President Trump says U.S. Rep. Nancy Pelosi, the California lawmaker conservatives love to hate, has earned another turn as speaker of the House. Does that signal the two might be able to work together on major policy issues if she’s elected?
It’s the question everyone in Washington, D.C., is asking after Democrats regained control of the House on Tuesday, placing Pelosi, the House minority leader, in line for the speakership, but the answer may be the most consequential for the pharmaceutical industry.
Tackling high drug prices is a centerpiece of the Democratic agenda and remains a top priority of the White House. And after Senate Majority Leader Mitch McConnell also expressed a willingness to tackle the issue, the industry is buzzing about what policy shifts are possible under the new, divided government.
With any other Republican president, drugmakers might be less worried. But the Trump administration’s latest proposals to lower treatment costs have veered away from orthodox GOP tenets, and companies are increasingly concerned that ideas once unimaginable under Republican control — like allowing Medicare to negotiate drug prices — could become a real possibility.
The departure of pharma allies, like Senate Finance Chairman Orrin Hatch of Utah, means there are far fewer influential and sympathetic lawmakers in Congress to provide a shield for the industry now that it can’t count on McConnell.
When Pelosi’s office pitched raising the portion of a drug that companies must cover under the Medicare D program to close the so called “donut hole” coverage gap in a recent federal spending bill, the Kentucky Republican relented, sources with knowledge of the negotiations say, dealing pharmaceutical companies their most significant loss in recent memory.
Now, the industry is scrambling to try to reverse the measure after failing to get a fix added to other major pieces of legislation this year. While it’s possible Congress and the White House find a way to do that during the upcoming lame-duck session, it could be the last favor that drugmakers get.
“Nobody is going to fall on their sword for pharmaceutical companies anymore,” one industry lobbyist said.
Even if Pelosi, Trump and McConnell all agree to pursue drug-pricing legislation, however, there are still numerous opportunities for the industry to influence the outcome.
A slew of Democratic lawmakers — like Sens. Cory Booker of New Jersey, Kamala Harris of California and Elizabeth Warren of Massachusetts — have essentially already started campaigning for a 2020 presidential bid. None are close allies of the industry, and they could seek to force any policy proposals further to the ideological left, alienating the Republican supporters necessary to advance legislation in the chamber.
Pelosi may face similar challenges in the House, with members like Rep. Elijah Cummings of Maryland eager to hit drug companies.
“The ideas they are going to be pushing are too far to the left,” one industry executive said.
Even if Congress proves unable to make policy changes, the political risks are significant. Democrats are eager to step up federal oversight, which they saw was lacking under the current House leadership, and that may focus on drugmakers as well as on the White House.
“With the Democrats in charge of the House, it’s not just investigations into Trump but into pharma,” another industry lobbyist said. “Companies should be really concerned because it’s going to be hard for them.”
Trump, meanwhile, can make some changes without Congress. His administration is already in the midst of trying to tie reimbursement rates for drugs in Medicare Part B to international prices, a proposal the industry despises because it targets the most profitable treatments.
