Democratic leaders negotiated the drug pricing proposal primarily with Senator Joe Manchin III of West Virginia, a conservative Democrat who abruptly walked out of talks on Mr. Biden’s domestic policy bill in December, effectively blocking it in its tracks. of. They released the plan this week in an effort to smooth the path for a reduced tax and climate spending package they hope to push through the Senate as early as this month amid Republican opposition. It will be paid for in part by the prescription drug proposal that is projected to save the government tens of billions of dollars over the next few years. Under the new measure, Medicare will for the first time have the ability 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 how much drug companies can raise prices each year, and make more vaccines free for those patients, according to draft. submitted on Wednesday. Its release was the most substantial progress in months toward reviving parts of Mr. Biden’s multitrillion-dollar plan, after an arduous series of closed-door talks in which top Democrats worked to satisfy the preferences of Mr. Manchin and others. centrists. in the Senate. With Republicans expected to be evenly opposed, it would need the support of every Democrat to advance in the evenly divided Senate under special budget rules that could protect it from a showdown. Senator Chuck Schumer, D-New York and the majority leader, has privately expressed a desire to pass such a bill by the end of this month. Some aides and lawmakers remain skeptical that Democrats can rally behind one with less than six months to go before midterm elections amid persistent concerns about rising inflation. Ahead of a planned August shutdown, Democrats are also juggling a tight timeframe to pass sweeping manufacturing and technology legislation aimed at boosting American competitiveness with China and public pressure to respond to a Supreme Court ruling to overturn Roe v. Wade, the landmark case that granted a constitutional right to abortion. In an effort to begin removing procedural hurdles and pave the way for quick action if a broader deal is reached, top Democrats on Wednesday asked the Senate lawmaker to begin considering an updated version of the drug pricing plan, according to an official who knows the private conversations they disclosed on the condition of anonymity. Because Democrats plan to use the fast-track budget process known as reconciliation, the measure must meet strict limits imposed by the Senate’s top rules official. The proposal to regulate drug prices was the cornerstone of the Build Back Better Act, Mr. Biden’s signature $2.2 trillion plan that included 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 sweeping and expensive package as inflation began to climb. Mr. Manchin has repeatedly said that any package must focus on reducing the national debt, tackling prescription drug costs and repealing parts of the tax law that Republicans attempted in 2017. And while he has opposed key pieces of his ambitious plans of his party on tackling climate change, Mr Manchin has signaled he is open to including a climate tax and clean energy package in his talks with Mr Schumer. “Senator Manchin has long supported proposals that would lower prescription drug costs for seniors, and his support for this proposal has never wavered,” said Sam Runyon, spokesman. “He’s happy that all 50 Democrats agree.” Reducing the high cost of prescription drugs remains a top priority for voters, something Democrats have vowed to tackle for years without success. The current Medicare drug benefit exposes many patients to high prices because the program cannot negotiate directly with pharmacists and because it asks beneficiaries to pay a percentage of the cost of expensive drugs without a cap. Some seniors who take 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 potential deal, which is likely to be around $1 trillion. The tax component also needs to win the support of Sen. Kyrsten Sinema of Arizona, a centrist Democrat who has resisted her party’s proposals to overhaul the tax code to pay for a broad security package. Discussions focusing on these remaining pieces are expected to continue in the coming days. Democrats have already abandoned many of their plans to boost support for families and children in the interest of keeping the overall cost of the legislation low and attracting Mr. Manchin’s support. They are also pushing to include an expansion of Affordable Care Act subsidies that were extended under the $1.9 trillion pandemic relief law enacted last year. These are due to expire at the end of the year. The drug package unveiled Wednesday is broadly similar to 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 by reducing premiums, deductibles and other payments in the Medicare drug benefit. 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 up 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 on certain prescription drugs. Previous legislation gave the department discretion to do so, but did not mandate it, and Democrats worried that a future health secretary in a Republican administration might refuse to do so. Some provisions of the original drug bill were also removed, including one that would have limited how much Americans could be asked to pay out-of-pocket for insulin each month. However, a vote on a separate bipartisan insulin bill led by Sens. Susan Collins, R-Maine, and Jeanne Shaheen, D-New Hampshire, is expected in the Senate in the coming weeks, although it is unclear whether it will attract enough support by the Republicans. Debra DeShong, the executive vice president of public affairs at the drug trade group PhRMA, expressed displeasure with the proposal, noting that some technical adjustments could cost Medicare beneficiaries more than they would have spent under previous versions of the bill . The industry has long opposed efforts to regulate prices. “The prescription drug bill released today went 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 overall package has grown as Mr. Biden’s popularity continues to decline and Democrats fear losing control of Congress. The Supreme Court’s decision to limit the Environmental Protection Agency’s ability to deal with carbon emissions last week also boosted the push by Democrats to pass legislation that would address the effects of climate change. The proposal under discussion could include up to $300 billion in clean energy tax incentives that the House originally approved in November. “We don’t have the help of a single Republican to move forward on lowering prescription drug prices and expanding our options around clean energy and addressing the climate crisis,” said Sen. Tina Smith, D-Minnesota. Republicans remained uniformly opposed to the domestic policy package. After cheering Mr. Manchin’s decision to withdraw from the talks in December, some Republicans have watched with concern as West Virginia continues to hold talks with Mr. Schumer in recent weeks. Sen. Mitch McConnell of Kentucky, the minority leader, threatened Thursday that Republicans would walk away from the manufacturing and technology bill, which has bipartisan support, if Democrats insisted on climate spending rescues and the package wearer. In a speech to the Paducah Area Chamber of Commerce in Kentucky on Tuesday, Mr. McConnell criticized the legislation and warned: “If they bring it back, it’s going to make all of this significantly worse.”
