NOEL KING, HOST:
House Speaker Nancy Pelosi has a bill to address the high cost of prescription drugs. Today it will probably get a vote on the House floor. Now, this is an issue that voters care a lot about, and they want Congress to do something. So what would this legislation do, exactly? NPR health policy reporter Selena Simmons-Duffin explains.
SELENA SIMMONS-DUFFIN, BYLINE: This is a big, complicated bill. It's 450 pages long. For simplicity, let's talk about the three main pillars.
RACHEL SACHS: The first is that it lowers out-of-pocket costs for many seniors and many Americans who really need relief at the pharmacy counter.
SIMMONS-DUFFIN: That's Rachel Sachs. She's a law professor at Washington University in St. Louis. Medicare currently has no limit on what seniors and disabled people in the program pay for drugs out of pocket. This bill would make a limit, set at $2,000 per year. The second pillar...
SACHS: It changes the incentives that pharmaceutical companies have right now to increase their prices year after year or even more often by requiring them to pay money back to the government when they do so.
SIMMONS-DUFFIN: This would hopefully solve the problem of giant price hikes for drugs like Humira and Xarelto, drugs that are famously expensive already. The last pillar is government negotiation. The Secretary of Health and Human Services would be directed to negotiate with drug companies over the cost of a certain set of drugs, using what those drugs cost in other countries as a reference.
Benedic Ippolito, an economist with the American Enterprise Institute, is not personally a fan of this idea. But he's glad to see serious ideas getting put forth in Congress - not just in this House bill, but also in the Senate.
BENEDIC IPPOLITO: We've seen a flurry of activity on drug pricing more broadly in recent months.
SIMMONS-DUFFIN: The Trump White House and Republicans in Congress have said the idea of the government directly negotiating on drug prices is never going to get signed into law. It's a nonstarter. But Ippolito thinks some proposals in this bill could become real, like those other pillars - the out-of-pocket cap for Medicare and the rebate for big price hikes.
IPPOLITO: What we've seen Congress start to coalesce around is a set of reforms that have real impacts for Americans. They have real impacts for federal spending. And it would meaningfully improve the drug market.
SIMMONS-DUFFIN: Ippolito thinks, politically, it's significant that this bill is getting a vote in the House, that Democrats will be able to say they tried to do something on an issue voters really care about even if it never becomes law.
IPPOLITO: There's no question that they can point to this and say, look. While it didn't get passed, we absolutely have proposed one of the most meaningful and ambitious and aggressive attempts to reduce drug prices that we've seen in recent history.
SIMMONS-DUFFIN: One of the biggest criticisms of this bill is that if drug companies don't think they can make huge profits, they might not invest as much developing new drugs.
STACIE DUSETZINA: There is a lot of debate over what type of tradeoff there would be on innovation as we start to move towards regulating the price of drugs.
SIMMONS-DUFFIN: That's Stacie Dusetzina. She's a professor of health policy at Vanderbilt University. She points to an estimate from the White House last week that said this bill would result in 100 fewer drugs being developed in the next decade.
DUSETZINA: I think that the information that we have that goes into those estimates is really poor. It's very hard to get accurate information on the cost of drug development. It's one of those things where we won't probably know the real effects until we try to make some changes.
SIMMONS-DUFFIN: Given the amount of activity and agreement there seems to be around at least some of these ideas, changes may yet be coming on drug pricing in the new year. Selena Simmons-Duffin, NPR News.
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