmaceutical company CEOs who declined to testify before his panel. Next time, he promised, he and committee Democrats will be “more insistent” that they show.
It wasn’t a sea change: Other Republicans on each panel, and even some Democrats, were more deferential to the drug industry. But the new positioning from key GOP lawmakers is yet another sign that increasing political enthusiasm for tackling drug costs could lead to bipartisan legislation, even in a divided Congress and even as the historically powerful pharmaceutical lobby pushes back.
The House Oversight Committee hearing, chaired by newly empowered Rep. Elijah Cummings (D-Md.), was the more dramatic hearing by far. Republicans accused the new Democratic majority of playing politics with a critical policy issue — a nearly inevitable conflict given the committee’s composition of newly emboldened progressives like Reps. Alexandria Ocasio-Cortez (D-N.Y.) and Rashida Tlaib (D-Mich.), and staunch conservatives, including several members of the Freedom Caucus.
Democrats “launched an investigation into pharmaceutical companies’ pricing models without minority consultation,” said Rep. Jim Jordan (R-Ohio), “and without any indication of their scope or plans other than signaling they would be dragging in pharmaceutical CEOs in the coming months for testimony.”
The effort, Jordan said, signaled not “a willingness to find answers, but an attempt to score political points.”
At the Senate Finance Committee hearing, meanwhile, discussions were more subdued and policy-focused, and highlighted a consensus that “anti-competitive” drug company behavior must be stopped and Medicare’s prescription drug benefit reformed.
Much of it was a retreading of policy concepts that academics, advocacy groups, and lawmakers alike have previously detailed.
The situation was, at least at times, similar on the House side — so much so that Cummings intervened.
“I want to know some solutions,” he said. “I have a fear that we will talk and talk and talk and talk and people will die while we are talking and it will only get worse.”
But Jordan wasn’t the only lawmaker to broach the idea of reforming the patent system and potentially cutting exclusivity for lucrative brand-name drugs. The topic was brought up by lawmakers across the ideological scale, from conservatives like Rep. Mark Green (R-Tenn.) to liberals like Rep. Raja Krishnamoorthi (D-Calif.)
Lawmakers also used both hearings to air other policy ideas unlikely to gain traction in a divided Congress. Sen. Ron Wyden (D-Ore.) pushed an idea that enjoys widespread support among Democrats: allowing Medicare to negotiate directly with manufacturers for drug costs. Sen. Bill Cassidy (R-La.), too, touted his plan for a “Netflix model” for pricey hepatitis C drugs, which would allow payers or state governments to pay a flat fee to ensure an entire group of patients or a population could get the drug, when needed, for a period of time.
One of the witnesses conservatives called in the House, economist Avik Roy, is well-known in Washington policy circles for often breaking from Republican orthodoxy on the issue of health care costs. In his testimony, Roy squarely took on the patent system, including a laundry list of current policies he argued keep drug prices high.
Roy also broke with the Trump administration, telling Rep. Mark Meadows (R-N.C.), a close ally of Trump, that the administration’s idea of tying what Medicare pays for drugs to what other countries pay was flawed. Roy argued that the countries that Medicare would use to peg prices “are the wrong countries to compare to the United States because they don’t necessarily have market-based approaches.” Republicans on the committee including Meadows were mum on their own opinions of the idea.
In the Senate, witnesses, including the conservative economist Douglas Holtz-Eakin, policy researcher Peter Bach, and Laura and John Arnold Foundation Vice President Mark Miller, did find areas of broad consensus.
All agreed that at age 16, Medicare’s Part D prescription drug benefit was due for an overhaul. The trio was generally supportive of proposed changes to physician fee schedules that reduce Medicare’s payments to doctors for some covered drugs. And there was broad consensus among witnesses and lawmakers alike on the need to crack down on “anti-competitive” pharmaceutical industry tactics sometimes used to extend intellectual property rights and prevent competition.
They were far more disparate in their reactions to Trump administration proposals like the use of an international price index to cap U.S. drug payments or altering the structure of “protected classes” under Medicare’s Part D — though each agreed on a need for reform.
“We are footing the globe’s bill for R&D, and it’s not OK,” Holtz-Eakin said. “I get that.”
On both sides of the Capitol, the hearings also provided a bird’s-eye view of the stakeholders who will figure most prominently into drug-pricing debates in the coming years — and the skepticism much of their testimony will carry.
Before the hearings, the pharmaceutical industry-funded group Alliance to Protect Medical Innovation criticized both Miller and Bach for enjoying the backing of Arnold Ventures, the newly renamed policy arm that the billionaire couple John and Laura Arnold has used to fund anti-industry drug pricing campaigns.
Holtz-Eakin, the president of the American Action Forum, was criticized in a Tuesday morning article from an outside oversight group because that group’s political arm has received millions of dollars from the drug industry. Bach was criticized in the same article for receiving fees from the drug company Gilead.
One witness who was spared the scrutiny in the Senate: Kathy Sego, an Indiana diabetes advocate whose son Hunter has been forced to skip insulin doses due to the drug’s skyrocketing costs.
“This is going on because manufactures have been taking advantage of families like yours, and nobody’s been willing to take them on,” Wyden told Sego during the hearing. “That’s going to end today.”