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News Analysis

Everyone Wants to Reduce Drug Prices. So Why Can’t We Do It?

Credit...Kevin Van Aelst

Of all the promises President Trump made for the early part of his term, controlling stinging drug prices might have seemed the easiest to achieve.

An angry public overwhelmingly wants change in an easily vilified industry. The pharmaceutical industry’s recent publicity nightmare included 1,000 percent price increases and a smirking chief executive who said, “I liken myself to the robber barons.” Even powerful members of Congress from both parties have said that drug prices are too high.

But any momentum to curtail prescription drug costs — a problem that a large number of Americans now believe government should solve — has been lost amid rancorous debates over replacing Obamacare and stalled amid roadblocks erected via lobbying and industry cash.

“There is a very aggressive lobby that is finding any and all means to thwart any reform to a system that has produced very lucrative profits,” said Ameet Sarpatwari, an epidemiologist and lawyer at Harvard Medical School who follows drug legislation. “Everything that’s coming out is being hit and hit hard — even stuff that’s common-sensical.”

Members of Congress who deal with health policy have spent much of the year advancing proposals to overhaul the Affordable Care Act, none of which was intended to reduce drug prices. The latest Republican proposal, by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, was no different.

Meanwhile, more than two dozen bills aimed at curbing drug costs have been introduced in this or the previous Congress, according to the Drug Pricing Lab, a Memorial Sloan Kettering Cancer Center program that has cataloged ideas for reducing prices. Many have bipartisan support.

Proposals include allowing cheaper imports from other developed countries; allowing the government to negotiate the price of Medicare-covered drugs; speeding approval of cheaper generics; requiring notification by drug companies before they raise prices; and restricting drug ads aimed at consumers.

Other ideas not in bill form include banning patents for pills that simply modify existing medicines without significant clinical benefits and adjusting prices according to a drug’s effectiveness.

“There’s clearly no single solution out there that will solve this rapidly rising spending,” said Dr. Peter Bach, who leads the lab. But, he added, “there’s not a lot of fundamental disagreement about the direction this needs to move.”

Mr. Trump drew new attention to the issue last month by tweeting that Merck’s chief executive, Kenneth Frazier, “will have more time to lower ripoff drug prices!” after Mr. Frazier quit the president’s manufacturing council to protest his remarks about white supremacists in Charlottesville, Va.

Those comments matched Mr. Trump’s characterization in January of drug companies as “getting away with murder.” That same day, a dozen Republican senators, including Ted Cruz of Texas, John McCain of Arizona and Mike Lee of Utah, voted for the old liberal idea of letting Americans buy cheaper drugs from Canada.

The measure was attached to a budget resolution and wouldn’t, by itself, have allowed imports. It failed 52 to 46 after 13 Democrats voted against it, with some citing safety concerns about foreign-sourced medicine — an idea promoted by American drug makers.

Even so, the vote prompted speculation that a price deal might be within reach. “When we’re talking about garden-variety, generic drugs that can be easily imported from another country that has regulatory procedures that make them safe?” Senator Lee said in an interview. “I don’t see why not.”

In response to the new threats, the Pharmaceutical Research and Manufacturers of America, already one of Washington’s biggest-spending trade groups, reportedly increased member dues 50 percent last year as they prepared for battle.

The pharmaceutical and health products industries spent $145 million on lobbying for the first half of 2017, according to the Center for Responsive Politics.

Drug makers gave $4.5 million to congressional campaigns in that period, including six-figure donations to House Speaker Paul Ryan; Representative Greg Walden, a Republican of Oregon who heads the House Energy and Commerce Committee; and Senator Orrin Hatch, Republican of Utah and chairman of the Senate Finance Committee, a Kaiser Health News analysis found.

The drug lobby has spent $28 million so far this year to air six ads depicting heroic researchers about 4,600 times on national TV, according to iSpot.tv, an ad tracker.

The industry hired the former F.B.I. director Louis Freeh to study the impact of importation. He concluded that it would “leave the safety of the U.S. prescription drug supply vulnerable to criminals seeking to harm patients.” Import proponents argue the Food and Drug Administration could easily ensure safety by licensing and inspecting Canadian suppliers.

Drug makers say that high prices reflect heavy investment in innovation and drug development. They reject the notion that the industry wields too much influence in Washington. The top 10 publicly traded United States drug companies made $67.8 billion after taxes last year, regulatory filings show.

“These are important issues with significant ramifications,” said Holly Campbell, a spokeswoman for the drug trade group. “So we will continue to be engaged with the administration to advance solutions that improve the marketplace and make it more responsive to the needs of patients.”

Efforts to restrain prices have also made little progress in the executive branch. The White House has long been expected to issue an executive order on drug costs. But leaked documents show that deliberations have focused on things the industry wants, like extending overseas patents and changing a drug-discount program for hospitals, and not so much on lowering prices.

Gerard Anderson, a health policy professor at Johns Hopkins University, said Mr. Trump’s draft order “did not talk at all about branded drugs or about specialty drugs,” including for rheumatoid arthritis and cancer, that have seen especially steep price increases. “If that represents the administration’s thinking, then my guess is there is not much effort.”

Mr. Trump’s feud with congressional Republicans, especially the Senate majority leader, Mitch McConnell, means “you’re not going to get any strong direction or leadership out of the White House” on drug prices, said Vishnu Lekraj, who follows pharma stocks for Morningstar, an investment research firm.

Another Trump administration official, Scott Gottlieb, the F.D.A. commissioner, has accused the industry of “gaming” the system to delay the appearance of cheap generics after patents expire. He has pledged to speed applications for generics when there is little competition as part of a “drug competition action plan,” but opposes stronger measures like allowing importation.

But this push by Mr. Gottlieb — who has served on the boards of several pharmaceutical companies and earned large consulting fees from the industry — may be less significant than it appears. Professor Anderson noted that directly pressuring companies to reduce brand-drug prices would be much more meaningful.

Yet even small measures might be too large for Congress. “It is sort of remarkable to see just how far the system can bend before meaningful reform is taken,” said Dr. Sarpatwari. “If there ever was a time to strike while it’s hot, it’s now.”

Jay Hancock is a reporter for Kaiser Health News.

The Kaiser Health News reporters Elizabeth Lucas and Sydney Lupkin contributed.

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A version of this article appears in print on  , Section SR, Page 7 of the New York edition with the headline: Big Pharma Can’t Lose. Order Reprints | Today’s Paper | Subscribe

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