[Senate Hearing 117-249]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 117-249

                            NO TIME TO WAIT:
                           PROPOSALS TO LOWER
                        PRESCRIPTION DRUG COSTS

=======================================================================

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS


                             SECOND SESSION

                               __________

                            PHOENIX, ARIZONA

                               __________

                             APRIL 12, 2022

                               __________

                           Serial No. 117-16

         Printed for the use of the Special Committee on Aging
         
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]         


        Available via the World Wide Web: http://www.govinfo.gov
        
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
47-456 PDF                 WASHINGTON : 2022                     
          
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                      SPECIAL COMMITTEE ON AGING

              ROBERT P. CASEY, JR., Pennsylvania, Chairman

KIRSTEN E. GILLIBRAND, New York      TIM SCOTT, South Carolina
RICHARD BLUMENTHAL, Connecticut      SUSAN M. COLLINS, Maine
ELIZABETH WARREN, Massachusetts      RICHARD BURR, North Carolina
JACKY ROSEN, Nevada                  MARCO RUBIO, Florida
MARK KELLY, Arizona                  MIKE BRAUN, Indiana
RAPHAEL WARNOCK, Georgia             RICK SCOTT, Florida
                                     MIKE LEE, Utah
                              ----------                              
                 Stacy Sanders, Majority Staff Director
                 Neri Martinez, Minority Staff Director
                        
                        
                        C  O  N  T  E  N  T  S

                              ----------                              

                                                                   Page

Opening Statement of Senator Mark Kelly..........................     1

                           PANEL OF WITNESSES

Dana Kennedy, State Director, AARP Arizona, Phoenix, Arizona.....     3
Suganya Karuppana, M.D., Chief Medical Officer, Valle Del Sol 
  Community Health, Phoenix, Arizona.............................     5
Dora Vasquez, Executive Director, Arizona Alliance for Retired 
  Americans, Phoenix, Arizona....................................     7
Jenny Pena, Associate Manager of Pharmacy Patient Advocacy, 
  Banner MD Anderson Cancer Center, Phoenix, Arizona.............     8
Judy Wilson, MS Patient, Phoenix, Arizona........................     9

                                APPENDIX
                      Prepared Witness Statements

Dana Kennedy, State Director, AARP Arizona, Phoenix, Arizona.....    25
Suganya Karuppana, M.D., Chief Medical Officer, Valle Del Sol 
  Community Health, Phoenix, Arizona.............................    28
Dora Vasquez, Executive Director, Arizona Alliance for Retired 
  Americans, Phoenix, Arizona....................................    34
Jenny Pena, Associate Manager of Pharmacy Patient Advocacy, 
  Banner MD Anderson Cancer Center, Phoenix, Arizona.............    37
Judy Wilson, MS Patient, Phoenix, Arizona........................    43

 
                            NO TIME TO WAIT:
                           PROPOSALS TO LOWER
                        PRESCRIPTION DRUG COSTS

                              ----------                              


                        TUESDAY, APRIL 12, 2022

                                       U.S. Senate,
                                Special Committee on Aging,
                                                  Phoenix, Arizona.
    The committee met, pursuant to notice, at 10:58 a.m., at 
ASU Collaboratory on Central at the Westward Ho, 618 North 
Central Avenue #100, Phoenix, Arizona, Hon. Mark Kelly, member 
of the committee, presiding.
    Present: Senator Kelly

                 OPENING STATEMENT OF SENATOR 
                           MARK KELLY

    Senator Kelly. Good morning, everybody, and thank you. 
Thank you for joining us here this morning at the Westward Ho. 
We chose this hearing here because hundreds of Arizona seniors 
call this place home, and I would like to thank Arizona State 
University for hosting us here in their downtown campus.
    I am very excited to be here today to chair a United States 
Special Committee on Aging hearing. This is my first field 
hearing, and I cannot think of a more important issue facing 
Arizona's seniors than the one we are here today to examine, 
and that is, how do you lower the cost of prescription drugs?
    You know, right now, supply chain issues are driving up the 
cost of everything, from a pound of ground beef to a gallon of 
gas, and when you live paycheck to paycheck, or especially when 
you are on a fixed income, these rising costs make everything 
harder. They make your life harder, but when you add on top of 
that, paying for your prescription drugs as well, and we are 
talking about medications that people need to survive, Arizona 
families and seniors are facing choices that nobody should ever 
have to make.
    Across Arizona and across the country, this is the reality 
for far too many people. Now I have heard this directly from my 
Senior Citizens Advisory Group. Now we get together about every 
3 months, and this is a problem that gets raised every 3 
months, and as it should be. You know, and it is that 34 
percent of seniors here in Arizona are concerned that their 
household won't be able to afford their needed prescription 
drugs in the next year, and those concerns, they are not 
unfounded.
    Last year, more than 1 in 10 Americans aged 65 and older 
skipped a pill because of the cost. One in eight older 
Americans report to have delayed their retirement because of 
the cost of their prescription medication. Now I have heard 
from Arizonans across the State who are seeing the costs of 
their prescriptions continue to climb or spike or even double 
in a year, and that is unacceptable, and the data backs this 
up.
    Medicare spending on prescription drugs is rising. Spending 
on Medicare Part D, the prescription drug benefit, has doubled 
over the past decade, and it is expected to grow faster than 
most other areas of Medicare spending in the years to come. Now 
this is going to result in both greater spending, greater 
spending for the Federal Government, and greater spending for 
Arizona seniors out of their pockets, and this is a problem.
    The data shows that spending is going to go up, but not 
because seniors are accessing more prescription drugs, but 
because the drugs are becoming more expensive. From 2012 to 
2017, the average cost of a prescription drug treatment in 
Arizona increased by almost 58 percent. The costs are going up, 
and this should alarm all of us, but that is why we are here 
today, and that is why I have worked on solutions to drive down 
the costs of prescription drugs. Just in the past couple of 
weeks, the House of Representatives passed a bill which I am a 
co-sponsor of that would cap the out-of-pocket cost of insulin 
at $35 a month.
    Now, as many of you know, insulin is a drug that is not 
optional if you are a Type I diabetic, you need it to survive, 
and many people have to take it for decades and they do it. Yet 
Americans, we pay 10 times more than folks in many other 
countries for insulin, so we are working to change that. I have 
also worked to negotiate a plan that would lower out-of-pocket 
costs for seniors, drive down prescription drug prices, and 
prevent price gouging from drug companies.
    Under this plan, for the first time ever, Medicare would be 
able to negotiate directly with drug companies to get a lower 
price on the most expensive drugs on the market. Now, this plan 
would also prevent drug companies from raising the prices of 
these drugs faster than the rise of inflation, or if they still 
choose to do that, it would require that they pay a rebate, and 
it would restructure the Part D benefit so that seniors on 
Medicare Part D pay no more than $2,000 annually out of their 
pocket, and it would also allow the costs to be spread out, 
that $2,000 out of their pocket to be spread out over the year. 
Now these reforms will drive down the price of prescription 
drugs, lower out-of-pocket costs for seniors, and make our 
country more financially secure, saving hundreds of billions of 
dollars over 10 years, and I will keep pushing this proposal 
forward in the Senate, and I will continue to make the case to 
my colleagues that we need to act now, not next month, not next 
year.
    Arizona seniors cannot and should not wait any longer, so 
today we are going to bring D.C. to Arizona, to hear directly 
from Arizonans about how rising prescription drug costs are 
impacting them and discuss the urgency to act on solutions, and 
I would like to ask each of our witnesses to please keep your 
remarks and questions to 5 minutes--you see how I did that. We 
got a clock right there, and now I will turn to introductions, 
I am pleased to introduce our witnesses. Our first witness is 
Ms. Dana Kennedy, who currently serves as the State Director 
for AARP. She has spent more than 20 years as a leading 
advocate for working families, retirees, and women, and has 
long worked with nonprofit organizations in the State focused 
on disability and aging.
    Thank you, Ms. Kennedy, for being here today and sharing 
your experience and your expertise with this committee. Our 
next witness, Dr. Suganya Karuppana--did I get that right?
    Dr. Karuppana. You got it.
    Senator Kelly. Alright, I practiced. She is the Chief 
Medical Officer at Valle del Sol Community Health. She also 
serves as a Chief Medical Operations Officer. Dr. Karuppana has 
more than 20 years of experience in health care and a decade in 
physician leadership in community health. Thank you, Dr. 
Karuppana, for being with us today and for sharing your work 
with this committee.
    Next, I would like to introduce Ms. Dora Vasquez. She is 
the Executive Director of Arizona Alliance for Retired 
Americans and has more than 25 years' experience in local and 
State Government. In her role, Ms. Vasquez works to advance 
public policy that strengthens the health and retirement 
security for older Americans, so thank you, Ms. Vasquez, for 
being here today and for sharing with the committee.
    Next, I will introduce Ms. Jenny Pena, Associate Manager of 
Pharmacy Patient Advocacy at the Banner MD Anderson Cancer 
Center. Ms. Pena has over 19 years' experience in the pharmacy 
career field. Her work as a patient advocate allows her to hear 
firsthand from patients who struggle to afford their health 
care and prescribed cancer treatment.
    Thank you, Ms. Pena, for being here with us today and for 
sharing your work with the committee, and last but not least, 
my new, good friend, Ms. Judy Wilson. Met her at her car 
outside. Ms. Wilson is a recently retired Medicare enrollee who 
is living with multiple sclerosis. She is also Rotarian for 22 
years, the volunteer for the MS Society, and a mentor for the 
Community Health Mentor Program, and a grandmother of four.
    Thank you, Ms. Wilson, for being here today and for also 
sharing your story. We will now turn to our witnesses for their 
statements, so we are going to begin with Ms. Kennedy, so Ms. 
Kennedy, you can begin, and we have got the clock there. If you 
go over by a minute or two, not a big deal. If you go under, we 
will you pass the time down the line.
    Ms. Kennedy.

          STATEMENT OF DANA KENNEDY, STATE DIRECTOR, 
                 AARP ARIZONA, PHOENIX, ARIZONA

    Ms. Kennedy. Great. Thank you, Senator. AARP, on behalf of 
our 38 million members, over 890,000 members in Arizona, and 
all older Americans nationwide appreciates the opportunity to 
submit testimony on this important hearing of the Senate Aging 
committee. High prescription drug prices hit older Americans 
particularly hard.
    On average, Medicare Part D enrollees take between four and 
five prescriptions per month, often for chronic conditions that 
will require treatment for the rest of their lives. At the same 
time, Medicare beneficiaries have a median annual income of 
just under $30,000. One-quarter have less than $8,500 in 
savings. In Arizona, the average annual cost of prescription 
drug treatment increased 26.3 percent between 2015 and 2019, 
while the annual income of Arizona residents only increased 
15.6 percent.
    This population simply does not have the resources to 
absorb the rapidly escalating prescription drug prices, and 
many are facing the reality of having to choose between their 
medications and other basic needs such as food and housing. In 
the case of one of our members, Leona G., age 74, she has maxed 
out her credit cards to afford her blood thinner Eliquis. She 
only received Social Security benefits and a small pension 
check each month. Unfortunately, Leona isn't alone.
    We know the one reason someone doesn't fill a prescription 
is because of the cost. For years, prescription drug prices 
increases have dwarfed even the highest rates of general 
inflation. If consumer prices had risen as fast as drug prices 
over the last 15 years, gas would now cost $12.20 a gallon, 
milk would be $13 a gallon.
    Just in January, the drug industry raised prices on over 
800 prescription medications just as they increased prices for 
decades, including three-quarters of the top 100 drugs with the 
highest spending in Medicare Part D. AARP is mindful that high 
and growing prescription drug prices are affecting all 
Americans in some way. Their high cost is passed along to 
everyone with health coverage through increased health care 
premiums, deductibles, and other forms of prescription drug 
spending and other public programs like Medicare and Medicaid.
    These escalating costs will eventually affect all of us in 
one form of health care costs, higher taxes, cuts to Medicare 
or Medicaid, or all of the above. In other words, every single 
American taxpayer is paying for high prescription drug prices, 
regardless of whether you are taking medicine or not. 
Fortunately, there is action the Senate can take right now. 
There is longstanding and overwhelming bipartisan support among 
voters for Medicare to negotiate with drug companies for lower 
prices.
    The policies before the Senate that the Senator Kelly is 
leading on include Medicare negotiations, capping out-of-pocket 
costs under Medicare Part D, and penalizing drug companies that 
increase their prices faster than inflation, will provide long 
overdue relief to older Americans across the country. These 
policies, taken together, will help reduce drug prices and out-
of-pocket costs. This is important because real relief for 
seniors and all Americans must include policies that get to the 
root of the problem, the high prices set by drug companies. 
American seniors aren't the only ones who stand to benefit.
    Lowering prescription drug prices will also save Medicare 
program and taxpayers hundreds of billions of dollars every 
year. Medicare spends more than $135 billion on prescription 
drugs. Last October, a survey commissioned by AARP Arizona 
conducted by OH Predictive Insights showed Arizonans across the 
aisle agreed on the need for affordable medication and action 
by Members of Congress.
    An overwhelming majority of Arizonans agree Congress needs 
to tackle high prescription drug costs because some people 
can't afford to buy medicine or pay their necessities. Eighty-
nine percent of those surveyed agreed. The survey results 
showed a vast majority support for each proposed measure being 
discussed in Congress to reduce drug prices. The most favored 
initiative was allowing Medicare to negotiate for the price of 
drugs, winning over ninety-four percent of Arizonans.
    Further, two-thirds, sixty-six percent of Arizonans 
surveyed do not believe that innovation will suffer if Medicare 
is allowed to negotiate for lower prices. Clearly, Americans 
are fed up with paying three times what people in other 
countries pay for the same drugs.
    More than 4 million people across the country, including 
over 113,000 in Arizona, are joining AARP to sign a petition to 
demand lower prices for prescription drugs. There will never be 
a better time to lower drug prices than the historic 
opportunity in front of Congress right now.
    Now is the time to get it done. Thank you.
    Senator Kelly. Thank you, Ms. Kennedy.
    Dr. Karuppana?

             STATEMENT OF SUGANYA KARUPPANA, M.D.,

              CHIEF MEDICAL OFFICER, VALLE DEL SOL

               COMMUNITY HEALTH, PHOENIX, ARIZONA

    Dr. Karuppana. Okay. Thank you, Senator Kelly and members 
of the Special Committee on Aging for inviting me to speak 
today on this vital topic, the high and ever rising cost of 
medications for our seniors. My career has been dedicated to 
serving communities with health disparities. I spent 6 years at 
UCLA's County Hospital. I was a Clinical Professor at the David 
Geffen School of Medicine, training our next generation of 
doctors. Since moving to Phoenix, I have worked exclusively in 
federally qualified health centers.
    As Chief Medical Officer at Valle del Sol Community Health 
in Phoenix, we serve a large number of Latinos, African-
American, Asian, Pacific Islanders, and Native American 
patients, all of whom are disproportionately impacted by high 
cost medications. As you know, within the Part D prescription 
drug program standard benefits, patients must pay the initial 
$480 out-of-pocket deductible before the initial coverage phase 
begins.
    Regrettably, for many patients that initial deductible is 
enough of a barrier for them to choose not to purchase a 
prescription and forgo needed treatments. While some patients 
can qualify for premium and cost sharing assistance, many are 
not forthcoming with their health care providers about their 
financial limitations because they are embarrassed, some even 
choose not to return to their provider when they cannot afford 
their medications for fear of reproach.
    Community health centers like Valle del Sol are starting to 
realize the need to screen for financial challenges and other 
social determinants of health upfront to address them early, 
rather than waiting to discover these problems after a patient 
develops complications due to lack of treatment. Unfortunately, 
screening and additional subsidies are not enough to solve 
today's problems.
    These are the types of scenarios we see day in and day out 
in community health centers and other facilities that treat our 
seniors on fixed incomes. Patients who have grown to trust 
their health care providers often turn to us for help. I can't 
tell you the number of times I have heard my patients say, doc, 
or doctora, please look at all of my meds and tell me, what can 
I skip? It costs me too much each month and I need to stop at 
least two or three of them, but when a patient has had a heart 
attack with a stent, breast cancer, and a blood clot, every one 
of her meds is critical to keeping her alive.
    These are hard decisions for patients, but also medically 
and ethically difficult for doctors and other health care 
providers who routinely face these circumstances. Another 
scenario we often see play out involves patients who can afford 
their regular daily meds and the initial out-of-pocket 
deductible, they can also meet the initial coverage phase where 
they are responsible for 25 percent of the medication costs, 
but when they have reached the Federal $4,430 threshold, the 
Medicare coverage gap, better known as the infamous donut hole, 
the patients are then still on the hook for 25 percent of the 
cost until they hit $7,050 in out-of-pocket spending when 
catastrophic coverage takes effect, and then, even after 
spending that much on medication, these seniors are still 
responsible for 5 percent of the cost of their meds without a 
cap until the year ends and the cycle begins again. For 
patients with complex conditions like rheumatologic disorders 
and cancers that require specific high cost medications, the 
coverage gap and no limit on how much they may have to pay out 
of pocket causes real problems.
    Many patients who have moderate financial resources are 
unable to get treatment because medications totaling thousands 
are putting those treatments out of reach. In some cases, 
patients ask for treatment regimens that are not evidence based 
in order to make it affordable. Those same patients with 
moderate resources may ration their treatment in order to make 
it affordable, so how do we address these issues? There are 
several prescription drug policies proposed by Senator Kelly 
that could improve the lives of my patients. For example, 
allowing the Federal Government to negotiate prices for high 
cost drugs covered under Medicare Part B and Part D, 
redesigning the Part D benefit to create a $2,000 cap on out-
of-pocket costs is much more reasonable than today's coverage 
gap, and capping co-pays on insulin at $35 will make life 
saving diabetes treatment more accessible.
    I close today with this, I believe we have a duty to care 
for our Nation's seniors, especially those who cannot care for 
themselves. Our seniors are not only our parents, our 
grandparents, the people who care for us, they nurtured and 
raised us, they are the reason we are all here today and we 
should remind ourselves we will be in their position later on. 
You don't need a physician to tell you that none of us escapes 
the aging process, and as such, we may soon find ourselves in 
facing the very difficulties I have described today. In that 
sense, our duty to our society and our seniors is our duty to 
ourselves. I thank the special committee for allowing me to 
speak today, and I am willing to answer any questions.
    Senator Kelly. Thank you, Dr. Karuppana.
    Ms. Vasquez?

         STATEMENT OF DORA VASQUEZ, EXECUTIVE DIRECTOR,

            ARIZONA ALLIANCE FOR RETIRED AMERICANS,

                        PHOENIX, ARIZONA

    Ms. Vasquez. Thank you, Senator Kelly. Good morning. Thank 
you for holding today's field hearing in the great State of 
Arizona and for inviting me to testify. I am Dora Vazquez, 
Executive Director of the Arizona Alliance for Retired 
Americans. The Arizona Alliance for Retired Americans is a 
grassroots organization representing more than 48,000 retirees 
and seniors statewide, working to advance public policy that 
strengthens the health and retirement security of older 
Americans.
    It is a pleasure to be here with you all today as we 
discuss ways to bring the skyrocketing cost of prescription 
drugs under control. There truly is no time to wait to lower 
prescription drug prices. The Arizona Alliance strongly 
supports efforts to eliminate waste and reduce drug costs in 
Medicare's prescription drug benefits plans and the system's 
finances overall and opposes proposals that shift any 
additional cost to beneficiaries.
    We support the fundamental goals of this hearing, namely, 
to demonstrate the harm that exceedingly high prescription drug 
prices cause seniors citizens and the American economy. Senator 
Kelly has been a leader in the effort to lower the cost of 
prescription drugs through Medicare negotiation, out-of-pocket 
caps, and a Part D redesign that includes a cap on the price of 
insulin. All of these tools are needed to reduce the cost of 
prescription drugs. Americans pay the highest prices in the 
world for prescription drugs, and prices of hundreds of drugs 
have already increased by 5 percent in 2022, far outpacing 
inflation.
    According to a March 9th, 2021, report by the Government 
Accountability Office, in 2020, Americans paid two to four 
times more for 20 brand name drugs than people in Canada, 
France, and Australia. Seniors who take the most prescription 
drugs to stay healthy bear the brunt of these high cost, 
because of this terribly excessive cost of prescription drugs, 
a quarter of Americans and 20 percent of seniors report not 
being able to afford their prescription.
    As a result, millions of Americans do not take their 
prescriptions as prescribed by their doctor and instead are not 
filling them, skipping doses, or taking fewer doses than 
directed. This should not be tolerated in a Nation as wealthy 
and resourceful as the United States. The Arizona Alliance 
strongly believes that the Secretary of Health and Human 
Services must be allowed to negotiate lower drug prices under 
Medicare.
    According to the Congressional Budget Office, Medicare 
price negotiation would not only assist seniors to afford their 
medicine, it would also save the U.S. Government billions of 
dollars. The CBO estimates that Senator Kelly's proposal to 
allow negotiations would lower spending by $78.8 billion over 
10 years. This would create savings that could be reinvested 
back into Medicare for greater or improved coverage.
    Another contributing factor to the casual effect of high 
drug prices is the abusive practice of drug companies that take 
advantage of the U.S. patent system. The Arizona Alliance 
strongly believes that legislation needs to be enacted to curb 
these often egregious abuses. Pharmaceutical corporations use 
numerous tactics to extend patent terms, costing Medicare 
billions of dollars.
    For example, and AbbVie Pharmaceutical reached an agreement 
through a pay for delay deal with its competitors, Novartis and 
Amgen, to delay the entry of those companies biosimilars in the 
United States until 2023, a delay agreement that is costing 
American taxpayers $19 billion. Last, the Arizona Alliance for 
Retired Americans strongly supports meaningful drug price 
reforms in the plan supported by Senator Kelly that passed in 
the House.
    The most important of these include capping co-pay for 
insulin at $35, setting a $2,000 annual out-of-pocket cap for 
seniors' medication in Medicare Part D, and creating new price 
gouging penalty for drug companies that raise prices faster 
than inflation. I want to thank you again for providing me with 
the opportunity to present testimony on behalf of the Arizona 
Alliance for Retired Americans on this critical issue, and I 
would be pleased to answer any questions you may have. Thank 
you.
    Senator Kelly. Thank you, Ms. Vasquez.
    Ms. Pena?

                    STATEMENT OF JENNY PENA,

        ASSOCIATE MANAGER OF PHARMACY PATIENT ADVOCACY,

       BANNER MD ANDERSON CANCER CENTER, PHOENIX, ARIZONA

    Ms. Pena. Thank you, Senator Kelly. My name is Jenny Pena, 
and I am the Associate Manager of Pharmacy Patient Advocacy at 
Banner MD Anderson Cancer Center, specializing in oncology. 
Banner MD Anderson is part of Banner Health, one of the largest 
secular nonprofit health care systems in the country and 
largest private employer in Arizona.
    I am also an Advisory Board Member of the National Health 
Career Association and was named next generation pharmacist, 
pharmacy technician of the year honoree in 2021. I would like 
to express my gratitude to Senator Kelly and the Senate Special 
Committee on Aging for providing this opportunity to testify on 
behalf of the patients I serve each day. As a patient advocate, 
I help patients who are facing life altering cancer diagnosis 
access financial assistance to cover costs of the drugs they 
have been prescribed.
    I work in oncology, these drugs are even pricier than other 
non-specialty drugs. An average oral drug to begin treating 
breast cancer at cost about $1,100. For pancreatic cancer, the 
average is around $5,500. The cost of starting oral treatment 
for chronic myeloid leukemia has an average cost of $32,000.
    These drugs are clearly incredibly expensive. According to 
the National Cancer Institute, most cancer drugs launched 
between 2009 and 2014 were priced at more than $100,000 per 
patient for 1 year of treatment. Once a patient has been 
prescribed treatment, it is my job to find out what their 
insurance will cover of those amounts and what will be left on 
their bill to pay out of pocket.
    I am extremely protective of my patients, and mama bear 
comes out when I am working back end of these claims with the 
insurance plans. I always fight to make sure my patients get 
the coverage they deserve, but even with good insurance 
coverage, my patients can still be left with thousands of 
dollars to pay out of pocket. I am the one who makes the phone 
call to let the patients know their insurance has approved 
their treatment, but that they are going to be left with a high 
co-pay.
    When my patients hear the amount they are on the hook for, 
I typically get one of two reactions, some people are angry. 
They have already faced countless doctors, tests, diagnosis, 
and other stressors. Now they are faced with costs that may 
impact their ability to seek treatment. Others are just sad--
now they are faced with costs that may impact their ability to 
seek treatment. They feel hopeless, the costs are too high, and 
they surrender to their unknown fate.
    Of course, some people don't even know--don't want to know 
what the co-pay is because they know they can't afford it. On 
these phone calls, you must have a lot of compassion. You are 
going to have patients with different emotions, but I 
sympathize. This is a very personal issue to me as well. Both 
of my parents are from El Salvador and my father is a cancer 
survivor.
    Thankfully, his diagnosis prompted many others within our 
community to get screened, including myself. I know that not 
everyone is able to take these proactive measures, and not 
everyone can maintain their treatment, especially in 
communities of color. Black and Hispanic individuals are more 
likely to report cost related nonadherence to their treatment.
    My goal is to help prevent anyone from foregoing their 
medication due to cost. To do this, I help my patients access 
the resources available to assist with these financial 
concerns, including foundation grants, free trials, 
manufacturer free drug programs, and voucher programs. However, 
the process of finding these resources is time consuming and 
complicated, time that many of the cancer patients do not have.
    Additionally, my Medicare patients are limited in the 
assistance they can receive, despite typically being the 
population who needs the most financial help. While I am 
typically successful in helping my patients, if I was mama bear 
before, my papa bear personality comes out, when I am working 
to turn over every stone to find a solution for these patients. 
I recognize that many medical facilities do not have roles like 
mine designated to patient advocacy.
    My role in helping patients access their medications is 
extremely important, and it is something I am so passionate 
about, but to be honest, this should not be necessary. I 
believe that everyone deserves access to affordable 
prescription drugs despite their age, income, socioeconomic 
status, or race.
    Congress has to do more to make sure people can access the 
care and treatment that they need. I am encouraged by the fact 
that I am here today to advocate for solutions. Thank you again 
for the opportunity to speak today, and I am happy to answer 
any questions.
    Senator Kelly. Thank you, Ms. Pena. We will wrap up the 
opening remarks with Ms. Wilson.

                   STATEMENT OF JUDY WILSON,

                  MS PATIENT, PHOENIX, ARIZONA

    Ms. Wilson. Senator Kelly. My name is Judy Wilson, and I am 
a recently retired. I am on Medicare. I returned for 22 years--
I volunteer for the MS Society, I mentor for Community Health 
Mentor Program and, most importantly, a grandmother of four 
wonderful children, and I am also living with multiple 
sclerosis. MS is an unpredictable, often disabling disease of 
the central nervous system that disrupts the flow of 
information within the brain, and between the brain and the 
body.
    I was diagnosed in 2010 after experiencing tingling in my 
fingers, lack of balance, depression and anxiety, inability to 
write, and incontinence. With the help of my general 
practitioner and many specialists, I was able to address many 
of my symptoms. Even still, I have lost much of my hearing, 
have no sense of smell, my eyesight is compromised, my gait is 
off, my number of falls has increased, and I have constant 
nerve pain in my feet and hands.
    Disease modifying treatments have proven to be the best way 
to manage the MS disease course. There are more than 20 on the 
market, and it is common for people with MS to move through 
several different treatments throughout their life. After some 
trial and error with several disease modifying treatments, or 
DMTs, my neurologist prescribed Copaxone, a self-injector that 
I take three times a week.
    When I transitioned to Medicare, I was able to get 
assistance from a charitable foundation, and they paid $3,272 
co-pay for the first 2 months of the year and then $250 per 
month after that, making my treatment affordable for me. 
Charitable foundations like the one I used exist for Medicare 
beneficiaries to apply to for assistance supporting their 
medication, but the need is far greater than supply.
    Unfortunately, in 2021, the foundation I relied on ran out 
of money. I am unable to afford the over $7,000 per year 
without financial help, so I reached out to my neurologist for 
help. After discussions with my doctor, I decided to go off my 
medications. I didn't have any other options and have so far 
been very lucky that I haven't had any relapses or any 
setbacks, but I want to emphasize that the decision to stop my 
medication was based on money, not medicine.
    If I could afford to go back on Copaxone, I would. MS is an 
extremely unpredictable, and just because I have been healthy 
so far doesn't necessarily guarantee that I will not have a 
relapse in the future. For most living with MS, a gap in 
medication could mean disease progression, and that would lead 
to permanent loss of mobility or cognitive function. This is a 
risk I take daily. No one should have to take this risk because 
they cannot afford medications they need.
    It seems ridiculous that I have to need a charity 
assistance to afford my medications, even though I am already 
paying $2,040 per year for health insurance through Medicare. I 
know I am not alone. A National MS Society survey found more 
than 70 percent of people with MS have received financial 
assistance for their DMT, and 40 percent of people with MS 
alter the use of their DMT due to cost, including stopping, 
skipping, or delaying treatment.
    As a volunteer self-help group leader for people living 
with MS in the Phoenix area, I hear firsthand how difficult it 
is for people to afford their medications. There are two others 
in my group who have discontinued use of their medications. One 
has recently gotten out of the hospital after a 2-weeks stay.
    Congress must pass legislation immediately that establishes 
an out-of-pocket cap in Medicare and a structure that allows 
beneficiaries to spread their costs throughout the year so that 
seniors like me can afford to take their needed medication. It 
is also critical that Congress keep drug price increases at the 
pace of inflation and allow Medicare to negotiate better drug 
prices on behalf of its beneficiaries.
    When I first began to take Copaxone in 2014, it was priced 
at approximately $60,000 a year. It is now at $75,000 a year. 
That is an increase of $15,000, or 25.6 percent, in just 8 
years for the same medication.
    There is no single policy solution that will address the 
high cost of prescription drugs, but these policies are an 
important step in the right direction and would immensely 
improve the quality of life for many seniors, including me. 
Thank you for the opportunity to share with you today.
    I look forward to working with you to address the high cost 
of medication.
    Senator Kelly. Thank you, Ms. Wilson. Now we are going to 
go back to Ms. Pena because she was going to deliver her 
remarks in Spanish as well.
    Ms. Pena. Gracias, Senador Kelly. Mi nombre es Jenny Pena y 
soy la Gerente Asociada de Defensa del Paciente Farmaceutico en 
Banner MD Anderson Cancer Center, especializada en oncologia.
    Banner MD Anderson es parte de Banner Health, uno de los 
sistemas de atenci0n medica sin fines de lucro mas grandes del 
pais y el empleado privado mas grande de Arizona. Tambien soy 
miembro de la junta asesora de la Asociacion Nacional de 
Profesionales de Salud y fui nombrada tecnico de farmacia del 
ano, the next generation pharmacist, homenajeada en 2021.
    Me gustaria expresar mi gratitud al Senador Kelly, y al 
comite especial del Senado sobre el Envejecimiento por brindar 
esta oportunidad de testificar en nombre de los pacientes que 
atiendo cada dia. Como defensor del paciente, ayudo a los 
pacientes que enfrentan diagnosticos de cancer que alteran sus 
vidas al acceder a asistencia financiera para cubrir los costos 
de los medicamentos que le han recetado.
    Debido a que trabajo en oncologia, estos medicamentos son 
incluso mas caros que otros medicamentos que no son de 
especialidad. Un medicamento oral promedio para comenzar a 
tratar el cancer the mama cuesta alrededor de $1,100. Para el 
cancer de pancreas, el promedio es de alrededor de $5,500. El 
costo de iniciar un tratamiento oral para la leucemia cronica 
tiene un costo promedio de $32,000.
    Estos medicamentos son claramente increiblemente caros. 
Segun el instituto Nacional del Cancer, la mayoria de los 
medicamentos contra el cancer lanzados entre 2009 y 2014 tenian 
un precio de mas de $100,000 por paciente por un ano de 
tratamiento. Una vez que a un paciente se le ha recetado un 
tratamiento, es mi trabajo averiguar que cubrira su seguro de 
esos montos, y que quedara en su factura para pagar de su 
bolsillo.
    Soy extremadamente protectora con mis pacientes, y osa mama 
sale cuando estoy trabajando en la parte final de estos 
reclamos con los planes de seguro. Siempre lucho para 
asegurarme que mis pacientes tengan la cobertura que se 
merecen. Pero incluso con una buena cobertura de seguro, mis 
pacientes aun pueden quedarse con miles de dolares para pagar 
de sus bolsillos.
    Soy la que hace esa llamada telefonica para informarle al 
paciente que su seguro a aprobado su tratamiento, pero que se 
quedara con un pago alto. Cuando mis pacientes escuchan la 
cantidad por la que estan endeudados, normalmente obtengo una 
de dos reacciones. Algunas personas estan enojadas. Ya se han 
enfrentado a innumerables medicos, pruebas, diagnosticos, y 
otros factores estresantes. Ahora se enfrentan a costos que 
pueden afectar su capacidad para buscar tratamiento. Otros 
simplemente estan tristes. Se sienten sin esperanza. El costo 
es demasiado alto y se rinden a su destino desconocido.
    Por supuesto algunas personas ni siquiera quieren saber 
cual es el monto de copago porque saben que no pueden pagarlo. 
En estas llamadas telefonicas debes tener mucha compasion. Vas 
a tener pacientes con diferentes emociones, pero simpatizo. 
Este tema tambien es muy personal para mi. Mis padres son del 
Salvador, y mi padre es sobreviviente de cancer.
    Afortunadamente su diagnostico hiso que muchos otros de 
nuestra comunidad se hicieran la prueba, incluyendome a mi. Se 
que no todos pueden tomar estas medidas proactivas y no todos 
pueden mantener su trato, especialmente en las comunidades de 
color. Las personas Hispanas y de color son mas propensas a no 
informar sobre su tratamiento relacionada los costos.
    Mi objetivo es ayudar a evitar que alguien renuncie a su 
medicamento debido al costo. Para hacer esto, ayudo a mis 
pacientes a acceder a los recursos disponibles para ayudar con 
estas preocupaciones financieras, incluidas subvencionas de 
fundaciones, pruebas gratuitas, programas de medicamentos 
gratuitos del fabricante, y programas de vales. Sin embargo, el 
proceso de encontrar estos recursos lleva mucho tiempo y es 
complicado, tiempo que mucho de esto pacientes con cancer no 
tienen.
    Ademas, mis pacientes de Medicare estan limitados en la 
asistencia que pueden recibir a pesar de que por lo general son 
la poblacion que mas ayuda financiera necesita. Si bien 
normalmente tengo exito en ayudar a mis pacientes y antes era 
mama oso, y personalidad de papa oso aparece cuando trabajo 
para remover cada piedra para encontrar una solucion para estos 
pacientes. Reconozco que muchas instalaciones medicas no tienen 
roles como el mio destinado a la defensa del paciente.
    Mi papel en ayudar a los pacientes a acceder a sus 
medicamentos es extremadamente importante, y es algo que me 
apasiona. Pero para ser honesta, esto no deberia ser necesario. 
Creo que todos merecen acceso a medicamentos recetados 
accesibles independientemente de su edad, ingresos, nivel 
socioeconomico, o rasa.
    El Congreso tiene que hacer mas para asegurarse de que las 
personas puedan acceder a la atencion y el tratamiento que 
necesitan. Me alienta el hecho de que estoy aqui hoy para 
abogar por soluciones. Gracias nuevamente por la oportunidad de 
hablar hoy, y estare feliz de responder cualquier pregunta.
    Senator Kelly. Well, thank you. Thank you, everybody, for 
their initial testimony here. We are going to start off with 
our round of questions, and again, we will try to keep the 
answers to 5 minutes per person here. We are going to start 
with Ms. Vasquez. In your initial testimony, you talked about, 
and hopefully we can get to this in your answer, talked about 
some of the ways that pharmaceutical companies can keep the 
cost up. Pay for delay is what you mentioned.
    There is also other ways of getting around the patent law, 
but let me start by saying that there are more than 1.3 million 
Arizona seniors on a Medicare plan, and in 2018, tens of 
thousands of seniors spent enough money on their prescription 
drugs to reach the catastrophic coverage, which based on the 
threshold in that year meant they spent more than $5,000 on 
medication.
    That has since gone up. That number is now over $7,000, and 
the average out-of-pocket costs for an Arizona senior on a 
Medicare Part D plan was $3,450 for the year. This is 
unacceptable, and for seniors, it is not sustainable, but today 
we are here to talk about solutions.
    Ms. Vasquez, what are some of the solutions that you have 
seen that can make prescription drugs more affordable for 
Arizona's seniors?
    Ms. Vasquez. Well, thank you, Senator Kelly. You know, as 
mentioned, we pay more than any other country for the same 
prescription drugs that members of the Alliance,
    Arizona Alliance urge the members of the U.S. Senate to 
pass the drug pricing agreement that you, Senator Kelly, 
support.
    There is no substitute for the real comprehensive drug 
pricing legislation from Congress to make health care more 
affordable for retirees, and we hear this time and time again, 
Congress must allow Medicare to negotiate lower drug prices and 
include provisions that cap out-of-pocket prescription drug 
costs at $2,000 per year under Medicare Part D.
    Senator Kelly, you worked on cap--to cap the price of 
insulin at $35 per month, and the agreement that you worked on 
creates a new price gouging penalty for drug companies that 
raise prices faster than inflation. In addition, we strongly 
encourage Congress to extend APTCs, the tax credits you get to 
take advantage--advance to lower your monthly health insurance 
premiums, and those need to be extended through 2025.
    The current subsidies in the American Rescue Plan benefit 
about 9 million people, and those will expire in 2022. Thank 
you.
    Senator Kelly. Thank you. Then we also need to do something 
on the patent reform.
    Ms. Vasquez. Absolutely.
    Senator Kelly. As well. You mentioned, one pharmaceutical 
company paying another to not bring a generic right to market, 
and that just hurts everybody.
    Ms. Vasquez. Right. Absolutely.
    Senator Kelly. Ms. Kennedy, you know, during your initial 
testimony, the thing that, you know, that I really did notice 
was--I mean, gas prices are high now, but if they went up at 
the rate of prescription drugs, you said $12.20 a gallon. That 
is remarkable, so that shows you how fast the price of drugs 
rises every single year, so lowering the cost of prescriptions, 
it is one of my top priorities and it has been while I have 
been in the
    U.S. Senate for 14, 15 months now, so Ms. Kennedy, AARP has 
been advocating for policies to reduce drug costs like those 
Ms. Vasquez just mentioned for many years, and AARP has 890,000 
members in the State of Arizona.
    Ms. Kennedy. We do.
    Senator Kelly. You have got to be like the biggest 
organization in the State.
    Ms. Kennedy. One of the largest.
    Senator Kelly. Yes--in the country with the number of 
members----
    Ms. Kennedy [continuing]. membership organizations.
    Senator Kelly. What do you hear from those 890,000 members? 
Can you share with us--you know, what are your members--what do 
they say about this topic?
    Ms. Kennedy. I mean, they are frustrated. I am frustrated. 
I actually started working on this issue in 1998. My first job 
out of college was working on this issue, and I have worked for 
the National Council of Senior Citizens, I worked for the 
Alliance for Retired Americans, and now seven and a half years 
with AARP, and so there is just a tremendous amount of 
frustration that, you know, year after year, we promise to get 
something done and we don't get something done, and of course, 
we did get an AARP supported Medicare Part D, the drug benefit, 
but unfortunately there are still--you know, we knew that there 
was still was some unfinished business, so actually getting the 
House version done in the Senate would be very helpful, but you 
know, what we hear from our members is, you know, they do cut 
their medications in half.
    They are very resourceful with what they do. They fill 
their prescriptions and try to make it last until they get 
their next Social Security check. There is a tremendous amount 
of guilt if a spouse has a certain terminal illness or chronic 
condition, and they simply can't afford it. We got a letter 
from a member and his wife, you know, suffered from a stroke 
and he feels very guilty that he can't afford her medications, 
and so there is just, you know, so many things that people are 
doing to be resourceful, but at the end of the day, they are 
just frustrated that something doesn't get done, and you know, 
we have the opportunity right now to get this done, and I 
really appreciate you championing this issue, and let's get it 
across the finish line.
    Senator Kelly. Yes. We don't always have the opportunity, 
and right now we do. I mean, there is really no excuse. I 
remember speaking to a senior at Prescott, they told me about 
how the price of a certain drug went up 3x, you know, 300 
percent in a year with no explanation. Do you ever have--does 
anybody ever tell you that a pharmaceutical company at least 
tried to explain why the price of the drug went up? Is that 
something you have ever heard?
    Ms. Kennedy. Sometimes they try and say that they offer 
some type of benefit to ask their physician if they could get 
some samples, but as far as them explaining why they are 
raising the prices, I haven't heard a reason for why they raise 
it the way they do.
    Senator Kelly. With 890,000 members, nobody has ever said, 
hey, at least the pharmaceutical company told me why the prices 
doubled.
    Ms. Kennedy. No.
    Senator Kelly. No explanation.
    Ms. Kennedy. No. I mean, the other thing is people go to 
great lengths to do the research during open enrollment and 
figure out like, what medications do I have and what is going 
to be the best plan for me? Then they could do all their 
research and sign up, and then there is, you know, some 
switching that goes around or they do fall into the donut hole 
as well, so that is something we need to fix. You know, once 
they actually hit that catastrophic benefit, it is very 
generous, but how much money do they have to spend to actually 
hit the catastrophic benefit?
    Senator Kelly. I want to ask you about insulin here. You 
know, so we got the House. The House passed this bill to cap at 
$35 a month per patient for folks with Part D commercial 
insurance plans, so can you describe what a difference this 
monthly cap would make to millions of seniors who are--happen 
to be Type I diabetics?
    Ms. Kennedy. Well, what I do know is we know families all 
across the country are struggling with outrageous prices of 
insulin and many other drugs, and just in January, prices went 
up yet again on 75 percent of the most prescribed drugs in 
Medicare, and that is why AARP remains laser focused on urging 
the Senate to pass a comprehensive prescription drug reform 
already passed by the House that will finally let Medicare 
negotiate for lower prices.
    It will cap out-of-pocket costs for millions of Americans, 
seniors, as well as cap monthly insulin costs, and AARP members 
have listened for decades as politicians have promised these 
commonsense reforms, and it is time for Senators to keep their 
promises on the voters, so definitely the insulin cap would 
help, but we definitely need comprehensive prescription drug 
reform.
    Senator Kelly. You know, the negotiation part of this is so 
important. The argument that some folks will try to make for 
pharmaceutical companies is they need these enormous profits in 
order to develop the next drug, and that is fundamentally not 
the situation. I mean, part of this negotiation, if enacted, 
would be, you know, there would be--that would be a topic of 
discussion.
    You know that we, the Federal Government, understands that 
companies need to make a profit and they need to have the 
resources, but when you see these prices going up, you know, 
26.3 percent between 2015 and 2019 is the number that you 
stated, when income is only going up 15 percent, that is 
unsustainable.
    Ms. Kennedy. Absolutely.
    Senator Kelly. I mean, you cannot--it is unfair now, but if 
those two rates, I mean, they will continue to diverge, nobody 
will be able to afford their prescription medications, so thank 
you.
    Ms. Kennedy. Thank you.
    Senator Kelly. Ms. Pena, so thank you for sharing your 
experiences with us today, and your work is important because I 
agree with you that we should be tackling the problem of high 
drug costs comprehensively at the source, not just asking you 
to have to patch this up with your patients, and I want to 
thank you for all the hard work that you do on behalf of people 
that, you know, are just in such a horrible situation.
    You know, as we heard today, patients on Medicare Part D 
pay 25 percent of their drug costs until they hit $7,050 in 
out-of-pocket spending, but I think what it is, is they are 
paying between--when they hit $480, it is $0 to $40 and then it 
is 25 percent up to $4,000 and something, and then it is 
nothing right up to $7,050, and then it is covered with a 5 
percent out-of-pocket after that, so you could see how this 
gets really expensive very quickly, so how long--could you give 
us an example how long it might take one of your patients to 
rack up $7,050 in drug costs, and would that necessarily take 
multiple drugs and several months, or could that be in one 
single treatment? Based on your testimony, I think we all know 
what the answer is here, but I want to hear from you.
    Ms. Pena. Yes. If you are a patient that can afford the co-
pay, depending, of course, on your insurance plan, it could 
take roughly about 3 months before you hit that $7,050, but if 
you are a patient on limited income or low income, and then you 
are out there seeking support from grants or foundations, and 
then again, assuming that you qualify based on your diagnosis 
and that there is even funds available in the grant because 
they do tend to run out, you maybe never reach that $7,050 
because you will never be able to accumulate that amount of 
money because of the high costs.
    Senator Kelly. Yes, so you pointed out that somebody who 
has pancreatic cancer, their drug costs, you said, was $5,500 
and I think you meant $5,500 per month, per month, so there are 
many scenarios where they are--it is just unaffordable.
    Ms. Pena. Correct.
    Senator Kelly. Like, they are never going to--they are 
never going to get there because they can't afford the first 
month of medication.
    Ms. Pena. Correct. Yes.
    Senator Kelly. However, if we restructured the Part D 
benefit program and there was a $2,000 cap, that maybe for some 
of these patients it would be realistic if we could spread that 
$2,000 over 12 months.
    Ms. Pena. I think any cap that is lower than what it is 
today would be very beneficial to all patients out there and in 
our communities.
    Senator Kelly. Okay. Thank you, and this next question is 
also for you, Ms. Pena. In your testimony, you mentioned the 
various reactions you get when you call your patients to help 
plan the next steps of how they are going to afford their 
treatment.
    You mentioned that every patient has a different reaction 
when you tell them. You said some of them are sad, some of them 
are angry. Some of them just realize they can't afford it, so I 
guess for them it doesn't even matter, but obviously everybody 
has a different and unique situation, and we know that the 
impact of these costs hits some Arizonans harder than others, 
and the high costs are not equally distributed, so can you 
describe the disproportionate impact of high drug costs on 
Latinos and African-Americans and the Native American patients 
that you deal with?
    Ms. Pena. Sure. I think part of it is culture. Growing up 
in a Hispanic household, you are taught to grow up on, you 
know, home remedies, a lot of old wives tales, right, and so we 
tend not to go to our providers to get treatment, but also in 
some research that I did when I was looking into cost related 
nonadherence in those communities of color, I found that a lot 
of it has to do with them not even being able to go see a 
provider.
    They can't even afford the co-pay to go get a diagnosis, go 
to urgent care, or see their primary care physician, and so 
they have to go through that first hurdle. If they do find the 
means to see a provider, they have a second hurdle, which is, 
can they afford that prescription medication that they just got 
prescribed for their diagnosis? It is just this consistent, 
vicious cycle of unattainable medication that they can never 
get for treatment, and so that really goes toward that cost 
related nonadherence for our communities of color.
    Senator Kelly. Then I think it is important that we point 
out when a patient doesn't take the medication that they need, 
that somewhere down the line they often wind up being 
hospitalized.
    Ms. Pena. Correct.
    Senator Kelly. The overall cost, you know, could be even 
higher for the Federal Government by not having individuals 
take the medication they need for whatever condition they have.
    Ms. Pena. Correct.
    Senator Kelly. Thank you. Dr. Karuppana, you know, nobody 
in our country should have to make the decision whether or not 
to buy groceries or pay rent or utility bill and take a pill, 
but in your testimony, you mentioned your experience with 
patients who are forced to ration or stop their medication 
because of cost, and could you share some examples of when the 
high cost of prescription drugs has not only led to hard 
choices, but do you have any examples of like harmful health 
outcomes, which was what I was just alluding to?
    Dr. Karuppana. Sure. I have two examples I can share. One 
is similar to what you were just referencing. I had a patient 
of mine who had diabetes, and she was previously well 
controlled, but she came in for followup with me and that 
particular day her sugars were very high, and I asked her, you 
know, what changed? She told me that she had to choose between 
paying for her insulin or paying for gas for her grandchild to 
go to work, and her grandchild was the breadwinner for the 
household and the rent was due, and so that was the obvious 
choice that she had to make, so that is a common one.
    Senator Kelly. Do you remember what her insulin cost was?
    Dr. Karuppana. Her insulin costs was like $250 or $300 a 
month. Another example I have is a patient of mine who had 
ulcerative colitis, so that is an inflammatory bowel disease 
that causes bloody diarrhea and can often lead to colon cancer, 
so without her treatment, she was having about 10 bloody stools 
a day. However, thanks to a disease modifying antirheumatic 
rheumatologic drug, her disease was well controlled, and the 
blood had stopped.
    Unfortunately, the specialized medication became too 
expensive, so she started to take her medication every few 
days. The blood in her stool was reduced to only three to four 
times a day, which she thought was better, but she didn't 
understand that that was still putting her at risk for colon 
cancer. She ended up needing to get a blood and iron 
transfusion, and she ended up being hospitalized because of her 
chronic blood loss, and all of that could have been avoided if 
she could have just stayed on her prescription.
    Senator Kelly. How is she doing now?
    Dr. Karuppana. I think she is doing great. I mean, she was 
eventually able to get on an assistance program that was able 
to keep her on her medication, but it took a long time to 
figure out a solution for her, and you know, she has suffered a 
lot of consequences in the interim.
    Senator Kelly. Do you think these policy solutions we have 
been talking about today will help your patients?
    Dr. Karuppana. Absolutely. From my first example, if there 
was a $35 cap on her insulin instead of the hundreds that she 
was paying every month, I think she would have been able to 
stay on her insulin and help her grandchild get to work, and in 
my second example, the patient who was paying the high amount 
for her medication for her ulcerative colitis, I think if there 
was an option to reduce the cost of that medication through the 
Federal Government negotiating the prices of those specifically 
high cost medications, and if there was that $2,000 cap that 
was spread out over the course of the year, both of those 
things would have allowed her to stay on her medication and 
avoid those health outcomes.
    Senator Kelly. What do you think her hospitalization cost 
are?
    Dr. Karuppana. Hospitalizations can run to hundreds of 
thousands of dollars. I think she was in for about 4 days, if I 
remember.
    Senator Kelly. Well, thank you. Ms. Wilson, I want to thank 
you for being here today and sharing your experience. I think 
it is really important for folks in my position to hear stories 
like yours to fully understand how these policies impact 
people's lives.
    As we have discussed today, I put forth a plan to reduce 
the cost of prescription drugs by allowing Medicare to 
negotiate directly with drug companies to bring down prices, 
and then to also limit how quickly those companies can then 
raise the price from year to year without a penalty. There is a 
provision in here for--to provide rebates if they raise them 
quicker, which is kind of like a penalty, but it would also cap 
the out-of-pocket cost of insulin at $35 per month, and for 
those on Medicare Part D plans, there would be a cap of $2,000 
on out-of-pocket expenses, so Ms. Wilson, can you describe how 
these types of policies, like capping your out-of-pocket 
prescription drug costs at $2,000 per year, would impact you 
and your family?
    Ms. Wilson. Sure. Thank you for the question, Senator 
Kelly. Although even $2,000 per year out of pocket is a lot of 
money, capping what I would have spent on prescription drugs at 
that amount would allow me to afford to get back on Copaxone, 
and I wouldn't have to worry about my MS progression because I 
am not on a disease modifying therapy.
    I would also love to see a policy that would allow me to 
spread out that $2,000 over a year, so I don't have to worry 
about paying all that at once in the first few months. Policies 
like this would be a relief to me and so many other seniors, 
and that would immediately improve my quality of life.
    Senator Kelly. Well, thank you. I am going to continue to 
work as hard as I can on this, you know, to make sure we get 
that cap, that it can be spread out, that pharmaceutical 
companies can't, you know, keep increasing the prices, and then 
if we do that, I hope to hear next time I see you that you 
were, after we do this, that you were able to get back on the 
Copaxone that you need for your MS. Let me close here by 
saying, I want to thank all of our witnesses here today for 
contributing your time, your experiences, your expertise, and I 
especially want to thank Ms. Wilson because it is always hard 
for people to talk about their personal story, especially when 
it is health care related, so I want to thank you personally 
for doing that and sharing that.
    As we have heard today, congressional action to reduce the 
cost of prescription drugs both for the Federal Government and 
for Arizonans is long overdue. I mean, this is not only 
savings--remember this, this is not only savings of the 
patient, this is savings for the Government as well. We have 
got a plan. We know what to do.
    We have got to allow Medicare to negotiate the cost of the 
most expensive drugs. I mean, that is clear. The Veterans 
Administration does this already. This is not unprecedented, 
but Medicare, because of current law, they don't--they are not 
allowed to do it, and it is essentially to, you know, make sure 
the pharmaceutical companies have very high profits, but the 
capping the out-of-pocket expenses at $2,000 for Medicare Part 
D plans, I mean, we have to get this done, and insulin that has 
been around for over 100 years, I don't know, 100 years? I 
think maybe more than that. Insulin has been around a long 
time. Why does it cost hundreds of dollars per month? You know, 
we have got to get that across the finish line, and then, you 
know, this legislation will also prevent pharmaceutical 
companies from increasing the price of their products at more 
than the price of inflation.
    Let me say that this is just like also like a fundamental 
question of fairness. I mean most of these drugs, correct me if 
I am wrong, but most of these drugs are developed and 
manufactured in the United States, and it is unfair that 
Americans have to pay two to three maybe four times more for 
certain prescription medications than, let's say, our, you 
know, friends on the other side of the border in Canada or any 
other country for that matter. It is just fundamentally unfair.
    I am going to continue to work with my colleagues to put 
this plan into place, and if the witnesses, if you have 
additional statements or something else you want to add that 
you didn't get to share today, the hearing record will be open 
for seven more days until Tuesday, April 19th.
    Thank you so much for participating today, and this is, 
just to finish, this is incredibly valuable for me and for the 
Senate Committee on Aging, so thank you, and I conclude this 
hearing.
    [Whereupon, at 12:04 p.m., the hearing was adjourned.]
     
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                                APPENDIX
    
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                      Prepared Witness Statements

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