WASHINGTON — House Speaker Nancy Pelosi (D., Calif.) on Thursday released her long awaited plan to lower drug prices for seniors on Medicare and younger people with private insurance.

Speaker of the House Nancy Pelosi

The proposal would allow Medicare to negotiate prices for up to 250 of the costliest drugs, including insulin. Drug manufacturers balking at negotiations would face harsh penalties. And pharma companies increasing prices above the rate of inflation would have to pay rebates to Medicare.

The proposal would cap copays under Medicare Part D at $2,000. And Medicare-negotiated prices would be offered to other buyers, such as employer health plans.

Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA) called the plan “radical,” saying it “would end the current market-based system that has made the United States the global leader in developing innovative, lifesaving treatments and cures.”

A group of House Republicans led by Rep. Greg Walden of Oregon denounced the plan for putting “politics over progress,” labeling it “a socialist proposal to appease her most extreme members.” But in a bid for bipartisan support, the proposal includes ideas from the Trump administration and Republican senators. As a candidate, Donald Trump supported Medicare negotiations. But after he was elected president, he seemed to adopt the traditional Republican stand that price negotiations are best left to private players like insurance companies.

Pelosi’s proposal would authorize Medicare to negotiate prices for drugs including Part B medications dispensed in doctors’ offices, many of which are cancer drugs. The maximum price would be set based on a combination of international prices, an idea the White House has suggested in a more limited fashion. Insulin prices would be subject to negotiations. Drug companies that refuse to negotiate would face a fine starting at 65% of sales for the drug at issue.

Mandating rebates to Medicare for pharma companies hiking prices beyond inflation echoes a plan from Sens. Chuck Grassley (R. Iowa), and Ron Wyden (D., Ore). The senators’ proposal has already gotten through a key committee, with Trump’s backing. But many Senate Republicans oppose such rebates.

Also part of the Grassley-Wyden bill, and supported by the White House, is the cap on Part D copays. As the program stands, there is no limit on copays.

PhRMA’s Ubl said Pelosi’s plan “would fundamentally restructure how patients access medicines by giving the federal government unprecedented, sweeping authority to set medicine prices in public and private markets while importing price controls from other countries that restrict access to innovative medicines. It would upend the successful Medicare Part D program that 40 million seniors rely on without any guarantee that savings would be used to lower costs at the pharmacy counter. We do not need to blow up the current system to make medicines more affordable. Instead, policy makers should pursue practical policy solutions such as sharing negotiated savings with patients at the pharmacy counter, lowering coinsurance in Medicare Part D, increasing transparency on patients’ costs, promoting value-based contracts, among other improvements to the system. These solutions are better alternatives to the far-reaching proposals in speaker Pelosi’s plan.”

If compromise can be reached among House Democrats, the administration and enough GOP legislators, the proposal could be added to year-end budget legislation.