Can the National Institutes of Health bring down drug prices? It doesn’t approve new medicines or pay for them, but its role in drug research gives it surprising leverage.

Sen. Bernie Sanders, chairman of the Health, Education, Labor and Pensions committee, voted against confirmation of Dr. Monica Bertagnolli as NIH director. Sanders, a Vermont independent who caucuses with the Democrats in the Senate, said that he didn’t think Bertagnolli was prepared to stand up to the pharmaceutical industry.

But Sanders tells NPR he plans to work with Bertagnolli, who was confirmed Nov. 7. He says something has to change at the NIH, which spends billions of dollars each year on biomedical research that lays the foundation for lucrative profits for the drug industry.

“And yet, despite the huge amount of money that taxpayers spend developing these drugs, the drug companies get the product and they end up charging us the highest prices in the world for it,” Sanders says.

Government contracts could exert leverage

The Moderna COVID vaccine is an example of the problem, he says. The vaccine was developed with the National Institute of Allergy and Infectious Diseases, part of the NIH. And the government agreed to buy 100 million doses even if it failed clinical trials, wasn’t authorized by the Food and Drug Administration and all those doses wound up in the trash.

Ameet Sarpatwari, assistant director of the Program on Regulation, Therapeutics and Law at Harvard Medical School, says the government could have made more use of its leverage as a funder. “That could have been to ensure reasonable pricing for Americans at the very least, ensuring that Americans aren’t paying more than people in other countries,” he says.

Moderna increased the price of its COVID shot this year from about $26 a dose to $130 a dose. The company has downplayed NIH’s role.

Generally, the pharmaceutical industry discounts the importance of NIH-funded research in its work. But Sarpatwari says the NIH is actually the largest single funder of biomedical research in the world.

A lot could be built into NIH contracts to protect Americans. “It’s quite possible to at least put in terms that will ensure fair access to the fruits of all of that support,” he says, adding the NIH has been hesitant to flex its muscles on pricing.

Sanders asks for scrutiny of licensing deal

Sanders wants that to change and says he hopes that the agency will be less cozy with the pharmaceutical industry under new leadership. He sent a letter last month asking for the administration to investigate NIH moves to grant an exclusive patent license for a cervical cancer drug developed at the agency to a mysterious startup incorporated in Delaware with no website.

The startup, Scarlet TCR, has a relationship with a former NIH employee and the deal could allow the company to someday charge high prices for a government invention.

The agency says no decision has been made regarding Scarlet TCR.

“NIH shares concerns about high drug prices and the burden they place on patients and their families,” NIH spokesperson Renate Myles wrote in an email to NPR. “As stated during her Senate confirmation hearing, Dr. Bertagnolli has expressed her commitment to ensuring that the benefits of NIH-funded research are affordable and available to all the Americans.”

Bertagnolli will work with Congress, Myles added.