Early in November, drug pricing reform officially made it into President Biden’s $1.75 trillion social spending package. It represented a major step towards the first tangible drug pricing reform in decades.

But after months of Biden pushing for reform — and years of bipartisan back and forth — the proposal is once again in jeopardy. On Sunday, Senator Joe Manchin said he wouldn’t vote for the Build Back Better Act (BBB) due to his concerns over inflation. In doing so, he left Democrats scrambling to piece together a framework that might still have a chance of passing.

The original drug pricing proposal in BBB, which would allow Medicare to negotiate prices for Part B and D drugs under certain circumstances, isn’t the only healthcare provision that may now be dropped along with the bill. The package also capped out-of-pocket drug spending for seniors at $2,000 per year, and included a proposal to close the Medicaid gap in 12 states.

Some congressional Democrats are hoping to revive the legislation by creating a new framework for an early-January vote. Manchin’s thumbs-up in the 50/50 Senate, however, is crucial.

“We are going to vote on a revised version of the House-passed Build Back Better Act — and we will keep voting on it until we get something done,” Senate Majority Leader Chuck Schumer wrote to Democrats on Monday.

Senate Finance Committee Chair Ron Wyden released a statement Sunday in which he noted that “it’s extremely disappointing to have to drop any major priorities,” specifically pointing to lowering healthcare costs and drug prices. “Democrats have made key promises to families who need more support… Failure is not an option here.”

Not all industry experts are convinced that the Manchin blow will prove fatal for BBB. Terry Haines, founder of healthcare consultancy Pangaea Policy, wrote in an update that “BBB proponents should cheer up a little, since our initial read on Manchin was that BBB is ‘only mostly dead.’”

“Manchin wants increased Washington focus on more immediate and pressing problems, including COVID-19 and inflation, which he characterizes as more important than BBB right now,” Haines continued. “Manchin also held out slim hope to BBB proponents, saying they ought to work the bill through normal congressional committee channels and get it vetted properly.”

Senate Democrats, in the meantime, plan to hold a special meeting Tuesday evening to parse through their plan for the bill.