The need to control the cost of prescription drugs has been a rare source of unity in a presidential campaign that will be better remembered for its sharp divisions.
Candidates have spent the campaign outlining their divergent approaches to health insurance, climate change and income inequality, and trading veiled and not-so-veiled jabs about each others’ records or lack thereof.
Prescription drug prices haven’t been a part of anyone’s stump speech, but they are a huge problem for thousands of people in New Hampshire. According to AARP, more than one in five New Hampshire residents has stopped taking a medication because of its cost.
A band of activists, dressed in red, has worked to keep prescription drug prices top-of-mind for candidates. The activists, volunteers with AARP, have been a fixture at town halls, asking candidates about prescription drug prices and reminding them with their bright red presence, to talk about the cost of medication.
“Citizens in our state have had devastating impacts from not taking their drugs,” said Bev Cotton of Weare, one of the volunteers. “What we’re asking of the candidates is, what’s their plan to combat these outrageous costs?” (Editor’s note: AARP is a sponsor of this special election guide.)
The candidates for President all agree drug prices are too high, and on many measures to lower drug costs.
Every candidate, Democrat and Republican, wants to allow cheaper drugs to be imported from other countries — a measure that could be accomplished through executive order.
All would allow Medicare — the publicly funded health insurance program for elderly and disabled Americans — to negotiate prices with drug companies, in the way the Department of Veterans Affairs and Tri-Care health systems for veterans and members of the military already do.
Democratic candidates would make that negotiated lower price available more widely by offering the same price to private insurers, offering a Medicare-like insurance program for sale, or by covering every American with a Medicare-like federally funded health insurance plan.
“The fact that Medicare can’t negotiate drug prices is a wealth transfer from the United States of America to the drug companies,” said former Rep. John Delaney, D-Md., who gave up his presidential campaign on Jan. 31.
The Democratically-controlled House of Representatives passed a bill in December that would have allowed Medicare to negotiate on drug prices. While President Donald Trump has called for legislation to allow Medicare to negotiate drug costs, he did not support that bill, and the Senate has shown no sign of taking it up.
Rep. Tulsi Gabbard, D-Hawaii, the only House member running for President, was campaigning in South Carolina on the day of the vote. She said she would have voted for the bill, but said she thought there were too many loopholes.
Sen. Bernie Sanders, D-Vt., Sen. Elizabeth Warren, D-Mass., and New York businessman Andrew Yang said they would use executive action to stop drug companies from raising prices, and to get generic drugs to market.
Sanders would direct the Department of Health and Human Services to review drug prices, and if any are deemed to be excessive, the government should speed up review of generic drugs.
If a company raises prices too much, Yang wants the government to license the drug away from the company, and fund the manufacture of a generic version.
“This would be a very, very strong disincentive for them to gouge the consumers,” he said.
Warren said she would take executive action to lower the prices of “critical public health drugs” like naloxone or Narcan, EpiPens, antibiotics, and medications for HIV and Hepatitis C, and speed up the approval of generic drugs.
Sens. Amy Klobuchar, D-Minn., and Michael Bennet, D-Colo., have highlighted legislation that would tackle drug prices.
In 2019, Klobuchar sponsored two bipartisan bills aimed at ending patent parking, and a third intended to speed the approval of generic drugs.
Bennet is the sponsor of a bill with Sen. Jeanne Shaheen, D-N.H., and two Republican senators to make it more difficult for drug companies to hang onto patents for longer than seven years without making substantive changes to their drugs.
A global industry
The candidates all agree that Americans are paying too much for their medicine, but they disagree on why.
“In America, we pay by far — not even close — the highest prices in the world for prescription drugs,” Sanders said. “They’ve spent so much money, they can do anything they want.”
He called the industry corrupt and accused drugmakers of price fixing.
Sanders has introduced the Prescription Drug Price Relief Act to peg drug prices to what other countries pay. Warren is a co-sponsor, but the measure has not been considered in the Senate.
Former Massachusetts Gov. Bill Weld, running in the Republican primary, said he would consider a similar policy.
Advertising is another thing that sets the American pharmaceutical industry apart.
Yang wants to make it illegal to advertise prescription drugs, noting that advertising drugs is only legal here and in New Zealand — and saying how annoying he finds the ads.
Former Vice President Joe Biden wants to end drug makers’ ability to deduct the cost of direct-to-consumer advertising from their taxes. Shaheen introduced a bill to end this deduction in January 2019; Bennet, Klobuchar, Sanders and Warren are all co-sponsors.
Research and innovation
Biden said the future of the pharmaceutical industry is in genomics, not chemicals. He said that would mean more companies would become the sole source of a particular drug. To control the cost of drugs when one company would have a monopoly, Biden said he wanted a panel of experts in the Department of Health and Human Services to decide a threshold price, based on a reasonable rate of return on investment.
Biden said creating a public health insurance option and taking other steps to control health insurance premiums, controlling the cost of prescription drugs and investment in research — particularly into cancer, diabetes and Alzheimer’s — would all happen early on in his administration.
Many of the candidates blame the influence of pharmaceutical industry lobbyists for a lack of progress on popular measures like drug importation.
“The fact that there’s a law that says you can’t go over to Canada and buy a drug — who could have written that but a drug company?” said Tom Steyer, the California billionaire businessman. “It’s unacceptable.”
Steyer said he thought political reforms might have to come before policy changes — Gabbard and Sanders want to tackle those reforms at the same time as drug policies.
The Democratic candidates also blamed Republican lawmakers for a lack of progress, but diverge in their approaches to overcoming that oppositon.
Warren said she supports eliminating the filibuster, “which I believe is essential to preventing right-wing senators who function as wholly owned subsidiaries of major American industries from blocking real legislative change in America.”
But, Warren said, she has been able to work with Republicans to pass bills before; as President, Warren said she would work with Republican legislators toward shared policy goals.
“The American people are sick and tired of overpaying drug prices,” Bennet said. “It would be better if we had a majority in the Senate,” but a committed President could be very effective, he said.
“If we have a Senate that’s still getting in the way,” said former Mayor Pete Buttigieg of South Bend, Ind., “this is one of the times you go directly to the people.”
He thought a pressure campaign would help convince Republican legislators to get on board with Democrats’ price-lowering prescriptions.
“These are things the American people want to see happen, even in conservative areas and conservative states,” Buttigieg said.
Biden too said he would try to persuade Americans to push their legislators to vote for reforms.
“You go out and you make the case, just like I did with regard to Obamacare,” Biden said. When repealing the Affordable Care Act was framed as taking away coverage for pre-existing conditions, backed up with testimonials about how the insurance law helped people, the controversial law became more popular, Biden said.
As lawmakers learn about the ways policies help people, Biden said, they will do the right thing. The same process, the same framing, could persuade lawmakers to back drug pricing measures.
Yang would ask Americans to tell the public and their members of Congress about choosing between paying for medicine and paying a bill, or about rationing a drug.
Anger is power
“I think there is so much anger and disgust at the pharmaceutical industry,” Sanders said. He said that anger should be enough to convince legislators to back major reforms.
Bennet said Democrats could move toward this issue in a general election campaign. President Trump made lowering drug prices a key part of his 2016 campaign, but Bennet said Trump has yet to enact or push for drug pricing measures.
“I think he couldn’t care less,” Bennet said. “He lied.”
The candidates vying for the chance to take on Trump said a different President would make all the difference. A President who believed drug prices are too high, and wanted to do something about it, could form an alliance with activist groups agitating for legislation.
“Where the presidency and the movements are aligned, that’s where we have the legislators in the middle, and we get them to do the right thing,” said Buttigieg. “There’s a powerful American majority ready to get this done. The only question is, can we engage and hold together that majority, and not allow it to get blown up?”