For months now, House Democratic Party leaders have been feuding behind closed doors with members of the Congressional Progressive Caucus about how to lower prescription drug prices. But as details of negotiations between House Speaker Nancy Pelosi (D-Calif.) and President Donald Trump have leaked into the public, frustration among progressives is boiling over. Speaking in a personal capacity on Thursday, Rep. Ro Khanna (D-Calif.) told HuffPost that he and “the overwhelming majority” of his fellow CPC members “will oppose” any prescription drug bill that cedes the government’s authority to regulate drug prices to an independent arbitration firm. It’s a direct challenge to Pelosi ― who is championing arbitration in private ― and an effort to disrupt the talks with Trump, which progressives believe are ignoring their views. “Any bill that allows Pharma to engage in arbitration is inconsistent with a real effort to hold Big Pharma accountable,” said Khanna, who is vice chairman of the CPC, but was careful to note that he was not speaking on behalf of CPC leadership. “The Democrats should at the very least get behind” price negotiation with the threat of ending drug monopolies. House Democrats promised lower prescription drug prices throughout the 2018 midterm campaigns, and began their new majority in 2019 with a plethora of legislative options. Sen. Bernie Sanders (I-Vt.) and Khanna proposed one plan in November, followed quickly by Sen. Jeff Merkley (D-Ore.) with another. Both bills would require pharmaceutical firms to bring the prices they charge in the United States in-line with a much lower average international price ― or face severe penalties. In early February, Rep. Lloyd Doggett (D-Texas), introduced yet another bill that would allow Medicare to negotiate lower prices with pharmaceutical companies. Under Doggett’s bill, if drug companies refused to play ball, the government would be empowered to license a competing firm to issue a high-priced drug and a lower, government-approved price. Since Doggett chairs the Health Subcommittee on the powerful Ways and Means Committee, his bill would be the logical starting point for a drug bill under ordinary congressional procedure. But big-ticket legislation has been bypassing the committee process since the Obama years. Most major bills in recent years have been negotiated between the White House and congressional leadership. The spat between progressives and Pelosi carries significant implications for the internal power dynamics of the Democratic caucus, in addition to its ramifications for household medical bills.

Bill Clark/Getty Images House Speaker Nancy Pelosi (D-Calif.) has kept progressives in her caucus in line thus far. Could a fight over lowering prescription drug prices change that?

.@realDonaldTrump is letting Big Pharma walk all over him. This isn't how you lower prescription drug prices. https://t.co/8SIoq30rYx — Nancy Pelosi (@SpeakerPelosi) October 22, 2018