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South Bend, Ind., Mayor Pete Buttigieg on Monday unveiled a sweeping plan aimed at lowering prescription drug prices — and though he’s one of the most moderate Democrats in the 2020 presidential race, the plan is anything but. Buttigieg’s proposal includes a number of drug pricing ideas once seen as radical, including a policy change that would force pharmaceutical manufacturers to forfeit as much as 95% of a drug’s revenue if the company refuses to negotiate prices. “Worst offender” drug companies could also forfeit their patent rights. (Florko and Facher, 10/7)

Buttigieg, the mayor of South Bend, Indiana, said his plan would cut out-of-pocket prescription drug costs for seniors on the Medicare government insurance program by at least 50% by the end of his first term and cap costs for out-of-pocket prescription drug costs for anyone who chooses his public insurance plan at under $250 per month. The plan would also go after pharmaceutical companies by penalizing those that raise drug prices by more than inflation, threatening to take patents away from companies that refuse to lower essential drug prices and allowing the federal government to negotiate with companies to make drugs more affordable. (Volcovici, 10/7)

The plan, titled "Affordable Medicine for All," would offset $100 to 200 billion in spending by penalizing pharmaceutical companies that raise prices by more than inflation and by increasing the annual Branded Prescription Drug Fee, a section of the Affordable Care Act that sets an annual fee according to each manufacturers share of drug sales to government programs like Medicare Part D and the VA. Buttigieg's plan, which CNN obtained Sunday afternoon, echoes proposals from fellow 2020 hopefuls, including California Sen. Kamala Harris and Vermont Sen. Bernie Sanders, in capping out-of-pocket drug spending, setting a limit at 50% for seniors on Medicare and at $250 per month for those choosing a public health insurance option under Buttigieg's newly released "Medicare for All Who Want It" plan. (Judd, 10/7)

The plan would be funded by significantly increasing an Obamacare-mandated fee on branded prescription drug companies to at least $8 billion per year, indexed to inflation. That’s about $5 billion more annually than drugmakers pay now. The pharmaceutical industry would also be on the hook for more of the costs of drugs when seniors with large out-of-pocket spending enter the “catastrophic” phase of the Medicare prescription drug benefit. Drugmakers would also be penalized if the cost of their branded medicines increased faster than inflation. (Karlin-Smith, 10/7)

It’s on the lips of every presidential candidate, Speaker Nancy Pelosi, and even President Trump: It’s time to lower drug prices. And yet when Congress passed a drug pricing bill last week that will save the government $3 billion — the first it’s passed in nearly a year — no one really noticed. You can’t blame them: There was no press conference from the bill sponsors, no snarky reaction from the drug industry, virtually no press release from any of the advocacy organizations that champ at the bit to weigh in on every twist and turn of the ongoing drug pricing debate in Washington. Even Trump, who has been eager to show his progress on lowering the costs of drugs, didn’t hold a signing ceremony for the bill. (Florko, 10/4)