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The Lower Drug Costs Now Act of 2019 represents a major departure from the U.S. status quo. It has several key but politically divisive provisions targeting prices paid to drug manufacturers and would reduce Medicare spending and beneficiaries’ out-of-pocket costs.

By negotiating prices only for drugs that have too little evidence to support full approval or are too late in their life cycle to justify continued high prices, Medicare could both deliver substantial savings and preserve the incentive framework for innovation.

Senator Lamar Alexander, a Tennessee Republican who was the bill’s lead sponsor, said that, despite Democrats’ and Republicans’ contentious disagreement on other subjects, “we have an urgent, bipartisan consensus, a virtually unanimous agreement, to deal with the most urgent public health epidemic facing our country today.” Keith Humphreys, a drug policy expert at Stanford University who worked with Senate and House staff on the bill, told the news website Vox that the lack of funds “reflects a fundamental disagreement between the parties over whether the government should appropriate the large sums a massive response would require. The Food and Drug Administration will be required to draw up new opioid prescribing guidelines for various conditions, and Medicare patients considered at risk will be part of a drug management programme.