Biden to push Build Back Better Act, focusing on its prescription drug provisions

By Betsy Klein and Tami Luhby, CNN

    (CNN) -- President Joe Biden on Monday will highlight provisions to lower the prices of prescription drugs in the Build Back Better Act as his signature legislation awaits Senate action.

Ahead of the speech, a White House official touted the bill's "historic action to lower the prices of drugs and hold drug companies accountable while deterring future price increases," noting that Americans pay "often two to three times as much" for prescription drugs "as citizens in other developed countries."

Biden, the official added, will meet with two women who suffer from diabetes ahead of his remarks. The bill, if passed, would cap the cost of insulin at $35 per month for Medicare beneficiaries and those with private insurance.


Provisions on prescription drugs


The bill would empower Medicare to negotiate prices of certain costly medications administered in doctors' offices or purchased at the pharmacy. The Health and Human Services secretary would negotiate up to 10 drugs in 2025. The number would rise to up to 20 medications starting in 2028. This controversial provision, which was dropped from the package and then restored after a deal was reached in the Senate, is a far more limited proposal than the one House Democratic leaders have backed in the past.

The legislation would also impose penalties if drug companies increase their prices on many medications faster than inflation. And it would redesign Medicare's Part D drug plans by adding a out-of-pocket spending cap -- set at $2,000 for 2024 -- on medications bought at the pharmacy.

About 10 fewer drugs would be introduced in the US market over the next three decades if the bill were enacted, the Congressional Budget Office projects. About 1,300 drugs are expected to be approved over that time period under current law, the agency said.

The bill also calls for blocking the implementation of a Trump administration regulation that would change the drug industry's rebate system, though it isn't set to go into effect until 2026. The rule effectively would ban drug makers from providing rebates to pharmacy benefit managers and insurers. Instead, drug companies would be encouraged to pass the discounts directly to patients at the pharmacy counter.

Altogether, the prescription drug measures would save around $297 billion, including about $79 billion from allowing Medicare to negotiate drug prices, according to the CBO. Prior House efforts to permit drug price negotiations would have saved far more.


State of play


The Senate is back Monday, with Democratic leadership hoping to pass the bill before the holiday amid continuing reservations from key holdout Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona, both pushing for a series of revisions before a vote. The House passed their version of the $1.9 trillion bill to expand the social safety net last month.

Manchin is seeking to pare back the bill on paid family leave, a methane fee on emissions and a Medicare expansion to cover hearing, plus changes to its tax title provisions -- meaning there need to be major changes to the bill, making it less likely it can pass before Christmas, as Senate Majority Leader Chuck Schumer has pushed.

Sinema, meanwhile, has not committed to voting for the bill but indicated last week in an exclusive interview with CNN that she plans to keep negotiating.

"When you negotiate directly in good faith with your colleagues and don't negotiate publicly, you're actually much more likely to find that agreement and get to an achievement that serves the interests of the people of your community, and that's what I'll continue to do," she said.

Last week as Biden addressed the lower-than-expected November jobs report, he made a continued push for the bill, which he said would ease long-term inflationary pressures and raise revenue, calling it "fiscally responsible."

"Throughout our history, we've emerged from crisis by investing in ourselves. And so we're going to keep at this. We're going to keep making progress for our families and for our nation," he said.

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