Lowering Prescription Drug Prices for Working Families Act

The bill amends Title XI of the Social Security Act to expand the Medicare Drug Price Negotiation Program established in 2022. The number of drugs subject to negotiation rises from 20 to 50 per year. Selection criteria are unchanged: the drugs must lack generic or biosimilar competitors and account for the highest Medicare spending.

A new "international reference pricing" floor is established. For any negotiated drug, the price Medicare pays cannot exceed 120 percent of the median price paid for the same drug in Canada, France, Germany, Japan, the United Kingdom, and Australia. Manufacturers refusing to negotiate face an excise tax beginning at 65 percent of the drug's U.S. sales revenue and rising over time.

The bill also requires the Secretary of Health and Human Services to publish negotiated prices publicly within 30 days of agreement, ending the current 90-day confidentiality window.

Proponents argue that other wealthy democracies pay 30 to 60 percent less for the same drugs and that the U.S. system is the outlier. They point to the Inflation Reduction Act's initial 10-drug negotiation round as evidence that the model works without disrupting drug development.

Critics raise two distinct concerns. The pharmaceutical industry argues that international reference pricing imports the rationing decisions of foreign single-payer systems into the United States, and that the excise tax functions as a de facto price control. A separate critique from some health economists is more empirical: the IRA's first negotiations produced modest savings against a much smaller drug list, and extrapolating to 50 drugs and a reference-price floor introduces real uncertainty about R&D effects that the bill does not study.