A plan being hatched by House Democratic leaders would allow the Department of Health and Human Services to negotiate prices for up to 250 Medicare-covered medications, as well as insulin.

The measure also would cap the price of medicines at 1.2 times the average international price of Australia, Canada, France, Germany, Japan and the United Kingdom. Drug companies that refuse to negotiate or lack a price agreement would face a fee of three-fourths of the gross sales of the drug in the previous year.

The legislation would cap what Medicare beneficiaries pay annually out-of-pocket starting in 2022 but doesn’t yet specify a threshold.