WASHINGTON — Top Senate Democrats on Wednesday released an updated plan aimed at lowering the cost of prescription drugs, signaling progress on a crucial part of their attempt to salvage part of President Biden’s crippled social safety net, climate and taxes.
Democratic leaders negotiated the drug pricing proposal primarily with Senator Joe Manchin III of West Virginia, a conservative Democrat who abruptly withdrew from negotiations on Mr. Biden’s domestic policy bill in December, effectively stalling them.
They released the plan this week in an effort to smooth the way for a reduced climate tax and spending package they hope to push through the Senate as early as this month over Republican opposition. It will be paid for in part by the prescription drug proposal, which is expected to save the government tens of billions of dollars in the coming years.
Under the new measure, Medicare would for the first time have the right to directly regulate prescription drug prices. It would cap the out-of-pocket amount Medicare patients can be asked to pay for prescription drugs at $2,000 a year, limit the amount drug companies can raise prices each year, and make more vaccines free for those patients. according to a draft presented on Wednesday.
Its release was the most significant progress in months toward reviving parts of Mr. Biden’s multitrillion-dollar plan, coming after a painstaking set of closed-door talks in which top Democrats worked to accommodate the preferences of Mr. n Manchin and other centrists in the Senate.
With Republicans expected to be equally opposed, it will need the support of every Democrat to move forward in the evenly divided Senate under special budget rules that could protect it from a filibuster.
Senator Chuck Schumer, Democrat of New York and the majority leader, has expressed a private desire to vote on such a bill by the end of this month. Some aides and lawmakers remain skeptical that Democrats can rally behind one less than six months before the midterm elections, amid persistent concerns about rising inflation.
Before the planned August recess, Democrats are also juggling a tight timeframe to push through sweeping manufacturing and technology legislation designed to boost American competitiveness with China and public pressure to respond to the Supreme Court’s decision to overturn Roe v. Wade, the landmark a case that gave a constitutional right to abortion.
In an effort to begin removing procedural hurdles and pave the way for quick action if a broader deal can be reached, top Democrats on Wednesday asked the Senate panel to begin a review of the updated version of the drug pricing plan, according to an official , privy to private discussions, which revealed them on condition of anonymity. Because Democrats plan to use the fast-track budget process known as reconciliation, the measure must adhere to strict limits imposed by the Senate’s top staffer.
The proposal to regulate drug prices was a cornerstone of the Build Back Better Act, Mr. Biden’s signature $2.2 trillion plan that encompasses much of his domestic agenda. It cleared the House in November with only Democratic votes, but stalled a month later after Mr. Manchin said he could not support such a stretched and expensive package as inflation began to rise.
Mr. Manchin has repeatedly said that any package should focus on reducing the national debt, tackling prescription drug costs and repealing parts of the tax law that Republicans pushed through in 2017. And while he has opposed key parts of his party’s ambitious plans to tackle climate change, Mr. Manchin has signaled a willingness to include a climate tax package and clean energy in his talks with Mr. Schumer.
“Senator Manchin has long advocated for proposals that would lower prescription drug costs for seniors, and his support for this proposal has never been in question,” said Sam Runyon, a spokesman. “He’s glad all 50 Democrats agree.”
Reducing the high cost of prescription drugs remains a top voter priority that Democrats have promised to tackle for years without success. Current Medicare drug benefits expose many patients to high prices because the program cannot negotiate directly with drug manufacturers and because it requires beneficiaries to pay a percentage of the cost of expensive drugs without cap. Some seniors taking expensive drugs for cancer and autoimmune diseases regularly spend $15,000 or more a year on drugs.
Mr. Manchin and Mr. Schumer have met repeatedly in recent weeks to hammer out the details of a possible deal that would likely be around $1 trillion. The tax component also needs to win the support of Sen. Kirsten Sinema of Arizona, a centrist Democrat who has opposed her party’s proposals to overhaul the tax code to pay for a broad package of protections.
Talks focused on these remaining parts are expected to continue in the coming days. Democrats have already shelved many of their plans to increase support for families and children in the interest of keeping the overall cost of the legislation low and enlisting Mr. Manchin’s support.
They are also pushing to include an extension of Affordable Care Act subsidies that were expanded under the $1.9 trillion pandemic relief law passed last year. They are due to expire at the end of the year.
The drug package presented Wednesday is largely similar to the drug provisions that were part of previous negotiations. But it reflects some of the pair’s negotiations: It now extends financial assistance to more low-income seniors, reducing their premiums, deductibles and other Medicare drug benefit payments.
The current program provides such assistance to seniors who earn less than 135 percent of the federal poverty level — about $18,000 a year for an individual — and more limited assistance to beneficiaries who earn slightly more. The legislation would expand those subsidies to 150 percent of the poverty level — about $20,000 a year — according to the summary.
It would also require the Department of Health and Human Services to negotiate lower prices for Medicare for certain prescription drugs. Previous legislation gave the department discretion to do so, but did not require it, and Democrats fear that a future health secretary in a Republican administration might balk.
Some provisions of the original drug bill were also removed, including one that would have limited the amount Americans could be asked to pay out-of-pocket for insulin each month. But a vote on a separate bipartisan insulin bill led by Sens. Susan Collins, Republican of Maine, and Jeanne Shaheen, Democrat of New Hampshire, is expected in the Senate in the coming weeks, although it is unclear whether it will attract enough Republican support.
Debra DeShong, executive vice president of public affairs at the drug trade group PhRMA, expressed displeasure with the proposal, noting that some technical fixes could cost Medicare beneficiaries more than they would have spent under previous versions of the bill. The industry has long resisted efforts to regulate prices.
“The prescription drug bill released today has gone from bad to worse for patients,” she said in a statement. “Democrats have weakened protections for patient costs included in previous versions, while doubling down on sweeping government price-fixing policies that will threaten patient access and future innovation.”
The urgency around the comprehensive package has increased as Mr. Biden’s popularity continues to decline and Democrats fear losing control of Congress.
The Supreme Court’s decision to limit the EPA’s ability to deal with carbon emissions last week also increased pressure among Democrats to pass legislation to counter the effects of climate change. The proposal under discussion could include up to $300 billion in clean energy tax incentives, which the House originally approved in November.
“We don’t have the help of a single Republican to move forward by lowering prescription drug prices and expanding our capacity for clean energy and addressing the climate crisis,” said Sen. Tina Smith, D-Minnesota.
Republicans continue to oppose the domestic policy package. After cheering Mr. Manchin’s decision to withdraw from talks in December, some Republicans watched with alarm as West Virginia resumed discussions with Mr. Schumer in recent weeks.
Sen. Mitch McConnell of Kentucky, the minority leader, threatened Thursday that Republicans would withdraw from the manufacturing and technology bill, which has bipartisan support, if Democrats push for a climate spending rescue and tax package.
In a speech to the Paducah, Kentucky Chamber of Commerce on Tuesday, Mr. McConnell criticized the legislation and warned, “If they bring it back, it’s just going to make all of this significantly worse.”
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