Senator Bernie Sanders (I-Vt.) is currently at odds with the White House regarding drug pricing, causing frustration and confusion among public health experts. They are concerned that his demands may hinder the confirmation of Monica Bertagnolli, the nominee for the National Institutes of Health (NIH) leadership position.
Bertagnolli, a respected cancer surgeon and current leader of the National Cancer Institute, has received support from a wide range of medical research professionals who have been advocating for her confirmation.
However, Sanders has stated that he will not hold a hearing for any health nominee until the White House presents a “robust” plan to lower drug prices. So far, such a plan has not been provided.
“We have not received a pricing plan from the administration,” Sanders recently commented. “The high cost of prescription drugs is a significant crisis for American healthcare, and it is a problem that needs to be addressed.”
The White House has not responded to inquiries about whether they have engaged with Sanders to discuss a way forward. While Sanders and President Biden recently met with young labor organizers, the topic of Bertagnolli’s nomination did not come up.
In response to previous questions, the White House has acknowledged that President Biden shares Sanders’s concerns about drug prices. They pointed to the Medicare drug price negotiation provisions in the Inflation Reduction Act and the $35 cap on insulin for Medicare beneficiaries as actions already taken to address the issue.
With just over a week until the August recess, health advocates and Bertagnolli’s allies are growing concerned. They believe that the White House should apply more pressure to persuade Senator Sanders to move forward with the nomination.
Harold Varmus, former NIH director under the Clinton administration and a close ally of Bertagnolli, believes that while the goal of lowering drug prices is honorable, it should not be tied to the current nomination.
“My concern is that we’re interfering with the functioning of the government… and this doesn’t seem like the right occasion to try to solve the issues through a game of chicken,” Varmus expressed.
“Having the party in control of the White House delaying its own nominations is not the way to establish a strong administration,” he added.
The position of NIH director has been vacant since Francis Collins left the agency in December 2021. Lawrence Tabak has been serving as the acting director for over 18 months.
Bertagnolli was nominated in May, but the earliest opportunity for a hearing is likely to be in September. During that time, the congressional calendar will be filled with appropriations bills and efforts to prevent a government shutdown, tasks that a confirmed leader could help navigate.
As the chairman of the Senate Health, Education, Labor and Pensions Committee, Senator Sanders holds significant influence and can prevent the confirmation of any health nominees without his support. The NIH is currently the only health agency with a Senate-confirmable vacancy at the top.
Sanders is calling for additional steps beyond those outlined in the Inflation Reduction Act. In a statement following the passage of the law last summer, he described the drug negotiation provision as a “small step,” particularly since it only applies to 10 drugs and won’t take effect until 2026.
He has advocated for specific policies, such as reinstating an NIH requirement that compels companies to sell a drug at a “reasonable” price if it was developed with research assistance from the federal government. This consideration would factor in the drug’s production cost, public need, and taxpayer investment. This policy was effective during the early 1990s but was repealed by Varmus in 1995 due to pharmaceutical companies’ lack of cooperation. Varmus argued that the NIH is not a regulatory agency and should not be involved in pricing decisions.
Sanders also wants the federal government to utilize “march-in rights” to seize drug patents and license them out to other manufacturers in order to lower prices. However, the administration has consistently declined to do so, including in the case of the prostate cancer drug Xtandi in March.
Health advocates argue that these issues are only tangentially related to the NIH and should not be used as leverage in the confirmation process.
Beyond the NIH, advocates are concerned that Sanders’s actions could set a precedent for politicizing future noncontroversial health nominees. For instance, the confirmation process for the director of the Centers for Disease Control and Prevention (CDC) will commence in January 2025.
“This is an example of what we can expect to happen during the confirmation process for the CDC director,” said Georges Benjamin, executive director of the American Public Health Association.
“It introduces politics into the process, potentially dissuading highly qualified individuals from seeking the position due to the hassle associated with confirmation,” Benjamin warned.
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