参议院多数党领袖查克·舒默(Chuck Schumer)周二宣布，民主党人已就一项旨在降低处方药成本的措施达成协议，这是乔·拜登总统“重建得更好”计划的关键部分。
处方药措施将被纳入社会支出计划，民主党人几个月来一直在努力寻找前进的道路。在这个问题上达成一致是阻碍民主党谈判的最后一个主要症结之一。
拟议中的处方药协议将允许政府就胰岛素和从2022年1月开始不再受到竞争保护的更小范围药物的价格进行直接谈判，并将老年人的自付费用限制在每年2000美元。
伊芙琳·霍克斯坦/路透社
参议院民主党领袖查克·舒默身旁是美国参议员帕特里克·莱希·安.
舒默说:“我们从全国各地患有严重疾病、买不起药的人那里听到了这一点。“处于一个多么艰苦的位置，太可怕了。今天，我们在帮助缓解这一问题方面迈出了巨大的一步。”
亚利桑那州参议员基尔斯顿·西内马反对之前的处方药改革提案，他支持新协议。
“参议员欢迎就一项历史性的、变革性的医疗保险药品谈判计划达成新协议，该计划将降低老年人的自付费用——确保药品价格的上涨速度不会超过通货膨胀——节省纳税人的钱，并保护创新，以确保亚利桑那州人和美国人继续获得救命药物、新的治疗方法和疗法，”她办公室的一份声明说。
曼德尔·恩根/法新社通过盖蒂图像
2021年10月28日，参议员基尔斯顿·西内马离开华盛顿国会大厦。
参议院财政委员会主席、首席谈判代表罗恩·怀登告诉记者:“这已经过去很长时间了。“对许多人来说，禁止谈判就像一个诅咒。这违背了常识。”
在妥协方案中，民主党人还旨在通过惩罚那些将药品价格提高到高于通货膨胀率的公司来控制未来药品的高成本。医疗保险本身无法限制乙部分(医生管理的药物)或丁部分(零售处方药)的药品价格，因此立法者希望制造商在药品价格上涨快于通货膨胀时向医疗保险支付回扣罚款。
美国退休人员协会也支持该协议，并敦促立法者迅速采取行动，使其成为现实。
他们的声明中写道:“允许医疗保险最终谈判药品价格对老年人来说是一大胜利。“防止价格上涨速度超过通胀，并在D部分增加一个硬的自付费用上限，将为药费最高的老年人提供真正的缓解。”
但是，尽管民主党议员庆祝他们在处方药问题上达成一致，但参议院的整体法案仍有不稳定的前进道路。
尽管预计众议院最快将在本周就拜登的经济议程和一项单独的两党基础设施法案进行投票，但参议院是一个悬而未决的问题，一名温和的民主党人似乎越来越坚定地反对。
弗吉尼亚州民主党参议员乔·曼钦(Joe Manchin)周二表示，他反对这项尚未完成的法案中的几项关键条款，包括扩大医疗补助计划，将老年人助听器纳入其中。
曼钦周二表示:“我不支持任何拥有破产信托基金的扩张。他还担心该法案的成本及其对通胀的潜在影响。
尽管拜登周四在前往国际气候峰会之前宣布，“我们有一个将在美国参议院获得50票的框架”，但民主党人可能已经很清楚曼钦现在提出的反对意见。
周二，曼钦否认曾支持拜登框架。他说白宫很清楚他的立场。
当美国广播公司新闻记者雷切尔·斯科特问及他是否已经签署了拜登的框架时，曼钦说:“没有”。“这将意味着这不是真的，”他说，指的是他持续的担忧。
如果众议院本周通过拜登的社会支出议程，舒默周二表示，参议院最早可能在11月15日开始就社会支出方案展开辩论。
但是如果没有曼钦的支持，在平分秋色的参议院中，这项支出法案是没有希望的。他威胁要完全停止支持。
曼钦对自己政党的成员声称他在拜登登上世界舞台时向他抛出了一个曲线球嗤之以鼻，他辩称，他一直很清楚自己想要对基础设施一揽子计划进行投票。
“我觉得基本上是时候做点什么了。总统在那里，他去了那里，他在离开前要求一些东西，每个人都忽略了它，”曼钦说。“我没有忽视它。我想到了一些本可以做的事情。问起来很简单:投票支持两党基础设施法案就行了。”
数周以来，进步人士一直表示，他们将暂停对两党基础设施协议的支持，直到他们完全确信拜登的“重建得更好”计划将包括他们的关键优先事项，并获得参议院民主党人的必要支持。
但是他们已经放弃了他们的立场，准备在本周就基础设施法案和重建更好的议程进行投票。这将使社会支出法案回到参议院，在那里它可以被修改。
国会进步党团主席、众议员普拉米拉·贾亚帕尔(Pramila Jayapal)指出，拜登承诺参议院民主党人将提供必要的选票来通过社会支出，她说，她的会议将相信拜登会兑现诺言。
拜登周二在格拉斯哥的新闻发布会上表示，他相信曼钦最终会支持这笔交易。
“我相信乔会在那里，”拜登说。
Schumer says Democrats reach deal on lowering prescription drug costs
Senate Majority Leader Chuck Schumer announced Tuesday that Democrats have reached a deal on a measure aimed at lowering the cost of prescription drugs -- a key part of President Joe Biden's "Build Back Better" package.
The prescription drug measures will be included in the social spending package that Democrats have been working to find a path forwards on for months. Agreement on this issue was one of the last remaining major sticking points gumming up Democratic negotiations.
The proposed deal on prescription drugs would allow for direct government negotiation on the price of insulin and a smaller universe of drugs that are no longer protected from competition beginning in January 2022, and cap out of pocket prescription drug expenses for seniors at $2,000 annually.
"We've heard this from people across the country who have serious illnesses and can't afford their medicine," Schumer said. "What a painstaking position to be in, it's horrible. Today we've taken a massive step forward in helping to alleviate that problem."
Sen Kyrsten Sinema of Arizona, who opposed previous proposals on prescription drug reform, endorsed the new agreement.
"The Senator welcomes a new agreement on a historic, transformative Medicare drug negotiation plan that will reduce out-of-pocket costs for seniors - ensuring drug prices cannot rise faster than inflation - save taxpayer dollars, and protect innovation to ensure Arizonans and Americans continue to have access to life-saving medications, and new cures and therapeutics," a statement from her office said.
"This has been a long time coming," Senate Finance Committee Chair Ron Wyden -- a lead negotiator -- told reporters. "The prohibition against negotiation for many people has been like a curse. It defies common sense."
Democrats, in the compromise, are also aiming to rein in future high costs of drugs by penalizing companies that raise their drug prices higher than the rate of inflation. Medicare is not, on its own, able to limit drug prices in either Part B (drugs administered by physicians) or Part D (retail prescription drugs), so lawmakers want manufacturers to pay a rebate penalty to Medicare when the price tag of a drug rises faster than inflation.
AARP also supports the deal, and urged lawmakers to act swiftly to make it a reality.
"Allowing Medicare to finally negotiate drug prices is a big win for seniors," their statement read. "Preventing prices from rising faster than inflation and adding a hard out-of-pocket cap to Part D will provide real relief for seniors with the highest drug costs."
But while Democratic lawmakers celebrate their agreement on prescription drugs, there remains a precarious path forward for the overall bill in the Senate .
Though the House is expected to vote on Biden’s economic agenda and a separate bipartisan infrastructure bill with the support of progressives as soon as this week, the Senate is an open question, with one moderate Democrat seemingly more entrenched in his opposition with each passing day.
Sen. Joe Manchin, D-W.Va., said Tuesday that he opposes several key provisions in the unfinished bill, including an expansion of Medicaid to include hearing aids for seniors.
“I’m not for any expansion that has a trust fund that is insolvent,” Manchin said Tuesday. He is also concerned about the cost of the bill and its potential impact on inflation.
Although Biden announced Thursday, before departing for an international climate summit, that "we have a framework that will get 50 votes in the United States Senate," Democrats may have been well aware of the objections Manchin is now making.
On Tuesday, Manchin denied having ever endorsed the Biden framework. He said the White House was well aware of his position.
"No," Manchin said when asked by ABC News Congressional Correspondent Rachel Scott if he had signed off on Biden’s framework. "That would mean this isn’t genuine," he said, referencing his ongoing concerns.
If the House passed Biden’s social spending agenda this week, Schumer said Tuesday that the Senate could begin debating the social spending package as soon as Nov. 15.
But without Manchin’s support, in the evenly divided Senate, the spending bill doesn’t stand a chance. He’s threatened to withhold his support entirely.
Manchin scoffed at claims from members of his own party that he had thrown Biden a curveball while he was on the world stage, arguing that he was always clear he wanted a vote on the infrastructure package.
"I feel basically it's time to do something. The president's over there, he went there, he asked for something before he left and everyone ignored it," Manchin said. "I didn't ignore it. I thought of something that could have been done. It was very easy ask: Just vote for the bipartisan infrastructure bill."
Progressives have for weeks said that they would withhold support for the bipartisan infrastructure deal until they had total assurance that Biden's Build Back Better plan would include their key priorities and get the necessary support from Senate Democrats.
But they’ve come off their position and are readying for a vote on both the infrastructure bill and the build back better agenda as soon as this week. That would leave the social spending bill to return to the Senate, where it could be modified.
Rep. Pramila Jayapal, who chairs the Congressional Progressive Caucus, pointed to Biden’s promise that Senate Democrats will provide the necessary votes to pass social spending, and said her conference will trust the Biden to make good on his word.
Biden said in a news conference on Tuesday in Glasgow that he was confident Manchin will eventually support the deal.
"I believe that Joe will be there," Biden said.
