https://www.nytimes.com/2021/11/02/us/politics/prescription-drug-prices-medicare.html

Democrats reached a deal on Tuesday to add a measure to control prescription drug costs to President Biden’s social safety net plan, agreeing to allow the government to negotiate prices for medications covered by Medicare, as the House moved closer to a vote on the sprawling bill.

Negotiators also closed in on a costly agreement to reinstate a federal tax deduction, eliminated in the 2017 tax cuts signed by President Donald J. Trump, for state and local taxes.

The prescription drug deal is limited. Starting in 2023, negotiations could begin on what Senator Ron Wyden of Oregon called the most expensive drugs — treatments for cancer and rheumatoid arthritis, as well as anticoagulants. Most drugs would still be granted patent exclusivity for nine years before negotiations could start, and more advanced drugs, called biologics, would be protected for 12 years.

But for the first time, Medicare would be able to step in after those periods, even if drug companies secure patent extensions or otherwise game the patent system.

The prescription drug compromise was hard-fought and required Democrats to overcome an onslaught of lobbying by the powerful pharmaceutical industry, which succeeded in substantially watering down their initial bid to allow the government to negotiate prices on a far broader universe of drugs. The final deal includes a $2,000 annual cap on out-of-pocket expenditures by older Americans facing catastrophic health issues, a strict $35 monthly cap on insulin expenses and automatic rebates on drugs whose prices rise faster than inflation.

But the pharmaceutical industry won its share of concessions. The inflation rebates initially contained a “look back” provision that would have assessed rebates on drug prices that began to soar as far back as 2012. That would have yielded one-time levies on drug companies in the billions of dollars. And some Democrats wanted Medicare to have price-negotiating authority immediately, with no patent exclusivity periods.

https://thehill.com/homenews/senate/579497-sanders-hits-back-at-manchins-spending-concerns h

Sen. Bernie Sanders (I-Vt.) took a veiled swipe at Sen. Joe Manchin (D-W.Va.) on Monday after the moderate senator raised a red flag about the costs of Democrats’ social and climate spending bill.

Sanders, speaking with reporters at the Capitol, didn’t mention Manchin by name, instead addressing “anybody in the Democratic caucus or elsewhere that’s worried about fiscal responsibility and the deficit.”

“The fact is … that, according to the CBO [Congressional Budget Office], the infrastructure bill runs up to a $250 billion deficit. It’s not paid for,” Sanders said.

“The legislation that I wanna see passed … is paid for in its entirety. It will not have an impact on inflation. So if we’re talking about fiscal responsibility, I think what we’re trying to do with the reconciliation bill is the right thing,” he added.

The CBO estimated in August that the roughly $1 trillion infrastructure bill, which was negotiated by a group of senators, including Manchin, would add $256 billion to the deficit over the next decade.

I've seen enough: Glenn Youngkin (R) defeats Terry McAuliffe (D) in the Virginia governor's race. #VAGOV

— Dave Wasserman (@Redistrict) November 3, 2021