The pharmaceutical industry, which suffered a stinging defeat last year when President Biden signed a law authorizing Medicare to negotiate the price of some prescription drugs, is now mounting a full-scale attack on the measure — just as negotiations are about to begin.

The law, the Inflation Reduction Act, is a signature legislative achievement for Mr. Biden, who has boasted that he took on the drug industry and won. Medicare is the federal health insurance program for the elderly and disabled; the provisions allowing it to negotiate prices are expected to save the government an estimated at $98.5 billion more than a decade while lowering insurance premiums and out-of-pocket costs for many older Americans.

on tuesday, Johnson & Johnson became the latest drug maker to take the Biden administration to federal court in an attempt to end the drug pricing program. Three other pharmaceutical companies – Merck, Bristol Myers Squibb and Astellas Pharma — conducted their own trials, as well as the industry’s leading trade group and the American Chamber of Commerce.

The suits make similar and overlapping claims that the drug pricing provisions are unconstitutional. They are scattered in federal courts across the country — a tactic experts say gives the industry a better chance of obtaining conflicting rulings that will speed the legal challenges to a business-friendly Supreme Court.

The legal push comes just weeks before the Centers for Medicare & Medicaid Services is scheduled to release a long-awaited list of the first 10 drugs that will be subject to negotiations. The list is issued before September 1; the manufacturers of the selected drugs have until October 1 to declare whether they will participate in negotiations — or face steep financial penalties for not doing so. The lower prices won’t take effect until 2026.

Earlier this month, the chamber asked a federal judge in Ohio to issue an injunction that would block any negotiations while its case is heard.

Lawrence O. Gostin, an expert in public health law at Georgetown University, said the Supreme Court may be sympathetic to some of the industry’s arguments. In particular, he pointed to a claim by drug manufacturers that by requiring them to negotiate or pay a fine, the law violates the Fifth Amendment’s prohibition on taking private property for public use without just compensation.

“The Supreme Court is openly hostile to any perceived violation of the Fifth Amendment,” Mr. Gostin said, adding, “It wouldn’t surprise me at all to see these cases go to the Supreme Court and for them to strike it down.”

For Mr. Biden and his fellow Democrats, that would be a painful blow. The president and Democrats have long campaigned on reducing drug prices and plan to make it a central issue of their 2024 campaigns. The White House press secretary, Karine Jean-Pierre, said in a statement that Mr. Biden is confident the administration will win in court.

“For decades, the pharmaceutical lobby has blocked efforts to let Medicare negotiate lower drug costs,” she said. “President Biden is proud to be the first president to defeat them.”

Republicans have opposed the drug pricing provisions, which they view as a form of government price control. But the politics of the matter is treacherous for them. Because so many Americans worry about high drug prices, it’s hard for Republicans to come to the industry’s defense, said Joel White, a Republican strategist with expertise in health policy.

Instead, Republicans are focusing on another drug industry priority: scrutinizing the practices of pharmacy managers who negotiate prices with drug companies on behalf of health plans. The drug companies say that through an intermediary, the managers of pharmacies contribute to the high cost of prescription drugs.

For drugmakers, the stakes of the legal challenges are greater than just their business with Medicare, their largest customer. The industry fears that Medicare will, in effect, set the bar for all payers, and that once the government’s lower prices are made public, pharmacy benefit managers negotiating on behalf of the privately insured will have more leverage to demand deeper discounts.

In conjunction with its legal campaign, the pharmaceutical industry is waging a public relations offensive. The industry trade group that filed one of the lawsuits, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, is running ads targeting pharmacy benefit managers, and industry executives publicly argue that the drug prices will lead to fewer cures. The implication is clear: Lower prices will mean a dent in revenues, which will discourage companies from developing certain drugs.

“You can’t take hundreds of billions of dollars out of the pharmaceutical industry and not expect it to have a real impact on the industry’s ability to develop new treatments and cures for patients,” said Robert Zirkelbach, executive vice president at PhRMA. He quoted analysis funded by the drug Gilead Sciences which claimed that the industry would lose $455 billion over seven years if companies negotiated with Medicare.

study released last month that was funded by the Biotechnology Innovation Organization, another trade group, warned that the pricing provisions would discourage innovation, resulting in as many as 139 fewer drug approvals over the next 10 years.

But that estimate is at odds with an analysis by the Congressional Budget Office, which estimated the law would result in just one fewer drug approval over a decade and about 13 fewer drugs over the next 30 years.

In addition, many new drugs “do not offer a clinically meaningful advantage over existing drugs,” said Ameet Sarpatwari, a pharmaceutical policy expert at Harvard Medical School. The Inflation Reduction Act, he said, might encourage companies to focus more heavily on innovative therapies, instead of so-called me-too drugs, because the law requires the government to consider the clinical benefit of drugs in determining the price Medicare will pay for them.

Until now, Medicare has been expressly prohibited from negotiating prices directly with drug manufacturers – a condition the industry demanded in exchange for supporting the creation of Part D, the Medicare prescription drug program, which was signed into law 20 years ago by President George W. Bush.

Under the Inflation Reduction Act, the government will select an initial set of 10 drugs for price negotiations based on how much the Part D program spends on them. More drugs will be added in the coming years.

Experts are waiting the initial list of medications to include commonly prescribed medications such as the blood thinners Eliquis and Xarelto; cancer drugs such as Imbruvica and Xtandi; Symbicort, which treats asthma and chronic obstructive disorder; and Enbrel, for rheumatoid arthritis and other autoimmune disorders.

Medicare already pays discounted prices for those drugs. In 2021, the most recent year for which data is available, Medicare spent about $4,000 per patient for Eliquis and Xarelto, which at the time had sticker prices of $6,000 a year. The lower price reflects rebates extracted from drugmakers by pharmacy benefit managers negotiating on behalf of the private companies that contract with the government to administer Part D plans.

But those negotiations are opaque and only modestly reduce Medicare spending. The rationale behind the drug price provisions of the Inflation Reduction Act is that because Medicare covers so many people, it can use its leverage to extract even deeper discounts.

The United States spends more per person on drugs than comparable nations, in part because other countries proactively control drug prices. Surveys show that many Americans give up taking their medications because they cannot afford them.

Experts say the Medicare negotiation program is likely to translate into direct savings for seniors, initially in the form of reduced premiums made possible by reduced drug spending. And when lower prices go into effect in 2028 for drugs administered in clinics and hospitals under another Medicare program, known as Part B, that could mean lower out-of-pocket costs for seniors covered by traditional Medicare who don’t have supplemental insurance.

Supporters of the Inflation Reduction Act say that in addition to saving money for the government and patients, the negotiations will inject much-needed transparency into the complicated process of determining drug prices. If a company refuses to negotiate, it must either pay a hefty excise tax or withdraw all of its drugs from both Medicare and Medicaid.

“This is not a ‘negotiation,'” Merck said in its complaint. “It amounts to blackmail.”

Taken together, the lawsuits make various constitutional arguments. In addition to the claim that the government violates the Fifth Amendment by wrongfully taking property, they include claims that the law violates the First Amendment by requiring drug companies to agree in writing that they are negotiating a “fair price.” Another argument is that the excise tax amounts to an excessive fine, which is prohibited by the Eighth Amendment.

“If the government can impose price controls like this on drug companies,” said Jennifer Dickey, deputy counsel at the chamber’s legal arm, “it could do the same to any sector of our economy.”

Biden administration officials say there is nothing binding about the law. They argue that the companies are free not to negotiate and that they can issue news releases or make other public statements disagreeing with the negotiated price. And they note that the government routinely negotiates for the purchase of other products and that the Department of Veterans Affairs already negotiates drug prices with pharmaceutical companies.

“To me, Medicare is doing what it should be doing,” said Mr. Gostin, the Georgetown professor. “It’s a huge buyer of product, and it basically uses that power, that bargaining power, to get the best price.”

The drug industry is “throwing the kitchen at the government,” he added. “They’re looking for what’s left, and their arguments are aimed squarely at the Supreme Court.”

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