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The biggest health care bill of the year is coming to the House floor this week.
House Democrats have packaged together a bunch of proposals to lower prescription drug costs and to reverse the Trump administration’s maneuvers to undermine the Affordable Care Act, and they are bringing them to the floor for a vote this week as one bill.
Intentional or not, it’s a clever bit of legislating. The prescription drug provisions are generally bipartisan; several have gotten the endorsement of Sen. Chuck Grassley (R-IA). Democrats have paired those policies with a few proposals to shore up Obamacare:
- providing money for states to set up their own insurance marketplaces
- restoring funding for ACA enrollment outreach and support cut by the Trump administration
- repealing President Donald Trump’s expansion of skimpy “short-term” insurance plans
So they will be forcing their Republican colleagues to either remain so committed to opposing the ACA that they vote against popular proposals to bring down drug costs — one of the top priorities for voters — or to acquiesce to preserving the health care law that they loathe but couldn’t kill.
It’s a real pickle for House Republicans. Several of the drug prices proposals that were packaged into this omnibus bill actually have GOP sponsors. Will Obamacare politics force them to turn on their own plans?
Whatever the politics and messaging, the drug prices pieces in particular point the possible way forward for a compromise between the two parties. The focus is on speeding generic drugs to market, an area where the parties do generally agree. Democrats have much grander ideas about how to lower drug costs, but Republicans are more trepidatious about disrupting the free market (and angering pharma). So small-bore compromises are the only way forward for the foreseeable future in a divided government.
The ongoing litigation accusing generic drug makers of collusion could whet the appetite for action on Captitol Hill. Let’s run through those provisions:
1) The bill targets generic drug “parking”
Right now, the first generic drug approved to compete with a brand-name product gets 180 days of market exclusivity before a second generic can come on the market. But sometimes, the first approved generic will “park” after its approval — not actually taking the drug to the commercial market, thereby delaying the entry of a second or third generic drug. Research has shown prices start to really come down once there are several generic drugs on the market, not just one.
So the House bill tries to prevent “parking” by permitting the FDA to approve a second generic application before the first drug has gone on the market under select circumstances.
It’s a wonky way to make sure there isn’t a clog in the regulatory process that prevents more generic drugs from going on sale and bringing prices down. It’s worth noting that the Trump administration has advanced a similar plan on its own.
2) The bill bans “pay-for-delay” agreements
This is pretty straight-forward: Sometimes, brand-name drug manufacturers will straight-up pay a generic manufacturer to delay the generic product from entering the market. The Federal Trade Commission has estimated that such deals increase spending on prescription drugs by $3.5 billion annually.
The House bill would prohibit such arrangements, which both parties see as anti-competitive. This is one of the ideas that Grassley has supported on the Senate side.
3) The bill makes it easier for generic manufacturers to get the materials from brand-name drug makers
Another hiccup in the generic drug pipeline is when brand-name manufactuers refuse to provide the materials that generic competitors need to produce their cheaper knockoff versions of the brand-name drug. You might hear wonks talk about REMS — a Risk Evaluation and Mitigation Strategy — which is the bureaucratic process brand-name companies use to block their generic competitors from getting the samples they require.
The House bill would allow generic manufacturers to request the FDA authorize them to obtain materials from the brand-name company, allow generic drug makers to sue in court for samples and the court would be allowed to award monetary damages to the generic company as a way to discourage brand-name companies from participating in anti-competitive behavior.
This is another area of overlap with Republicans; Grassley has sponsored a similar bill with Democratic Sen. Amy Klobuchar.
It’s smart to be skeptical about any health care legislation passing a Democratic House, then a Republican Senate, and then being signed by Trump. But these are proposals that have received support from both sides of the aisle. It’ll be interesting to see how this collision of drug prices politics and Obamacare posturing shakes out.
This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.
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