Democratic leaders are discussing changes to a signature bill to lower prescription drug prices in a bid to win over a handful of moderate Democrats needed for passage.

House and Senate leaders have discussed a proposal that would remove one of the provisions moderates find most objectionable in Speaker Nancy PelosiNancy PelosiPelosi and Pope Francis meet amid push for action on climate changeGrowing number of Democrats endorse abolishing debt limit altogetherIlhan Omar to Biden: ‘Deliver on your promise to cancel student debt’MOREs (D-Calif.) bill, a cap on prices based on what other wealthy countries pay for drugs, and have pitched the proposal to moderates, sources say.

But some moderates who voted against the drug pricing measure last month in a House committee are still not signing on, illustrating the difficult path forward for a key piece of Democrats agenda that is intended to help pay for President BidenJoe BidenBiden remembers Gen. Odierno: ‘Part of some of our most poignant memories’ Building back better by investing in workers and communitiesInternal battles heat up over Biden agendaMOREs sweeping Build Back Better package.

Rep. Scott PetersScott H. PetersInternal battles heat up over Biden agendaModerate Democrat says he can’t back House spending plan ‘in its current form’LIVE COVERAGE: Biden tries to unify divided HouseMORE (D-Calif.), one of the three House lawmakers who voted no last month, said he spoke with White House staff and Speakers office staff on a call last week about ways to bridge their differences on drug pricing, but that there has not yet been a resolution.

I think it’s great that they’re talking to me, but I also don’t want to overstate, I don’t want to suggest that they proposed something yet that I think will work or will pass, Peters told The Hill.

I didn’t expect it to come to a resolution in one meeting, and so we’ll continue those conversations, he added.  

House and Senate leaders have discussed a proposal that would use domestic prices to help set a cap on drug costs, rather than using the lower prices paid in other countries, a move to somewhat scale back the legislation.

That proposal would also allow Medicare to negotiate lower drug prices, but would not extend those lower drug prices to people with private insurance plans, sources say. That would significantly scale back the scope of the measure, in a move that stems from what is allowed under the complicated Senate rules used to bypass a Republican filibuster in the Senate.

Peters, as well as a handful of other moderates, have concerns about the impact on drug companies ability to innovate and develop new treatments.

Advocates for action on the issue have expressed frustration with Peters and other moderates, saying they are simply doing the bidding of the pharmaceutical industry. Drug companies are lobbying hard against the legislation, and have launched a seven-figure ad campaign against it.

In addition to Peters, Reps. Kurt SchraderWalter (Kurt) Kurt SchraderInternal battles heat up over Biden agendaModerate Democrat says he can’t back House spending plan ‘in its current form’Club for Growth squeezes front-line Democrats on reconciliation planMORE (D-Ore.) and Kathleen RiceKathleen Maura RiceInternal battles heat up over Biden agendaModerate Democrat says he can’t back House spending plan ‘in its current form’Lawmakers using leadership PACs as ‘slush funds’ to live lavish lifestyles: reportMORE (D-N.Y.) voted against the drug pricing measure last month. Reps. Stephanie MurphyStephanie MurphySinema slams delay of infrastructure vote: ‘Inexcusable’ Progressives hit back after moderates take aim at PelosiCentrist Democrats go after Pelosi over delayed infrastructure vote: ‘Deeply regrettable’MORE (D-Fla.) and Lou CorreaJose (Lou) Luis CorreaDemocrats grasping at straws on immigrationThe Hill’s Morning Report – Presented by Alibaba – Government shutdown fears increase as leaders dig inDrug companies on verge of sinking longtime Democratic priorityMORE (D-Calif.) also cosponsored a scaled-back, alternative drug pricing measure from Peters and Schrader that they say would address their concerns about innovation.

Democrats can only lose three votes in the House and still pass the package. And in the Senate, they cannot lose a single vote, given unified Republican opposition.

Asked about progress on drug pricing, a senior Democratic aide said the provisions remain under discussion.

In the Senate, Sens. Robert MenendezRobert (Bob) MenendezAdvocates frustrated by shrinking legal migration under BidenRand Paul blocks quick vote on House-passed B Iron Dome fundingSenate parliamentarian rules out Democrats’ immigration plan BMORE (D-N.J.) and Kyrsten SinemaKyrsten SinemaMcConnell vows GOP won’t help raise debt ceiling in December after Schumer ‘tantrum’The Hill’s 12:30 Report: House interrupts recess for debt ceiling voteDaydreaming about Kyrsten SinemaMORE (D-Ariz.) are question marks on the drug pricing measures.

Menendez said Wednesday that he has had discussion with Senate Finance Committee Chairman Ron WydenRonald (Ron) Lee WydenTo build back better, put a fee on corporate carbon pollutionOvernight Energy & Environment Biden set to restore national monuments rolled back by TrumpHillicon Valley Presented by American Edge Project Russia dominant force behind cyberattacks in last year, report findsMORE (D-Ore.), who is taking the lead on crafting the legislation in that chamber, but that he had not seen enough specifics to form a view.

Show me a proposal and I’ll tell you how I feel, he said.

A Sinema spokesperson said the senator is carefully reviewing various proposals around this issue — and, as always, does not negotiate those policy specifics through the press.

In a sign of the frustration with the handful of Democratic lawmakers expressing resistance on the issue, Sen. Bernie SandersBernie SandersInternal battles heat up over Biden agendaSeattle-area lawmakers say colleague’s campaign flyer is racist, ‘horrifying’Sanders alums launch progressive firmMORE (I-Vt.) told reporters on Friday he would begin calling out some of those members of Congress, throwing up roadblocks on drug pricing, and pointed to pharmaceutical industry lobbying and campaign donations. 

You’ve got lobbying firms led by former Democratic leaders, Republican leaders working overtime to try to defeat this legislation, he said.

The Democratic group Protect Our Care is also putting pressure on both Sinema and Menendez to support drug pricing action, including ads in Arizona and a mobile billboard outside Menendezs office in New Jersey.

Backers point out that action on the issue is extremely popular in polls. A Kaiser Family Foundation poll earlier this year found that 88 percent of the public supports allowing the government to negotiate lower drug prices.

Many Democrats in competitive districts also favor action.

In a meeting between Biden and such frontline members this week, almost every member who was on that Zoom call mentioned Medicare negotiation as a top priority for them, Rep. Susan WildSusan WildBiden meets with vulnerable House Democrats with agenda in limbo Congress needs to help schools meet mental health challengesLawmakers say Biden must do more on global vaccinesMORE (D-Pa.) said on a call hosted by the group Lower Drug Prices Now.

Some employer groups are also pushing for action on drug prices to lower their costs, but are watching to see if the measure will apply to private insurance and not just Medicare. A provision in the measure to limit drug price increases to the rate of inflation could apply to private insurance, sources say.

Getting substantial savings from drug pricing provisions is also key for paying for other health care priorities in the package, like extending enhanced financial assistance under ObamaCare, expanding Medicaid in the 12 GOP-led states that have so far refused, and widening Medicare benefits to include dental, hearing and vision coverage.

Rep. Peter WelchPeter Francis WelchSchumer feels heat to get Manchin and Sinema on boardFailed drug vote points to bigger challenges for DemocratsShakespeare gets a congressional hearing in this year’s ‘Will on the Hill’MORE (D-Vt.) acknowledged that changes could have to be made on a variety of fronts, including drug pricing, to win enough votes.

We’ve advocated for it, now how do we get the votes to pass it? he said. We’re just transitioning from advocacy to legislative negotiation.