House Speaker Nancy Pelosi (D-Calif.) told Democrats on Wednesday night that she will put her weight behind a byzantine proposal aimed at lowering prescription drug prices ― a plan that progressive critics worry will ultimately have little to no effect. Pelosi’s office has been in private talks with the Trump administration about a prescription drug policy for months. Her decision to proceed with that drug plan surprised her fellow Democrats, coming the same day as a very public spat in which President Donald Trump walked out on a meeting with the speaker and refused to negotiate on an infrastructure bill unless Democrats abandoned investigations into his administration. Capitol Hill sources tell HuffPost that the prescription drug proposal, which has not been officially released to the public, would empower the secretary of health and human services to negotiate lower prices with pharmaceutical companies for drugs sold in the U.S. If the two parties failed to reach an agreement on an individual medication, the Government Accountability Office would be permitted to set a final price close to the typical amount charged for the drug in other countries. The Department of Health and Human Services would be required to negotiate on at least 25 drugs each year, and companies that refused to participate would be slapped with a tax equal to 50 percent of their prior year’s sales of the drug. Prices on all drugs covered under Medicare Parts B and D could not be increased going forward, and any company that still did so would have 100% of the price hike taxed away. A senior Democratic aide who described the plan to HuffPost cautioned that nothing had been set in stone, but said House leadership hoped to move quickly on the proposal after the Memorial Day recess.

NurPhoto via Getty Images House Speaker Nancy Pelosi has said she's moving forward with a byzantine proposal to lower prescription drug prices.

Although much still depends on the final details of the legislation, the scheme that Pelosi presented to her colleagues would represent a serious defeat for Democrats concerned about the power of Big Pharma and monopolies writ large. It is not clear, for instance, how HHS would select the 25 drugs in question or how long any lower prices would remain valid. “Twenty-five drugs is not enough,” said Steven Knievel, an advocate in Public Citizen’s Access to Medicines program. “They need to do more. Our demand is to do all drugs.” There is also nothing as yet to prevent HHS from simply negotiating bad deals that do not meaningfully lower drug prices. Presidents have long had the authority to set lower prices for costly drugs by issuing compulsory licenses, but Republicans and Democrats alike have failed to act on that power. Pelosi’s plan would make it slightly less cumbersome for presidents who want to lower drug prices to do so, but it does not actually require meaningful changes. “This is not even close to sufficient,” said Alex Lawson, executive director of Social Security Works, a left-leaning group that focuses on Social Security and Medicare issues. Lawson called the proposal an “extremely narrow” arrangement that eschews “structural reform.” “The American people are not demanding that some people get slightly lower drug prices at some point in the future,” Lawson said. “People are demanding lower drug prices right now.” “We think this arbitration proposal adds more rigging to a rigged system,” said John Hassell, national director of advocacy for the AIDS Healthcare Foundation. “It creates this hocus pocus process that isn’t going to lower prescription drug prices. It’s going to nickel and dime it on the sides. ... This is ridiculous.” The GAO’s role in the Pelosi proposal is unusual. The nonpartisan oversight agency examines government programs and serves as a kind of in-house think tank for Congress. It also plays an oversight role in the government contracting process and can investigate whether federal contracts have been improperly awarded. But the agency has no experience regulating industries or setting prices. Pelosi’s team settled on a role for the GAO after initially proposing a private-sector arbitration firm ― a plan that elicited outrage from progressives in Congress.

The American people are not demanding that some people get slightly lower drug prices at some point in the future. People are demanding lower drug prices right now. Alex Lawson, executive director of Social Security Works