Washington (AP) — Democrats have promised to pass legislation to curb prescription drug prices this year, but pay patients and taxes while maintaining the benefits of boosting investors to potentially promising treatments. Opinions are still divided on how to reduce their costs.

In other words, find the balance. How big is the stick that Medicare needs to negotiate a price with a pharmaceutical company?

With potential savings of hundreds of billions of dollars, the bets are enormous. Medicare spends more than $ 200 billion annually on prescription drugs, a category that continues to grow as expensive new drugs enter the market. For example, the Alzheimer’s disease drug approved last week costs $ 56,000 a year, which could spike the out-of-pocket costs for patients using it.

If the bill is successful, it will advance the main plans of President Joe Biden’s domestic agenda, even when the Democratic Party is struggling to make other progress. Allowing Medicare to negotiate drug prices consistently gains strong public support in polls.

Speaker of the House Nancy Pelosi, D-Calip, imposes high taxes on pharmaceutical companies that refuse to do business with Medicare, while using average prices in other developed economies as a reference point for fair rates here. Operates the law to do. Her bill will limit price increases and allow private health insurance to receive Medicare negotiated fees.

In the Senate, Finance Commission Chairman Ron Wyden, D-Ore, is also working on legislation. His starting point is a less ambitious bipartisan bill from the previous parliament. The price increases for drugs already on the market are limited, but not the initial price. It would have capped the out-of-pocket costs of pharmacy drugs for Medicare recipients under the Pelosi bill.

“It wasn’t long before we empowered Medicare to negotiate better prices for prescription drugs,” Weiden said. But casting enough votes in the Senate is another matter. It’s unclear if Weiden can count on all Democrats in the split room, or if Republicans sign on.

Progressivists such as Senator Bernie Sanders (Vermont) want to take advantage of Medicare’s savings to bring new benefits to the dentistry, visual and auditory range. It represents the historic expansion of the program under the long-term financial shadow, and its huge hospitalization trust fund is projected to be in the red in 2026.

Democrats have personal discussions among them and organize coalitions around different approaches. In public, they still seem to be able to overcome their differences.

“The Democratic Party has gone through the Medicare prescription drug reform and I will be part of it,” D-Mass Rep. Jake Auchincloss told The Associated Press. The first legislator raised concerns that Pelosi’s approach was a price control system rather than negotiation. His voice is important because Pelosi is helping to lead a group of like-minded Democrats, and Pelosi can’t afford to lose a lot of votes.

The strong and well-funded lobbying of the pharmaceutical industry is closely involved. Already, advertising has raised concerns that government price controls may hinder the development of breakthrough therapies.

Stephen Ubl, CEO of Pharmaceutical Research and Manufacturers of America, believes that the industry wants to reduce patient out-of-pocket costs and that insurers and companies that manage prescription benefits also need to be scrutinized.

“We hope there will be a balanced drug price bill in Congress this year,” Ubl told AP in a recent interview. He later added, “Our industry understands that the process can be somewhat painful.”

But so far, the industry has not shown its willingness to accept Medicare negotiations or a significant curtailment of pricing power.

Health economist Len Nichols, who advised the Democrats in the medical policy debate, said there was logic behind the basic elements of Pelosi’s approach.

“We need to set some objective base prices as the basis for negotiations, and then we need a way to force pharmaceutical companies to come to the table,” he said. “That’s right in the direction.”

However, it is important to get the right balance.

“We have just experienced an amazing example of incredibly effective innovation,” said Nichols, referring to the COVID-19 vaccine, which has pushed back a deadly pandemic in the country. “Innovation is important, and the structure of negotiating arrangements needs to balance the need for affordability with the need to encourage innovation.”

The industry’s success with the COVID-19 vaccine is marked by a major asterisk. Taxpayers have invested approximately $ 20 billion in the research and development, manufacture, and supply of vaccine candidates. This is estimated by a nonpartisan and responsible federal budget committee advocating reduction of the federal deficit. Still, the money went to a company that knew what they were doing and they delivered.

Joshua Gordon, director of health policy for the budget group, said there is a clear trade-off between drug price control and reduced incentives for innovation. But that doesn’t mean you can’t find a better balance.

“Obviously, the government is creating a drug market through patents and (Food and Drug Administration) exclusivity, and there are clearly areas that businesses are using,” he said.

Gordon added that lawmakers are not necessarily tied to the approach currently at the table. They can follow the German example of a drug company setting an initial price for a drug, but then the review process determines if it is worth keeping paying for it.

One of Pelosi’s top lieutenants recently said he was open to discussing different approaches, but should include Medicare’s bargaining power.

“The government cannot deviate from the basic idea that … should have the right to negotiate prices,” DN.J said. Frank Pallone said in a phone call sponsored by advocacy group Protect Our Care. “I believe that all Democrats and some Republicans in the Senate will vote for it.”