Roger Marshall on Prescription Drug Prices: The Orphan-Drug Exemption, Votes Against Lower Drug Prices, and FDA Cuts

On July 1, 2025, Roger Marshall cast one of the 50 votes that passed the One Big Beautiful Bill Act, which exempts more drugs from Medicare price negotiation; the cancer drugs Keytruda and Opdivo were not chosen for negotiation as a result. The same night, Marshall voted against an amendment to cut Medicare drug prices in half, and in April 2026 he voted against capping U.S. drug prices at European and Canadian levels.

Marshall, a physician, also voted to confirm Martin Makary to run the Food and Drug Administration, where layoffs left inspectors of the foreign factories that make many U.S. drugs saying "You can't inspect as many sites." Kansas has 589,686 Medicare enrollees.

Roger Marshall's Votes on Prescription Drug Prices

• Marshall Cast a Deciding Vote to Exempt More Drugs From Medicare Price Negotiation in July 2025. On July 1, 2025, Roger Marshall voted for H.R. 1, which passed 50 to 50 with the Vice President breaking the tie. Its section 71203 widens the orphan-drug exemption from Medicare negotiation. The Congressional Budget Office estimates the change costs Medicare an additional $8.8 billion, and it covers drugs with $17.5 billion in total spending by Medicare and beneficiaries in 2023. Selection of Keytruda and Opdivo has been delayed beyond 2026; KFF estimates a typical negotiated discount on Keytruda would mean annual savings on cost-sharing liability of around $3,300 for the seniors who take it.
• Marshall Voted Against Cutting Medicare Drug Prices in Half in July 2025. On July 1, 2025, during the debate on H.R. 1, Marshall voted no on Senator Bernie Sanders's amendment "To cut the price of prescription drugs under Medicare in half and expand Medicare to cover dental, vision, and hearing." All 53 Republican senators voted no. A majority of the public, 59%, is worried about affording prescription drugs, the largest share since KFF began asking in 2018.
• Marshall Voted Against Capping U.S. Drug Prices at European and Canadian Levels in April 2026. On April 23, 2026, Marshall voted no on waiving budget rules for an amendment "To reduce the price of prescription drugs in the United States by more than 50 percent by adopting Most Favored Nation drug pricing so that the American people pay no more for prescription drugs than Europeans or Canadians." It got 49 votes, short of the 60 needed. Seven in 10 adults, 72%, say there is not enough government regulation limiting drug prices.
• Marshall Voted Against Auditing the Administration's Confidential Drug-Price Deals in April 2026. On April 23, 2026, Marshall voted no on an amendment calling for a Government Accountability Office study of the "economic consequences of private or confidential drug pricing agreements" between federal agencies and drug makers. It failed 48 to 50. KFF reports that the details of these deals are confidential and not available to the public.
• Marshall Voted Against Blocking Higher Drug Costs for Seniors and Against Ending Price Gouging in 2025. On April 5, 2025, Marshall voted no on a point of order "against legislation that would increase drug costs for seniors and people with disabilities on Medicare," which failed 49 to 50. On February 21, 2025, he voted no on an amendment for a reserve fund "relating to ending price gouging on prescription drugs," which lost 49 to 51. The law that followed is the one whose orphan-drug change raises Medicare drug spending.
• Marshall Voted Against Keeping a $35 Insulin Cap for People With Private Insurance in August 2022. On August 7, 2022, Roger Marshall voted against a motion to keep a $35 monthly insulin cap for people with private insurance in the Inflation Reduction Act. The motion to waive the budget rules failed 57 to 43, three votes short of what was needed, and the cap was removed from the bill. Nearly four years later, people with private insurance still had no federal cap: in July 2026 the Senate was considering a bill that would cap the cost of insulin at $35 per month for people on private insurance.
• Marshall Voted to Confirm Martin Makary, Whose FDA Lost Drug-Factory Inspectors, in March 2025. On March 25, 2025, Marshall voted to confirm Martin Makary as commissioner of food and drugs. Weeks later, layoffs at his agency left the inspectors who check the foreign factories that make many generic drugs saying "You can't inspect as many sites," ProPublica reported on July 7, 2025. Makary resigned on May 12, 2026, and Kyle Diamantas, who had been deputy commissioner for food, became acting head of the agency.
• Marshall Voted to Confirm Robert F. Kennedy Jr., Whose Department Dropped $2 Generic Drugs for Medicare, in February 2025. On February 13, 2025, Marshall voted to confirm Robert F. Kennedy Jr. as secretary of health and human services. On March 12, 2025, his department's Medicare innovation center dropped the $2 Drug List model, which would have standardized cost sharing for certain generic drugs under Medicare Part D.
• Marshall Voted to Confirm Mehmet Oz, Whose Agency Ended a Drug-Plan Premium Program, in April 2025. On April 3, 2025, Marshall voted to confirm Mehmet Oz to run the Centers for Medicare & Medicaid Services. In 2026 his agency ended a Part D premium demonstration; for 2027, all 4 million PDP enrollees who paid no monthly premium in 2026 will pay one unless they qualify for low-income help, changes KFF calls "possibly related" to the demonstration's end.

What Roger Marshall's Drug-Price Votes Mean for Kansas

• Medicare enrollees. Kansas's 589,686 Medicare enrollees, 393,633 of them in traditional Medicare and 196,054 in Medicare Advantage, are the people for whom negotiated Medicare prices matter; the law Marshall voted for exempts more drugs from negotiation.

Frequently Asked Questions About Roger Marshall on Prescription drugs

Last updated: 2026-10-25

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