让政府直接谈判降低处方药价格制药公司——为纳税人和病人提取大量储蓄——可能不会成为民主党的一部分全面的社会支出计划，白宫周四表示。

这一进展打破了许多消费者权益倡导者认为几十年来最有可能立即缓解因药费飙升而负担沉重的家庭的希望。这也标志着那些花费数百万美元游说反对政府直接干预定价的制药商取得了重大胜利。

“除非政府介入并为我们战斗，否则我们必须战斗。我们别无选择，”来自华盛顿特区的39岁的劳拉·马斯顿说，她需要每天服用胰岛素来生存。这种药物的标价在过去25年里上涨了1000%。

她说:“每天我都觉得自己生活在一个以自由为荣的国家，但我没有获得自由，因为在14岁时，我被诊断为1型糖尿病患者。

美国人为处方药支付的费用比世界上任何其他国家的公民都多，平均每人每年1200美元，根据经济合作与发展组织。

当个别美国保险公司与制药商谈判折扣时，联邦法律禁止政府做同样的事情。

大多数民主党人和患者团体都推动修改法律，允许政府在与其他富裕国家的支付挂钩的上限下，通过医疗保险来谈判价格。前总统唐纳德·特朗普还在2016年发起了这个想法。

无党派的凯泽家庭基金会负责卫生政策的执行副总裁拉里·莱维特(Larry Levitt)表示:“这个想法不仅仅是让医疗保险为自己的项目谈判价格，还将这些谈判价格扩大到私人保险计划。“这将使毒品与其他类型的毒品平起平坐卫生保健。医疗保险协商或设定医院护理和医生就诊的价格。"

根据一个国会预算办公室的数据，联邦政府可以在10年内节省4500亿美元分析-有助于抵消其他举措的成本或减少赤字的节余。消费者也可以在药房柜台获得节省。

“每个人都会通过几个不同的渠道感受到这一点。兰德公司的健康政策研究员安德鲁·马尔卡希对此进行了研究，他说:“在某些情况下，这意味着药房的自付费用减少，在其他一些情况下，这意味着我们支付处方药保险的费用减少。”这个问题。

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制药公司警告称，收入损失的代价将是巨大的，这将颠覆美国经济的一个关键部分，导致就业岗位减少，用于新药研发的资金减少。

“我们当然有利润，但这不像是我们保留的，对吗?我们把它还给股东，他们给我们钱，让我们在R&D承担巨大风险，”礼来公司首席执行官戴夫·里克斯说，公开文件显示，他去年获得了2300万美元的薪酬。

里克斯估计，尽管获得了数十亿美元的利润，但如果政府限制价格，该公司将不得不将实验性药物项目削减一半——这抑制了新冠肺炎大流行期间制造商的创新。

里克斯说:“全球批准治疗COVID的六种药物中有五种来自美国公司——两种来自我的公司，全球使用的疫苗中有三种来自美国公司。

一项独立的政府分析预测，未来10年，上市的新药将减少两种，此后10年将减少23种。

俄亥俄州的苏·米利肯(Sue Millikan)是一名退休人员，也是医疗保险覆盖范围内的祖母，她说高价格令她担忧，但错过医疗突破的前景也令她担忧。

密立根说:“由于我们的自由，我们能够在这个国家做事情，发明和生产东西，我不想看到对此的限制。“我可以看到它在其他国家发生的地方，在那里它限制了他们得到多少药物，当他们得到它们时，你能多快得到东西，我不想看到这种情况在这里发生。”

布莱恩·奥林·多齐尔/美联社档案

众议院议长南希·佩洛西在新闻发布会上谈到医疗保健和公共关系.

尽管许多美国人都有同样的担忧，民调显示大多数美国人——民主党人、共和党人和无党派人士——一直支持政府就药品价格进行谈判。

“试图弄清楚10年、20年、30年后可能会发生什么，这真的很投机，”莱维特说。“我们甚至不知道会有什么科学突破，更不知道哪些药物可能会上市，哪些可能不会上市。”

他说:“在发达国家中，美国是唯一一个没有让政府在谈判或制定药品价格方面发挥作用的国家，这就是为什么我们支付的价格比世界其他国家高得多。

undefined更多:拜登、民主党在支出谈判中得分较低:美联社-NORC民调

据报道，对于像马斯顿这样的糖尿病患者来说，政府谈判药品价格可能意味着每月少供应28至176美元的胰岛素分析美国进步中心。

“这将是证明这一点的伟大的第一步，我认为两党中更多的人将从中受益并对此表示赞赏，”她说。

但白宫周四表示，这一想法在国会没有足够的票数。

一位要求不透露身份的拜登政府高级官员告诉记者:“归根结底，目前还没有足够的选票来让事情越过界线。

汤姆·威廉姆斯/美联社档案

参议员伯尼·桑德斯在PhRMA华盛顿办公室前的集会上发言...

罗恩·怀登参议员。他是参议院财政委员会主席，也是医疗保险药物谈判的主要倡导者，他说他仍在为该计划的精简版本而斗争。

伯尼·桑德斯参议员。，也坚决主张在对社会支出计划进行最终表决之前恢复该提案。

他说:“美国人民非常非常清楚，他们厌倦了为处方药支付世界上最高的价格。“年复一年，国会议员谈论处方药的高成本，但年复一年，我们却无能为力，这真是令人愤慨。”

目前，制药公司似乎正在赢得这场辩论。该行业正在推动替代救济，如限制关键药物的自付费用和扩大某些药物的医疗保险覆盖面。

“我们的理解是这是一个框架。今年，我们将继续随时准备与政策制定者合作，实施有意义的改革，降低患者的自付费用，”药品行业贸易组织PhRMA的发言人布莱恩·纽维尔(Brian Newell)表示。

与此同时，数百万美国人希望国会不要浪费这一时刻，多年来关于药品价格的辩论最终将导致一些行动。

“我认为没有人对药品价格的上涨感到满意，”米利肯说。

Prescription drug cost relief nixed from Democrats' plan

A popular plan to let the government directlynegotiate lower prescription drug priceswith pharmaceutical companies -- extracting significant savings for taxpayers and patients -- will likely not be part of the Democrats'sweeping social spending package, the White House said Thursday.

The development dashed hopes for what many consumer advocates had considered the best chance in decades for immediate relief to families burdened by soaring costs of medication. It also marks a major victory for drug makers who have spent millions of dollars lobbying against direct government intervention in pricing.

"Unless the government steps in and fights the fight for us, we have to fight it. And we don't have a choice," said Laura Marston, 39, of Washington, D.C., who needs daily doses ofinsulin to survive. The drug's list price has risen 1000% over the last 25 years.

"Every day I feel like I live in a country that prides itself on freedom, but I don't get to be free because at 14 I was diagnosed as a type 1 diabetic," she said.

Americans pay more for prescription drugs than citizens of any other country in the world, on average $1,200 per person, per year,according tothe Organization for Economic Cooperation and Development.

While individual American insurance companies negotiate discounts with drug makers, federal law prohibits the government from doing the same thing.

Most Democrats and patient groups have pushed for changes to the law that would allow the government to negotiate prices through Medicare under a cap pegged to what other wealthy nations pay.Former President Donald Trumpalso campaigned on the idea in 2016.

"The idea is not just to have Medicare negotiate prices for its own program but to extend those negotiated prices to private insurance plans as well," said Larry Levitt, executive vice president for health policy at the nonpartisan Kaiser Family Foundation. "This would put drugs on equal footing with other types ofhealth care. Medicare negotiates or sets the price for hospital care, for doctor visits."

The federal government could save $450 billion over 10 years, according to one Congressional Budget Officeanalysis-- savings that could help offset the costs of other initiatives or reduce the deficit. Consumers would also reap savings at the pharmacy counter.

"Everyone would feel it through a couple of different channels. In some cases, it would mean less out of pocket at the pharmacy, and in some other cases it would mean less that we pay for prescription drug coverage," said Andrew Mulcahy, a health policy researcher at RAND Corporation, who has studiedthe issue.

Drug companies have warned that the trade-offs from lost revenue would be significant, upending a key part of the U.S. economy, leading to job losses and less money for research and development of new drugs.

"Of course we make profit, but it's not like we keep it, right? We return it to shareholders who give us money to take huge risk on R&D," said Lilly CEO Dave Ricks, whom public filings show received a $23 million compensation package last year.

Ricks estimates that despite earning billions in profits, the company would have to cut experimental drug projects in half if the government capped prices -- curbing the kind of innovation seen from manufacturers during the COVID-19 pandemic.

"Five of the six medicines approved globally to treat COVID are from American companies -- two from mine, and three of vaccines that are used globally are from American companies," Ricks said.

An independent government analysis forecasts there would be two fewer new drugs brought to market over the next 10 years, with 23 fewer over the decade after that.

Sue Millikan of Ohio, a retiree and grandmother covered by Medicare, says high prices concern her but so does the prospect of missing out on medical breakthroughs.

"We are able to do things here in this country because of our freedoms and invent things and produce things, and I don't want to see restrictions to that," Millikan said. "I can see where it's happening in other countries where it limits how many drugs they get, when they get them, how fast you can get stuff, and I don't want to see that happen here."

While many Americans share those concerns,polls showthat large majorities of Americans -- Democrats, Republicans and Independents -- have consistently supported government negotiation of drug prices.

"It's really speculative to try to figure out what might happen, you know, 10, 20, 30 years from now," said Levitt. "We don't even know what scientific breakthroughs there will be, let alone what drugs might or might not come to market."

"The United States is alone among developed countries in not having a role for the government in negotiating or setting the price of drugs, and that's why we pay much higher prices than the rest of the world," he said.

For diabetics like Marston, government negotiation of drug prices could mean between $28 and $176 less for a monthly supply of insulin, according toan analysisby the Center for American Progress.

"It would be a great first step to demonstrate that and I think more people across both parties would benefit from that and appreciate that," she said.

But the White House on Thursday said the idea doesn't have enough votes in Congress.

"At the end of the day, there are not yet enough votes to get something across the line," a senior Biden administration official, who asked not to be identified, told reporters.

Sen. Ron Wyden, D-Oreg., who chairs the Senate Finance Committee and is a leading advocate for Medicare drug negotiations, says he is still fighting for a slimmed-down version of the plan.

Sen. Bernie Sanders, I-Vt., is also adamant that the proposal be restored before a final vote on the social spending plan.

"The American people are very, very clear that they are sick and tired of paying the highest prices in the world for prescription drugs," he said. "It is really outrageous that year after year, members of Congress talk about the high cost of prescription drugs and yet, year after year, we are not able to do anything about it."

For now, the drug companies appear to be winning the debate. The industry is pushing alternatives for relief, like caps on out-of-pocket expenses for critical medicines and expansion of Medicare coverage of some drugs.

"Our understanding is this is a framework. We continue to stand ready to work with policymakers this year to enact meaningful reforms that will lower out-of-pocket drug costs for patients," said Brian Newell, spokesman for PhRMA, the drug industry trade group.

In the meantime, millions of Americans hope Congress won't squander this moment, and years of debate over drug prices will finally lead to some action.

"I don't think anybody's happy with how drug prices have gone up," Millikan said.