The Washington PostDemocracy Dies in Darkness

Opinion Democrats have a deal on prescription drugs. If it holds, it was worth the wait.

Senate Majority Leader Charles E. Schumer, Democrat of New York. (Jabin Botsford/The Washington Post)

On Tuesday, Senate Majority Leader Charles E. Schumer (D-N.Y.) announced that “an agreement has been reached to lower prescription drug prices for seniors and families in the Build Back Better legislation.”

Critically, he specifically mentioned that Sen. Kyrsten Sinema (D-Ariz.), a key holdout on the prescription drug issue, is on board with the deal. Sinema announced her support, and clarified that key House centrists are behind it.

It certainly doesn’t go as far as many Democrats wanted, which was to allow Medicare to negotiate the price of all the drugs it purchases. Indeed, the potential demise of that goal has been understandably held up by many, particularly on the left, as proof of Democratic fecklessness and the dysfunction of the legislative process.

But given all the forces pushing against it and the difficulty of reaching any agreement at all, if this deal ultimately passes, it can tentatively be called a significant achievement.

Rather than a sweeping change, it’s a collection of measures meant to bring down prices in a piecemeal way. Based on what Sinema’s office told us, combined with Schumer’s statement, here are some of the details:

  • Out-of-pocket spending on medications for seniors would be capped at $2,000 per year. Senators had discussed a monthly cap as well, but Schumer did not mention that. Presumably, the government will pick up the tab after people reach that $2,000 cap.
  • The price of insulin, a drug that is a century old yet whose price has exploded in recent years in what looks like a clear case of drug industry profiteering, will be capped at $35 a month.
  • The price of drugs will not be allowed to rise faster than the rate of inflation.
  • Medicare will negotiate the price of many drugs 9 years after they are approved, when they end their period of “regulatory exclusivity.” For the more complex drugs known as biologics (which are among the most expensive), there would be a longer period before they are subject to negotiation.

In recent days, many liberals have grown increasingly distressed as some of the most important and popular provisions in the original Build Back Better plan, such as family and medical leave, were deleted to satisfy Sinema or Sen. Joe Manchin III (D-W. V.).

None was more popular than Medicare negotiating prices. According to a recent Kaiser Family Foundation poll, 83 percent of Americans favor such negotiation.

And it wasn’t just the liberals. Over the weekend, a group of moderate House Democrats wrote a letter to their leadership saying, “If we fail, those on the other side of this issue will need to explain to Americans why they let Big Pharma win, why entrenched special interests take precedence over the American people.”

That really illustrates the unifying potential this issue has for the Democratic Party. Indeed, the plan’s potential collapse was so crushing because this has long been the archetypal issue that Democrats could theoretically deliver on if granted power.

Democrats took back the House in 2018 with endless ads vowing to control prescription drug prices. And this was the kind of reform that held the prospect of change that people would experience in their daily lives.

So when it looked like it would fall out of the reconciliation bill, it became yet another symbol of the ways that Democrats were failing to deliver on an issue of central importance to their voters, all because a chunk of their caucus appeared captive to special interests.

It would hardly have been the first time an industry used its power to kill a popular proposal that would have cut into its profits. The biggest reason we spend by far the highest prices in the world is the power of the pharmaceutical industry, which spends over $150 million a year on lobbying and employs hundreds of lobbyists.

“Pharma is everywhere,” says Sen. Ron Wyden (D-Oreg.). “They have got more lobbyists than anybody.”

Now that prescription drug reform is back in the bill, if it survives we might have an opportunity to see what happens politically when Democrats promise palpable, real-world change — and deliver on it.

“This means so much for people,” Anne Shoup, a senior adviser with Protect Our Care, told us. “It’s a kitchen table issue. It affects their health and well being — their ability to live their lives.” The deal also just received a strong endorsement from the politically powerful AARP.

Obviously, the process of having to compromise with centrists has produced an outcome that isn’t quite what many hoped for. But the positive from seeing change on this issue could well overtake any sense of disappointment among voters.

“It’s not quite as strong as what was originally proposed, but this is extremely meaningful,” Shoup told us. “People should take a win,” Shoup added, suggesting that Democrats were on the verge of delivering “real meaningful change for people.”

Though Sinema’s conduct throughout has been very trying at times, this may show that the worst interpretations of her motives — that she was looking to scuttle the Biden agenda from within — were just a tad overheated.

Although this agreement isn’t exactly a vindication of everything Democrats have done, if it passes, it will show that they were capable of achieving something meaningful even in the face of powerful forces — and internal disagreements — that might have stopped them.