However, the effort to reframe the drug price debate comes as Democrats prepare to run on the issue up and down the ballot next year against a Republican Party unlikely to cede any ground with campaign attacks and more likely to focus on the border and inflation.

A new poll from nonprofit KFF shows that 58 percent of independent voters trust Democrats to lower drug costs compared with 39 percent of Republicans.

“If they want to run their campaigns based on keeping the profits of the drug companies high, welcome,” Sen. Amy Klobuchar (D-Minn.) told POLITICO. “Why don’t they go for it and see how well President Biden does because people are going to understand that seniors want to see less expensive drugs.”

Nevertheless, Republicans are strategizing the best message to counter the first Medicare drug price negotiations.

“Republicans have to figure out how to go after it,” said Joe Grogan, a Republican strategist who served as a domestic policy adviser for former President Donald Trump. “They go after it by taking it head on: it is killing clinical programs, fundamentally restricting the amount of treatments.”

Grogan said the negotiations process can stifle innovation by demanding makers of the selected drugs accept a final negotiated rate or leave Medicare and Medicaid, which can amount to 40 percent of total revenue depending on the drugmaker.

“Company after company is making changes to commercial strategy due to the fact they have to anticipate government price-setting and basically [the] extortion that price dictates,” Grogan said.

Some companies have said they are pulling back funding for certain clinical programs. Eli Lilly, for example, blamed the IRA for nixing a $40 million cancer drug due to the negotiations program, according to a November report in Endpoints News.

Grogan added that drug companies could decide to no longer fund clinical trials that search for new uses for a drug already on the market.

“It is not negotiating the prices, it is price-setting and companies are responding to kill programs that are no longer going to be profitable in a high-risk business to bring to market,” he said.

But the question is “what do Republicans want and [what is] the alternative here?” asked White.

Congressional Republicans slammed Biden’s Tuesday drug price announcement, saying they will impose crippling price controls.

“I hope that our colleagues on both sides of the aisle can come together to mitigate these devastating effects and advance consensus-based, market-driven solutions to access and affordability challenges,” said Sen. Mike Crapo (R-Idaho), the top Republican on the Senate Finance Committee.

But White conceded that right now Republicans “don’t have a plan that cuts with voters or resonates with voters and stands as a clear contrast to what Democrats are offering.”

The Republican-led House is working on bills to reform pharmacy benefit managers, which some GOP lawmakers say act as middlemen that do not pass on discounts negotiated with drugmakers to patients.

Florida Gov. Ron DeSantis, who is running second behind Trump in most polls, signed into law his own bill to regulate PBMs in the state. The DeSantis campaign did not return a request for comment on Tuesday’s announcement.

“That is a gimme, it seems to me. PBMs are everybody’s favorite villain these days,” said Joe Antos, senior fellow with think tank American Enterprise Institute.

So far, most 2024 campaigns have not put forth detailed health care policy plans and have been largely mum on drug prices specifically.

One of the exceptions is the frontrunner: Trump.

He promises to revive an executive order he issued while in office that mandated the federal government pay the same price for pharmaceuticals as countries overseas. The Biden administration pulled the order in 2021 after a federal judge struck it down.

“We’ve been ripped off by everybody for so many decades. We are tired of it. Not going to happen,” Trump said in a video on his campaign website.

Former Vice President Mike Pence has made general statements on improving transparency and competition to lower costs. He also proposed reviving Operation Warp Speed, the federal program created to expedite Covid-19 vaccines, but for new drugs.

Strategists say that candidates will need to explain their vision for health care as the campaign shifts into high gear. Except for abortion, health care was largely missing from the first GOP presidential candidate debate in Milwaukee, Wis., last week.

“There is an opportunity and an obligation on the presidential campaign,” Grogan said. “The Trump indictments have dominated so much of the debate, but there will be a necessity to flesh out economic visions.”

David Lim contributed to this report.