Despite this election season’s divisiveness, both major parties’ presidential candidates have embraced the idea of authorizing Medicare Part D to negotiate directly with drug companies to set prescription drug prices. The Medicare Modernization Act of 2003 (MMA), which established Medicare Part D, included a ban on such negotiation. In theory, if the Centers for Medicare and Medicaid Services (CMS) could negotiate with pharmaceutical companies, the agency could leverage its purchasing power to pay less for drugs. The idea has received considerable media attention over the past few months and has broad public support, reflected in a recent poll showing 87 percent of Americans have a favorable view of the idea.

Nevertheless, if history is any guide, politics may prevent a full repeal of the ban. It took almost 40 years to add a prescription-drug benefit to Medicare — a fact that may be surprising given how much seniors spend on pharmaceuticals. A coalition of stakeholders, including the pharmaceutical industry, helped defeat President Bill Clinton’s failed effort at health reform, and President Obama is said to have learned from that experience. President Obama secured the support of the drug industry early in the process of enacting the Affordable Care Act (ACA), so it may not be a surprise that the ACA does not do much to address drug pricing. The political process has continued to stymie more recent efforts to make even modest changes in this direction. The candidates’ promises to repeal the ban may therefore be difficult to keep.

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