Disagreement over provisions intended to ensure affordability of vaccines and other medications is holding up agreement on an emergency funding package to fight the novel coronavirus-caused illness that has killed over 3,000 worldwide, sources familiar with the talks said.

Republicans are raising concerns that Democrats’ proposals would chill research and development and interfere with the development of a vaccine, according to sources who spoke without being identified so they could talk freely. Republicans say they share the goal of making sure a vaccine is affordable, but do not want to suppress its development.

But senior Democratic aides said they are not advocating price controls. “Democrats want the supplemental to include significant funding for the federal government to purchase large quantities of coronavirus diagnostics, treatments and vaccine [when it becomes available], which will then be made available to the public without cost,” one aide said.

Another aide pointed to what was done during the 2009 swine flu outbreak. Congress provided $7.65 billion in a supplemental appropriation, part of which was for government vaccine purchases and the cost of planning and implementing a nationwide vaccination campaign.

Democratic negotiators were also pushing to ensure “fair and reasonable price” standards in existing contracting regulations are adhered to for new purchases of vaccines and other medications to treat COVID-19, the illness caused by the new coronavirus. An aide said that would prevent drugmakers from charging above-market rates.

The disputes over affordability provisions threatened to delay passage of the emergency aid bill, expected to total between $7 billion and $8 billion, that House leaders were aiming to bring to the floor as soon as Wednesday or Thursday.

Negotiators were continuing discussions behind the scenes as Washington state officials announced four more deaths, bringing the state’s toll to six — all of which occurred at EvergreenHealth, a Kirkland, Washington, hospital.

Health officials say older individuals are the most susceptible, and most of the victims so far have been in their 70s or 80s. Over the weekend, Senate Minority Leader Charles E. Schumer called for a provision in the supplemental that would ensure seniors covered under Medicare could receive COVID-19 vaccines free of charge, similar to flu shots. But some other immunizations are subject to copays under Medicare.

“Vaccines must be affordable and available to all who need them,” Schumer said Monday on the Senate floor. He added that “seniors, who need the vaccines most, should not have to worry if they can afford it once it’s available.”

New federal funds are expected to flow to the Department of Health and Human Services under the emerging aid package, including money for vaccine development and to reimburse state and local public health officials. Funding would also be distributed through the U.S. Agency for International Development and Department of State to help foreign jurisdictions contain recent COVID-19 outbreaks.

Trump, drugmakers meet

President Donald Trump met Monday with executives of several major pharmaceutical companies at the White House, including Johnson & Johnson, Regeneron Pharmaceuticals Inc., Pfizer Inc., Sanofi, GlaxoSmithKline PLC, Gilead Sciences Inc., Novavax Inc., Inovio Pharmaceuticals Inc., CureVac AG and Moderna Inc.

Trump appeared impatient for new medicines to be available quickly and promised that top government officials would help facilitate the process. “Anybody delays you, please call me,” he said.

While different companies touted how quickly they can get doses made and ready for testing, they emphasized that timelines would depend on federal regulators and whether the medicines proved safe and effective. Anthony Fauci, who leads the National Institute for Allergy and Infectious Diseases, reminded Trump that it would likely be at least a year before any vaccines are approved. 

When other administration officials noted development of a COVID-19 treatment would likely go more quickly, Trump said that “is even better” than a vaccine. 

Trump’s meeting with drug company officials was originally scheduled to discuss broader drug pricing legislation, until the onset of COVID-19 changed the main topic. The White House backs a version of drug pricing legislation offered by Senate Finance Committee leaders. The House passed its own bill Dec. 12.

The main difference between the House and Senate bills is the House bill would require drugmakers to negotiate with HHS on prices for certain drugs that cost the health care system the most. Prices couldn’t exceed a limit based on an international average. The Senate bill doesn’t contain those provisions.

Nonetheless, Democrats are making clear in the supplemental funding talks they are capitalizing on public sentiment against drug price inflation.

They are arguing that since the COVID-19 aid bill would make a large public investment in developing a vaccine, “it only makes sense to ensure that taxpayers are not forced to pay inflated prices for a lifesaving product they already paid to develop” through their taxpayer dollars, a person familiar with the talks said.

Pharma politics

At a House Energy and Commerce hearing last week, Democrats charged that taxpayers have footed the bill for coronavirus-related research and development at the National Institutes of Health. HHS Secretary Alex Azar disputed that claim, arguing that companies such as Moderna and Gilead have funded continued product development after benefiting from basic research at NIH.

“We would want to ensure that we work to make it affordable, but we can’t control that price because we need the private sector to invest,” Azar said. Democrats jumped all over the former Eli Lilly and Co. executive’s comments, and on Monday the Democratic Congressional Campaign Committee unveiled Facebook ads targeting seven House Republicans for their alleged fealty to the drug industry.

“Washington Republicans are already blocking bipartisan House-passed legislation to bring down the cost of prescription drugs,” DCCC spokesperson Robyn Patterson said in a statement. “This virus is a threat to millions of Americans and House Republicans have an obligation to stand up to the White House and drug manufacturers by demanding they work to ensure a coronavirus vaccine is affordable for working families.”

Of the seven targeted Republicans, two voted for the House Democrats’ drug pricing bill in December: Jaime Herrera Beutler of Washington and Jeff Van Drew of New Jersey; Van Drew was still officially a Democrat at the time but subsequently switched parties.

Rep. Jan Schakowsky of Illinois and other House Democrats have been pushing HHS to avoid granting an exclusive license to any private manufacturer for a coronavirus vaccine or favorable treatment in federal grants or contracts. Fauci has advocated partnerships with specific drug companies in the past, however, arguing that such relationships are critical to vaccine development.

[Related: States counting on reimbursements for coronavirus response]

House and Senate appropriators are still aiming to wrap up negotiations within the next 24 hours in order for the House Appropriations Committee to file the legislation Tuesday. Speaker Nancy Pelosi said last week that the House hopes to take up the bill this week. It could go to the floor as early as Wednesday.

Appropriators are “real close” to a deal on the coronavirus funding, Senate Appropriations Chairman Richard C. Shelby said Monday evening. “It’s going to be funded well and I think the administration is on board with it,” the Alabama Republican said. 

The cost of the package has steadily climbed since Trump proposed a supplemental that would total $2.5 billion, including transfers from other accounts.

Sources said negotiators are optimistic they will reach agreement since both parties want to move the package as soon as possible. Senate Majority Leader Mitch McConnell on Monday urged Democrats to let appropriators “do their work” and “supply these important funds within the next two weeks.”

There is also an understanding that no one knows how much fighting the virus will cost. If more money is appropriated than needed, it could be repurposed for other pandemic or health purposes down the road. If more funding is needed, another emergency supplemental could be advanced.

Congressional leaders were also talking about whether to add language that would extend expiring Foreign Intelligence Surveillance Act authorities, currently set to expire March 15.

House Appropriations Chairwoman Nita M. Lowey declined to comment on FISA or other aspects of the supplemental talks. “It’s still being discussed,” the New York Democrat said.

Niels Lesniewski, Doug Sword, Katherine Tully-McManus, Lindsey McPherson and Andrew Siddons contributed to this report.