It’s been a rollercoaster ride for drug pricing efforts in recent years. While lawmakers on both sides of the aisle have long been discussing the need for some pricing regulation, no legislation has officially passed — or, frankly, come all that close.

The proposal that nearly reached the finish line was part of President Biden’s $1.9 trillion Build Back Better bill. The inclusion of the pricing provision was deemed the most significant move toward reform in years. Then Sen. Joe Manchin pulled his support, and the bill failed.

But drug pricing is back on the table once anew. Earlier this month, Democratic Senators resurrected parts of Build Back Better in an effort to pass legislation before midterm elections in the fall.

The latest Senate proposal would allow Medicare to negotiate prescription drug prices and limit yearly out-of-pocket drug costs for people on Medicare to $2,000. It would also make vaccines free for Medicare beneficiaries. The Department of Health and Human Services would be given the power to choose 10 drugs for cost negotiation beginning in 2026, with the number of drugs increasing over time.

Gerard Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health, said the new bill’s impact on drug pricing would be “significant.” It would save nearly $300 billion over the course of 10 years — that’s $30 billion a year, representing about 10% of drug spending in the U.S.

“Drug pricing reform is more real than it’s ever been, but it’s not completely certain,” Anderson stressed. “You have to thread the needle to get all the Democratic Senators to find it acceptable, which is the challenge that has been there for the past year and a half.”

Anderson added that average American patients would immediately feel the impact. “If you’re taking one of the drugs that are negotiated — and those are generally going to be the big-selling drugs — you’ll get a substantial reduction in the amount you have to pay out-of-pocket,” he said.

Not surprisingly, the pharma industry is already voicing opposition. Lobbying group PhRMA released a statement on the latest proposal, noting it “went from bad to worse for patients. Democrats weakened protections for patient costs included in previous versions, while doubling down on sweeping government price-setting policies that will threaten patient access and future innovations.”

During each iteration of the pricing debate, industry groups have argued that allowing the federal government to negotiate drug prices won’t fix the bigger issues leading to high prescription drug costs in the U.S. Basically, they blame it on the middlemen: insurers and pharmacy benefit managers.

That has played out once anew. “Unfortunately, pharmacy benefit managers and insurers will continue to benefit by shifting more of the cost burden to patients when it comes to coinsurance and premium increases,” PhRMA said in its most recent statement.

That line of argument holds increasingly less water with Anderson, who believes that change is long overdue.

“The pharma industry is correct in that it’s a much more complex issue than this legislation tackles,” he said. “It’s important for this legislation to pass, but more work will need to be done.”