The leaks from the White House and the circulation of pre-budget talking points on Friday made it clear that fixes to Medicare will come from cutting benefits to seniors and disabled people. For the last several months, certain politicians have been building support for options that could involve raising the eligibility age, making more people pay higher premiums, and changing the way Medigap policies work so they would be prohibited from covering as much. Such proposals would require beneficiaries to have more “skin in the game,” as the wonks often put it. In other words, it would make them pay more for their care. The goal: Prompt them to use fewer medical services by making them pay more out-of-pocket.

Late last month, in a New York Times piece titled “Medicare Shift May Lead Way to Budget Pact,” reporters Jackie Calmes and Robert Pear signaled that “President Obama and Congressional Republicans have quietly raised the idea of broad systemic changes to Medicare that could produce significant savings.” Now it looks like those cuts are really on the table and will affect millions of beneficiaries.

What’s not on the table? Here’s one thing: a requirement that drug makers negotiate prices with the government for the drugs used by Medicare beneficiaries, an option that accounts for drugs costing far less in other countries. Taking such a step would make drug companies contribute to shoring up Medicare.

But with the notable exception of Steven Brill’s discussion in Time of why Congress has handcuffed Medicare when it comes to obtaining lower drug prices, there has been little in-depth examination of the topic in the mainstream media. The 2003 law that gave seniors a drug benefit prohibited the government from negotiating cheaper prices for consumers. Aside from a casual mention of this now and then, the press has rarely touched the topic.

Bruce Vladeck, who headed the Medicare agency during the Clinton era, told Kaiser Health News that the single thing Medicare could do to lower its costs and help beneficiaries would be to require Medicare drug plans to buy drugs at the Federal Supply Schedule Price—used by the Veterans Administration, the Department of Defense, and safety net hospitals. Beneficiaries would get lower prices too.

Brill estimated that that if drug makers were paid what other countries pay them, Medicare could save some $250 billion over 10 years and, depending on whether that amount is compared with GOP and Democratic deficit reduction proposals, “that’s a third or a half of the Medicare cuts now being talked about.” Liberal economist Dean Baker, co-director of the Center for Economic and Policy Research, crunched numbers from the Organization for Economic Cooperation and Development and came up with similar savings. He found that if seniors paid the same prices as people in Canada, the federal government would save nearly $230 billion over the next decade. States would save about $31 billion and Medicare beneficiaries $48 billion. If the federal government paid the same prices as are paid in Denmark, its savings would be more than $500 billion.

But such numbers are apparently not persuasive when they’re up against the lobbying might of the drug manufacturers. According to Open Secrets.org, drug makers spent $152 million on lobbying in 2012, an amount that has steadily increased since 2002-2003, the time when Congress was debating Medicare’s prescription drug benefit, which handed drug makers the gift of no negotiations over the prices they charge.

Although heavy-duty price negotiation is not on the table, a weaker measure that brings some price relief to the program and beneficiaries is. Politico reported the president’s budget contains a provision that would allow the government to obtain rebates from pharmaceutical makers for drugs covered under Medicare for beneficiaries enrolled in its low-income subsidy program. Mandating these discounts in the form of rebates begins to use Medicare’s purchasing leverage and would ensure lower drug prices for this group than insurers currently charge the government to provide the medicines. The savings—$137 billion over 10 years, according to the Congressional Budget Office—are not as great as negotiating prices for all Medicare beneficiaries. Still it’s a savings for a government that professes to be strapped for money, and Obama has proposed this before.

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.