At a Labor Day speech in Milwaukee, Joe Biden declared nothing less than victory over the pharmaceutical industry.
“We beat pharma!” Biden said, leaning into the microphone. “We beat pharma this year, and it mattered. We’re going to change people’s lives.”
The president was referring to the August passage of the Inflation Reduction Act, which, among widely touted provisions to fight the climate crisis and tax big corporations, also aims to reduce prescription drug costs for seniors. The law allows Medicare to begin negotiating with pharmaceutical companies on some expensive drugs – a long-sought goal for activists and the key “victory” that Biden believes he has scored over the powerful pharmaceutical lobby.
What Biden did not mention in his speech, however, was that the law also includes limits on those negotiations – meaning analysts believe it may be some time before the scorekeepers decide whether to declare Biden the winner.
It also means that the Democrats could have difficulty using the accomplishment in their next big test, the midterm elections, where they hope to win over seniors – at least those who have not decided how they will vote.
“The impact on the election will be if you can convince people over age 60 that they really will be seeing something to help them with their drug costs,” said Robert Blendon, a professor of health policy and political analysis at Harvard University. “But if somebody tells them they are not going to see that until 2026, that’s not as exciting as ‘I really expect this year I’m going to get relief with the bills I have.’”
The pharmaceutical part of the IRA law requires the federal government to start negotiating for some expensive drugs covered under Medicare – but not until 2026, and only with 10 retail prescription drugs that year, according to the Kaiser Family Foundation. Another 15 retail drugs will be eligible for negotiation starting the following year, then 35 more in 2028 and 2029, including drugs administered by physicians.
The act also requires pharmaceutical companies to pay rebates to Medicare if they increase drug prices faster than inflation; and, beginning in 2025, a $2,000 annual cap that means nobody on Medicare would have to pay more than that amount out of their own pocket.
“Despite their limitations, the drug pricing reform provisions of the [act] have the potential to transform the ways in which Medicare pays for drugs, and to provide financial benefits to millions of seniors who have difficulty affording their medications,” Rachel Sachs, a Washington University law professor and expert in health law, wrote in Health Affairs.
Biden has tried to make political hay out of the deal to reduce drug costs. He has called out his opponents for not supporting the measures, reminding listeners that all Republicans voted against the Inflation Reduction Act.
“For decades, big pharma won – year in, year out – because they own chunks of the Congress – because they had help, like your senior senator, Ron Johnson,” Biden told the crowd in Wisconsin, referring to the Republican lawmaker who is up for re-election this year. Johnson’s opponent, the lieutenant governor of Wisconsin, Mandela Barnes, has also criticized the incumbent’s ties to the pharmaceutical industry.
But recent polling indicates that despite the drug price “win”, the race is a toss-up. Democrats are favored to retain control of the Senate, but Republicans are favored to take control of the House, according to the most recent modeling from the FiveThirtyEight.
Democrats’ struggles could be because voters are less concerned with the pharmaceutical industry than they are with other issues. A majority of voters told a recent survey from Politico and Harvard that inflation, the economy and jobs, gun policy, abortion and gas prices all rank ahead of healthcare (at least non-Covid-19 healthcare) in the list of what will affect their decisions in the midterms.
The Covid-19 pandemic and surrounding upheaval in recent years “has made people unbelievably short-term in how they think about the issues”, Blendon added.
The number of drugs affected by the new law is also very limited. And since the requirements will not immediately take effect, they could be reversed or softened by a Republican administration, said Simon Haeder, professor of public health at Texas A&M University.
“We will really see if it’s a big deal maybe five, 10 years down the line, and the only way this turns into a big deal is if this is a nose or the toes in the door kind of thing and spurs larger changes,” said Haeder.
Also, since the healthcare provisions are part of a wider law on climate and corporation taxes, voters may not be aware of what it does about drug prices specifically, Blendon said.
Whit Ayres, a Republican pollster, argues the healthcare provisions will not make much difference in the midterms. The breakthrough on drug price negotiations will be “subsumed by other broader issues about inflation, crime, immigration, the future of democracy, education and broader healthcare issues that go well beyond the limited negotiation for a small number of drugs.”
The key for Democrats in making sure that’s not the case, Blendon argues, is advertising.
“If you were working in the White House, you want everything to try to highlight the drug price provisions, particularly in districts with older people,” he said. “If they are aware that something is being done for people over age 60, 65 for drug prices, it will help the Democrats.”
AARP (formerly known as the American Association of Retired Persons) is trying to increase awareness of how the law could benefit people over 65, who are eligible for Medicare. The organization has published articles, held town hall meetings and devoted its September monthly bulletin to explaining the law.
Leigh Purvis, the director of AARP’s healthcare costs and access, thinks the law could help Democrats with the delays in drug price negotiation requirements, because some parts of it – notably the rebates for inflation, and the cap on insulin payments – take effect next year.
“This law is effectively starting very soon, and it’s just a matter of helping people see those changes and recognize them for what they are and what caused them,” Purvis said.
