House Hearing Highlights Partisan Divide on Drug Pricing and Healthcare Affordability

The House Committee on Energy and Commerce Subcommittee on Health held a Feb. 11 hearing focused on the prescription drug supply chain, revealing deep partisan divisions over how to address high drug costs that push patients to forgo care.

Republicans focused on structural problems in the supply chain, arguing that vertical integration, market concentration among PBMs, and opaque rebate and contracting practices distort competition and inflate costs. They emphasized increasing transparency across the supply chain, strengthening employer leverage, supporting independent and rural pharmacies, modernizing FDA processes to accelerate generics and biosimilars, and removing regulatory barriers that limit competition. Republicans repeatedly stressed preserving U.S. pharmaceutical innovation while lowering costs, expressing concern that policies included in the Inflation Reduction Act (IRA) and regulatory unpredictability could discourage investment. They framed PBM reform, competition, and supply chain transparency as key tools to reduce prices without undermining research and development.

Democrats centered their remarks on patient affordability and corporate accountability, arguing that high drug prices stem from systemic pricing strategies, excessive industry profits, and market concentration among PBMs and manufacturers. They defended the IRA's Medicare negotiation and inflation rebate provisions, called for expanding affordability protections such as enhanced premium tax credits (EPTCs), and criticized reported lack of transparency in administration drug pricing agreements. Democrats also raised concerns about instability at NIH and FDA, warning that research cuts and regulatory interference threaten innovation and public trust. Throughout the hearing, they emphasized that affordability and innovation are not mutually exclusive and advocated building on existing price negotiation authorities to deliver meaningful consumer savings.

One-third of adults report they didn't fill a prescription, skipped doses, cut pills in half or opted for over-the-counter medications due to cost in the past year, according to a poll by health policy researcher KFF.

Democrats argued policies from Republicans and the Trump administration — like major cuts to Medicaid and National Institutes of Health grants, as well as allowing more generous financial support for Affordable Care Act plans to lapse — are making the country's healthcare affordability issues worse. Lawmakers pointed toward the enhanced ACA premium tax credits, which expired at the end of the year and sent premiums soaring on the exchanges.

Another challenge to pharmaceutical innovation are shifts at the HHS, including funding cuts for research and moves to overhaul vaccine policy, Democrats say. The NIH issued about 24% fewer grants last year, which is likely to lead to fewer treatments over time since nearly all newly approved drugs are supported by agency funding at some point in their development, testified Rachel Sachs, a professor of law at Washington University in St. Louis.

The administration's new vaccine policy could also create barriers, Democrats say. Moderna said Tuesday that the Food and Drug Administration declined to review an application to approve the pharmaceutical firm's messenger RNA-based influenza vaccine, a decision it called "inconsistent" with the agency's previous guidance. During the hearing, John Crowley, president and CEO of the Biotechnology Innovation Organization, said he couldn't comment on any specific company or decision, but noted biotech firms are "concerned about shifting standards."

One of the administration's latest efforts to bring down the cost of drugs, TrumpRx, likely won't help much, Democrats say. The online portal allows consumers to buy around 40 drugs directly from manufacturers that reached pricing deals with the White House. However, many of the included medications are already heavily rebated or wouldn't be more affordable than accessing them through insurance. And TrumpRx often directs patients back to pharmaceutical companies' existing direct-to-consumer sales or discount programs.

The hearing included testimony from trade groups representing pharmaceutical manufacturers, group purchasing organizations, distributors, pharmacy benefit managers, employers and pharmacies. Pharmaceutical Research and Manufacturers of America (PhRMA) Chief Operating Officer Lori Reilly, Esq., testified that the 340B program has been exploited by PBMs, private equity firms, and some nonprofit hospitals, and urged the committee to examine the program more closely.

Many lawmakers in particular raised concerns about PBMs — middlemen that work with insurers, employers and other payers to manage prescription drug benefits — which have increasingly been targeted by Congress and regulators. They also noted the supply chain for medications is complex, including a number of stakeholders involved in drug delivery.