After years – perhaps decades – of Democrats treating the pharmaceutical industry as a top foe, the party seems to be warming up to the industry, at least if you carefully read legislative tea leaves from Washington, D.C.
One thing that makes this especially surprising is that the shift is occurring not under the aegis of Sen. Bob Menendez or Rep. Josh Gottheimer, both New Jersey Democrats who represent locales where Big Pharma has a big footprint.
It is occurring rather under the watch of Sen. Bernie Sanders, the Vermont democratic socialist who is now chairman of the powerful Senate Health, Education, Labor and Pensions Committee.
In the area of health care, Sanders has famously championed his Medicare for All proposal, which attracted opposition from PhRMA, the trade association that represents pharmaceutical companies’ interests in Washington. However, PhRMA appears to have been something of a junior partner in that effort, with hospital and health care provider groups and insurers more overtly leading the charge against it in 2019, as the 2020 presidential contest in which Medicare for All proposals were hotly debated kicked off.
Sanders also has supported Medicare drug price negotiation and prescription drug re-importation policies, which PhRMA hates.
Sanders working with drug industry on 2 key issues
But now, Sanders appears to be cooperating with the drug industry on two things it treats as top priorities. The first is pushing an insulin price cap proposal that would impact insurers but not insulin manufacturers themselves (the people who set the actual prices).
The second is passing legislation that would target pharmaceutical benefit managers (PBMs), third-party companies that negotiate lower drug prices for subscribers to health insurance plans but which have attracted criticism for being another layer of corporate bureaucracy that adds to the high cost of health care in America.
Probably not coincidentally, concern about PBMs on Capitol Hill has increased at the same time that the pharmaceutical industry launched ad buys hammering PBMs last month (the insurance industry, which takes the PBM side of the fight, has also spent big).
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Those of us who work in advocacy and oppose Sanders’ Medicare for All plan have also heard plenty over the years about how, actually, it could be just fine for the pharmaceutical industry. Advocates argued that a stronger government role could even help companies more quickly bring drugs to market.
Meantime, the United Kingdom’s socialized health care system is notoriously stingy with drugs it considers insufficiently proven or of cost benefit. But the U.K. system also offers easier access to prescription drugs and vastly greater availability of over-the-counter medications that would require a doctor’s visit and a prescription in the U.S.
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Ultimately, the kinds of policies Sanders wants in health care could be better than you might think for Big Pharma.
If you’re a free-market type who believes that the more money the industry makes, the better because it has every incentive to plow profit into developing new and better medications, cures and vaccines, this is all fine. But that’s not where Sanders or his strongest backers are coming from. Higher profits for drug companies also is not where the general public seems to be, either. Nor is it where a lot of Republicans are.
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Why then are Sanders and populist Republicans such as Missouri Sen. Josh Hawley, who criticized Big Pharma over vaccine mandates and aggressive marketing of vaccines, palling around with drugmakers?
It may be a case of politicians realizing that they had disconnected with their voters on access to and the price of medications.
To Sanders and Democrats’ credit, the insulin proposal seems popular – even if it deals with a product many people find pricey by regulating payment processors rather than the manufacturers who set the price. Per a survey by Navigator Research for Democratic consulting firm GSG, 78% of registered voters support the Inflation Reduction Act’s insulin price cap provision. That includes majorities of independent voters and supporters of both major parties.
But pharmaceutical companies, which would benefit from proposals that the chairman of the Senate Health, Education, Labor and Pensions Committee is now pushing, are not at all popular.
While Big Pharma’s favorability numbers improved during the pandemic, a Caliber study in January found that “only 4 out of 10 people are likely to say something positive about a pharma company if given the chance.”
A YouGov study in March found that pharmaceutical was the top industry that Americans said needed more, not less, regulation.
Only after the industry took voluntary – and reversible – actions to drop insulin prices did it achieve rough parity in terms of overall reputation with the insurance sector, per a Harris poll in April.
Maybe that shouldn’t come as a surprise given that an Axios-Ipsos poll in February showed that “lowering costs for health care and prescription drugs” was the top priority for more than 1,200 adults surveyed, beating its nearest opponent – reducing gun deaths – by 36 points.
Clearly, drug costs remain a major concern, and the pharmaceutical sector continues to be mistrusted by Americans. The entirety of the policymaking class, including Sanders and Republicans concerned about issues that affect lower-income Americans, might need to undertake a fresh reading of the room. They also may need to reconsider the substance of what they are considering instead of selling the idea that they are “doing something” on health care.
Liz Mair is the founder, owner and president of Mair Strategies LLC. She has periodically consulted on health care policy, including efforts to bring down drug prices and combat Medicare for All.
