Sen. Charles E. Grassley’s return to the helm of the Finance Committee could put him in a position to address high prescription prices, although former aides say his biggest initial contribution to the drug debate will be his zeal for accountability.

Mark Hayes, a former Finance chief health counsel under Grassley, said the Iowa Republican’s well-earned reputation for oversight can be a catalyst for action.

“While the legislative process can often present its challenges, shining a light on an issue can often get change moving faster,” Hayes said.

Grassley might also be open to working with the Trump administration on some issues, like revisiting Medicare requirements to cover all drugs in six protected categories, predicted Rodney Whitlock, vice president for health policy at consulting firm ML Strategies and a former Finance health policy adviser.

Grassley has backed some aspects of the Trump administration’s drug pricing plans that other Republicans have not, such as a proposal to link some Medicare reimbursements to the lower prices paid in other countries.

Grassley’s office declined to offer specifics on his health care agenda. But Whitlock speculated that hearings are possible.

“Every health care stakeholder who has anything to do with drug pricing should expect Grassley is going to be very comfortable talking about it,” Whitlock said.

But, he added, “We’re a long way away from actually trying to write and design legislative changes.”

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Grassley’s positions

Grassley was chairman of the Finance Committee from 2003 to 2006. He then served as ranking member until 2011. In his previous term as Finance chairman, he used the post to investigate the safety issues surrounding the painkiller Vioxx and pushed for more surveillance into risks once a drug is on the market.

In his statement announcing the decision to return, Grassley said one of his priorities would be “improving the affordability, quality and accessibility of health care, including in rural America.”

While the Finance Committee oversees the Medicare and Medicaid federal health programs, some of the main drug-pricing policies that Grassley supports would not go through Finance. Bills related to importing cheaper drugs from Canada if they are safe and discouraging drugmakers from anti-competitive behavior would go through other committees.

And Grassley has historically opposed the policy that many other drug industry critics would like his committee to approve: letting the government negotiate with manufacturers over Medicare drug reimbursements.

So while Grassley will likely call attention to the issue of drug prices, it’s too soon to say what kind of legislative impact he’ll have.

In the current Congress, his efforts on drug pricing were mainly before the Judiciary Committee, whose chairmanship he is vacating.

Despite opposition from Senate Republican leaders, this summer he moved a bill through the Judiciary panel that would discourage drugmakers from blocking sales of samples needed for potential generic competitors to develop their cheaper copies. He also sponsored a bill that would restrict financial deals that branded drug companies strike with generic drugmakers to delay the introduction of a cheaper version.

The bill related to drug samples is a perennial candidate to ride along with must-pass spending bills and could advance during the lame-duck session. If it needs to be reintroduced next session, it still might gain traction, since the next expected Judiciary chairman, Lindsey Graham of South Carolina, voted for it in committee.

But Grassley aligns with the pharmaceutical industry on aspects of the drug pricing debate.

He is interested in the 340B program, which allows hospitals serving low-income patients to buy certain drugs at a discount from their manufacturers but still collect reimbursements closer to the original, higher price. The number of participating hospitals ballooned after the 2010 health care law expanded both the 340B program and access to coverage.

The pharmaceutical industry argues that too many wealthy hospitals now take advantage of the discounts, driving up drug prices elsewhere. In March, Grassley introduced a bill that would require the hospitals to report the amount they paid for the drugs and the amount they were reimbursed.

He also sponsored a bill to make it easier for Medicare’s prescription drug benefit to reimburse for drugs when they are given for something other than their FDA-approved indication.

Still, advocates for lower drug prices are excited about Grassley’s move to Finance and say it could prompt bipartisan cooperation.

David Mitchell, the founder of Patients for Affordable Drugs, a nonprofit group whose campaign arm is highly critical of lawmakers who accept industry funding, cheered Grassley’s choice.

“He’s a real leader on bipartisan legislation to lower [prescription] prices,” Mitchell said in a Twitter message. He added that the combination of Grassley with Oregon’s Ron Wyden, the committee’s ranking Democrat, is a “big win for patients.”

In December 2015, the duo released the results of an 18-month investigation into the prices of the hepatitis C drugs Harvoni and Sovaldi, which at the time of their introductions had prices of around $80,000 — or $90,000 for a single treatment course. While some lawmakers argue that prices reflect the research costs needed to bring a drug to market, Grassley and Wyden found that the companies set the prices irrespective of those costs.

Wyden, for his part, is urging Grassley to build on his record of calling attention to drug prices.

“Voters made clear that they want their representatives in Congress to put working Americans’ interests above multinational corporations or insurance companies or Big Pharma,” Wyden said in a statement. “Americans have asked for real change, and I urge the incoming chairman to work with all the members of the committee to make that a reality.”