[Senate Hearing 117-303]
[From the U.S. Government Publishing Office]





                                                        S. Hrg. 117-303
 
                     AFFORDABLE PRESCRIPTIONS NOW:
                     EXAMINING LEGISLATION TO LOWER
                           COSTS FOR SENIORS

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

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS


                             SECOND SESSION

                               __________

                         FAYETTEVILLE, GEORGIA

                               __________

                              JULY 1, 2022

                               __________

                           Serial No. 117-19

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


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


             U.S. GOVERNMENT PUBLISHING OFFICE 
47-982PDF           WASHINGTON : 2022         
 
 
 
        
                       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 Raphael Warnock, Member of the 
  Committee......................................................     1

                           PANEL OF WITNESSES

Lee Baker, CFP, Past President, AARP Georgia, Atlanta, Georgia...     4
Elizabeth Ernst, State Director, Protect Our Care Georgia, 
  Atlanta, Georgia...............................................     6
Keerthi Gogineni, MD, MSHP, Associate Professor Hematology-
  Oncology, Emory University School of Medicine, Atlanta, Georgia     7
Gretchen Spring, Caregiver, Marietta, Georgia....................     9

                                APPENDIX
                      Prepared Witness Statements

Lee Baker, CFP, Past President, AARP Georgia, Atlanta, Georgia...    21
Elizabeth Ernst, State Director, Protect Our Care Georgia, 
  Atlanta, Georgia...............................................    24
Keerthi Gogineni, MD, MSHP, Associate Professor Hematology-
  Oncology, Emory University School of Medicine, Atlanta, Georgia    27
Gretchen Spring, Caregiver, Marietta, Georgia....................    29


                     AFFORDABLE PRESCRIPTIONS NOW:

                     EXAMINING LEGISLATION TO LOWER

                           COSTS FOR SENIORS

                              ----------                              


                          FRIDAY, JULY 1, 2022

                                        U.S. Senate
                                 Special Committee on Aging
                                                   Fayetteville, GA
    The committee met, pursuant to notice, at 10:13 a.m., at 
Fayette Senior Services, 4 Center Drive, Fayetteville, Georgia, 
Hon. Raphael Warnock, Member of the Committee, presiding.
    Present: Senator Warnock

                 OPENING STATEMENT OF SENATOR 
            RAPHAEL WARNOCK, MEMBER OF THE COMMITTEE

    Senator Warnock. Good morning to everybody. Thank you so 
very much for being here. This U.S. Senate Special Committee on 
Aging field hearing here in the State of Georgia will come to 
order. The purpose of this hearing titled, Affordable 
Prescriptions Now, Examining Legislation To Lower Costs For 
Seniors, is to examine the urgent importance of lowering 
prescription drug costs for hardworking Georgia families, 
especially our senior citizens, and so I am glad to be here in 
Fayetteville today.
    I want to acknowledge the presence of the Mayor. Mayor 
Johnson, thank you so very much for being here. Other officers 
and elected officials, thank you for hosting us for this 
important hearing. I want to thank the Fayette County Senior 
Services Center for hosting this important field hearing at 
their facility today, and I also want to thank the folks who 
are able to join us here in person and for the many folks who 
are watching us online.
    As I travel around the State and as I talk to Georgians, 
one thing is clear, Georgians are doing our best to navigate a 
changing economy but are being crushed by the rising cost of 
prescription drugs. As a voice of Georgia in the U.S. Senate, I 
have been focused on pushing through legislation to lower costs 
on everything, from prescription drugs, to gas, to groceries, 
and seniors shouldn't have to choose between buying groceries 
and buying the drugs that they need, and so we are focused on 
this. We are also focused on holding corporations accountable 
for making record profits, record profits, right now, in the 
middle of the pandemic, record profits on the back of Georgians 
who have been paying record prices, the pain you feel and the 
profits that they are enjoying are connected, and you can't 
talk about one without the other, and so something I hear 
consistently from Georgians, especially seniors, is about how 
they are being squeezed by the high cost of prescription drugs 
and the burden it puts on their health and on their wallets. 
During a recent call with the Georgia AARP members, I heard 
from J.C. Irons, a senior citizen from Cherokee County, whose 
out-of-pocket costs for prescription drugs ranges from $4,000 
to $7,500 per year.
    He shared that since he is on a fixed income, he is often 
not able to buy all of the drugs prescribed to him. If you 
cannot afford your medication, then you don't have affordable 
health care now. Plain and simple, but this isn't just a 
Georgia problem, this is an issue that touches seniors all 
across our country.
    The AARP says that the average older American takes 4.7 
prescription drugs per month, typically on a chronic basis, and 
more than four in five seniors say drug costs are unreasonable. 
Additionally, nearly 25 percent of older Americans who take 
prescription drugs say it is difficult for them to afford their 
prescription drugs, including about one in ten who say it is, 
``very difficult,'' very difficult in the evening of their 
lives and struggling with the costs of something that is very 
basic, so vital, and necessary, so this issue is personal for 
me. This is about something much bigger than politics. It is 
about my mother. You know, my mom is 84 years old, and I think 
about her, and people like her, and I think about the 
parishioners in my own church that I have counseled over the 
years who have had to deal with the consequences of rationing 
lifesaving medication like insulin because they couldn't afford 
it.
    One of my seniors, who is in her 90's, a classmate and 
schoolmate of her childhood buddy M.L., they called him Martin 
Luther King Jr., texting me this morning. She texts in her 
90's. Talking about the challenges of managing her health care, 
and so I am focused on fighting the good fight for her and for 
my mother and so many others. Focused on lowering prescription 
drug costs in the Senate, and so I am a proud member of the 
Aging committee.
    I am glad to be chairing a field hearing in Georgia today, 
a first for our State, so it is a historic hearing we are 
having to explore this issue that I know is top of mind for 
many Georgians. This hearing will unpack the current challenges 
our seniors are facing brought on by high drug costs, and it 
will highlight benefits of lowering prescription drugs for all 
Georgians, but especially for seniors.
    One of the major reasons we are here is that Georgia 
seniors can't keep waiting for Washington to take action. That 
is the message I took away from my visit to East Point's Oak 
Street Health Clinic back in May, where seniors told me about 
the stress that is being caused by high prescription drug 
costs.
    I am looking forward to hearing from our witnesses today 
who will underscore why it is so very important that Congress 
take urgent action now to tackle this issue and lower 
prescription drug costs. I am also looking forward to exploring 
in this hearing what Washington can do in the short term and in 
the long term to lower drug costs for our seniors.
    For my part, I am proud to be leading the charge with 
several legislative proposals to fix this critical issue, 
including some policies that we will discuss today, like 
capping out-of-pocket costs and allowing Medicare to negotiate 
drug prices. While the Affordable Care Act set an annual limit 
on out-of-pocket costs for people with private insurance, 
Medicare beneficiaries, which includes many, if not most of our 
seniors Georgians, currently lack that basic protection, can't 
negotiate the price.
    What kind of capitalism is that, where you don't get to 
negotiate the price of something you are buying? According to 
the Kaiser Family Foundation, 1.2 million seniors face out-of-
pocket drug costs of more than $2,000 in 2019. No senior 
citizens should have to choose between buying groceries and 
taking necessary medication, but today and as these statistics 
demonstrate, far too many seniors face an impossible choice.
    That is why I support allowing Medicare to negotiate and 
bring down the cost of prescription drugs, and I am pushing my 
colleagues in Congress to make this happen. It is also why I 
introduced the Cap and Drug Cost for Seniors Act legislation to 
cap annual cost of--annual out-of-pocket costs for seniors at 
$2,000 for the entire year, and you may have heard I am also 
championing the Affordable Insulin Now Act that would cap the 
cost of insulin for seniors on Medicare, as well as individuals 
on private plans at $35 per month. That in a State where 12 
percent of the adults have diabetes and $1 in $4 in our health 
care system is spent on people with diabetes, and so I am so 
glad to be holding this hearing today because we are closer 
than ever to getting critical legislation to lower drug costs 
across the finish line and I won't stop pushing until we get it 
done. I plan to use today's discussion to help move our efforts 
in Washington forward by underlining the importance of Congress 
taking urgent action right now on this issue in the very next 
work period when we return from the 4th of July.
    That will be a good time to declare seniors' independence 
from incredibly high prescription drug costs. I look forward to 
hearing more from our witnesses on this very topic, and I thank 
you again for being here, Mayor and so many others, to share 
your experience and your expertise.
    Before we begin, I want to remind the witnesses to please 
keep their remarks and questions to 5 minutes, something that 
the Senator did not manage to do----
    The privilege of the chair. I am going to ask you to keep 
your remarks and your questions of 5 minutes, and I will turn 
to an introduction of our witnesses. I am pleased to introduce, 
first of all, Mr. Lee Baker, who served as the President of 
AARP, Georgia. I have a fine feeling for AARP.
    A couple of years ago, my daughter, who is a toddler, she 
got an invitation to join a preschool. They, you know, they saw 
that it was her birthday, and they said, dear Chloe, we would 
like to invite you to our preschool, and I was turning 50, and 
in that same batch of mail, I got my invitation to join AARP--
preschool AARP.
    Mr. Baker is a graduate of Georgia Tech. He has been a 
tireless advocate for the aging population for over a decade. 
He has years of experience in financial resiliency and 
understands just how important it is for seniors to be able to 
afford their prescription drugs. Thank you, Mr. Baker. Thank 
you all for being here.
    Thank you for your expertise. Our next witness is Ms. 
Elizabeth Ernst, State Director of Protect Our Care, Georgia. 
Protect Our Care is a national health organization that works 
to find ways to make health care more affordable and 
accessible.
    Ms. Ernst has been working as an advocate for various 
patient, consumer rights, and environmental protection issues 
important to Americans for 15 years and has been a strong voice 
for improving access to health care in our State. Thank you so 
very much, Ms. Ernst, for being here. Next--well, here is the 
test, Dr. Keerthi Gogineni. Okay?
    Dr. Gogineni. Yes, I recognize that name.
    Senator Warnock. A dual provider in both oncology and 
hematology. She works with patients at Grady, a safety net 
hospital in Atlanta, and thank God for Grady, and Emory 
University Hospital as well. Dr. Gogineni has firsthand 
experience in seeing how exorbitant prescription drug costs 
lead to difficult choices for patients and compromises their 
ability to get treatment.
    As a breast oncologist, she has guided patients through a 
complex maze of treatment options, and as an associate 
professor, she has taught residents and fellows about health 
policy issues affecting oncology. Thank you so very much, Dr. 
Gogineni, for being with us today and sharing your expertise 
with the committee, and then finally, last but not least, our 
next witness is Ms. Gretchen Spring from Marietta.
    Ms. Spring spent the last 6 years as a caregiver for her 
late husband, Peter, who lost his battle with Alzheimer's 
disease earlier this year. Prayers and strength to you.
    Ms. Spring. Yes. Thank you.
    Senator Warnock. She will share the stress and the burden 
that she and Peter faced just to purchase the prescription 
drugs they needed. Ms. Spring and Peter had to max out their 
credit cards and take out personal loans for food so they could 
afford their medications, but I will allow her to tell her own 
story. We now turn to our witnesses for their statements, and 
we will begin with Mr. Baker.

                 STATEMENT OF LEE BAKER, CFP, 
         PAST PRESIDENT, AARP GEORGIA, ATLANTA, GEORGIA

    Mr. Baker. Thank you, Senator. AARP, on behalf of our 38 
million members across the country, including over 1 million 
members right here in Georgia, and all older Americans 
nationwide, appreciates the opportunity to submit testimony on 
this important hearing and historic 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.
    Here in Georgia, the average annual cost of prescription 
drug treatment increased 26.3 percent between 2015 and 2019, 
while the annual income of Georgia residents only increased by 
about 18 percent. This population simply does not have the 
resources to absorb rapidly escalating prescription drug 
prices, and many are facing the reality of having to choose 
between their medications and rising prices for other basic 
needs, like food and housing.
    In the case of one of our other members here in Georgia, 
Eleanor, someone in her late 60's, she spends about $200 each 
time she refills her glaucoma eyedrops. She is able to get by 
for now, but she wonders what is going to happen if she needs 
any other prescription medications in the future. 
Unfortunately, Eleanor isn't alone. We know that the No. 1 
reason someone does not fill their prescription is 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 actually be about $12 a gallon. Milk would be $13 a 
gallon. Just in January, the drug industry raised prices on 
over 800 prescription medications, just as they have increased 
prices for decades, including three-fourths 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, higher deductibles, and other 
forms of cost sharing. We have also seen massive increases in 
prescription drug spending under public programs like Medicare 
and Medicaid.
    These escalating costs will eventually affect all of us in 
one form or another through higher health care costs, higher 
taxes, cuts to Medicare or Medicaid, or some combination of all 
of the above. In other words, every single American taxpayer is 
paying for higher prescription drug prices regardless of 
whether or not you are taking medicine yourself. Fortunately, 
there is action that the Senate can take right now, and we hope 
they do when they get back from the 4th of July break.
    There is long, longstanding and overwhelming bipartisan 
support among voters for allowing Medicare to negotiate with 
drug companies for lower prices. The policies before the 
Senate, that Senator Warnock is leading on, including Medicare 
negotiation, as he mentioned, capping out-of-pocket costs on 
the Medicare Part D, and for insulin, and penalizing drug 
companies that increase their prices faster than the general 
rate of 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. America's seniors aren't the only ones who stand to 
benefit.
    Lowering prescription drug prices will also save the 
Medicare program and taxpayers hundreds of billions of dollars 
every year. Medicare spends more than $135 billion on 
prescription drugs. Nationally, we have survey data that shows 
that the vast majority of older adults support each proposed 
measure being discussed in Congress to reduce drug prices.
    The most favored initiative was allowing Medicare to 
negotiate for drug prices, winning over 87 percent of older 
adults. Seventy-eight percent support putting a cap on out-of-
pocket costs that older adults pay for their prescription drugs 
under Medicare Part D. 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 92,000 here in Georgia, signed a petition to demand lower 
prices for prescription drugs. There will never be a better 
time than now, this historic opportunity in front of Congress. 
Now is the time to get it done.
    Senator Warnock. Thank you so very much for your testimony, 
Mr. Baker. Ms. Ernst, you may begin.

                 STATEMENT OF ELIZABETH ERNST,

                  STATE DIRECTOR, PROTECT OUR

                 CARE GEORGIA, ATLANTA, GEORGIA

    Ms. Ernst. Thank you so much, Senator Warnock, and thank 
you for your leadership and for inviting Protect Our Care to 
submit testimony on the importance of lowering prescription 
drug costs for our seniors. Seniors are at the center of 
America's drug pricing crisis. As many as one in four seniors 
nationwide struggle to afford prescription drugs, with higher 
rates among more vulnerable groups, including low income, 
people of color, and those in poor health.
    Yolanda H. is a 70 year old diabetic living in Albany. As 
she is in the Medicare donut hole, she is charged $300 for each 
of her three diabetes medications. That is $900 a month for a 
senior who lives solely on her Social Security income. She 
rations her life saving medicines so she can eat or pay other 
living expenses, and as a result, she has experienced vision 
loss, kidney compromise, and painful neuropathy, and 
unfortunately, Yolanda isn't alone. In 2017, 32 percent of 
Georgia residents reported they stopped taking medications as 
prescribed due to cost, and every day, drugmakers exploit our 
broken health care system by hiking the prices of lifesaving 
medications in order to make record breaking profits.
    Between 2019 and 2020, half of all drugs covered by 
Medicare Part D had price increases equal to or greater than 
the rate of inflation, and a 2020 congressional report traced 
the steep price hikes of the cancer drug Revlimid to the desire 
of executives to meet company revenue goals and shareholder 
earning targets.
    In Georgia, this drug price rose 44 percent from 2015 to 
2020. This extraordinary corporate greed has serious 
consequences on our public--our nation's public health. A 
recent study found that increasing out-of-pocket drug costs by 
only $10 created a 33 percent increase in mortality due to a 
decrease in medicine accessibility.
    This is a distressing choice that Eustacia from Marietta is 
all too familiar with. She is a 64 year old Air Force--retired 
Air Force veteran who struggles not only with her high 
prescription drug costs not covered by her VA plan, but also 
for her 80 year old mother who was on Medicare. When her mother 
drug prices increased, Eustacia and her sisters pooled their 
money together to pay for her drugs.
    She worries about what will happen as her and her mother's 
drug costs continue to rise when they are both on fixed 
incomes. It is really a cruel game Georgia's seniors and their 
families are forced to play all as a result of corporate greed, 
and yet research shows that drug companies could lose $1 
trillion in sales and still be the most profitable industry. 
Skyrocketing prescription drug prices are affecting all 
Georgians, not just seniors.
    In recent years, Georgia residents and their insurers have 
spent more on prescription drugs and for out of pocket 
medicines than most States in the U.S. We have also seen 
massive increases in prescription drug spending under Medicare 
and Medicaid. Not only are Georgia taxpayers bearing these 
price hikes, these high costs are also passed along to everyone 
with health insurance through increased premiums, increased 
deductibles, and the like, and simply put, every single 
Georgia--Georgian is paying for high prescription drug costs 
regardless of who is taking the medications, and that is a hard 
pill to swallow. The problem is only going to get worse without 
intervention. The policies Senator Warnock has championed will 
provide immediate relief to all Americans.
    Under his Affordable Insulin Now Act, which caps patients 
out of cost insulin--out of pocket insulin cost at $35 a month 
under Medicare and private plans, seniors like Yolanda will be 
able to afford her life saving medications without compromising 
a basic quality of life, and by reducing out-of-pocket costs 
under Medicaid Part D through Senator Warnock's Capping Drug 
Costs for Seniors Act families like you Eustacia's will not 
have to face the possibility of making the choice of which 
family members stay healthy and which can't.
    Coupled with his Medicaid Save Lives Act and the Medicare 
drug pricing negotiation proposals before the Senate, these 
critical bills attack the high prices set by the pharmaceutical 
industry. Americans are sick and tired of paying these high, 
exorbitant drug prices, and as the country continues to recover 
from the economic and health crisis brought upon by the 
pandemic, American families can no longer afford to wait.
    We ask that Congress seize this opportunity to lower 
prescription drug prices through these popular policies. The 
time for fair, affordable drug pricing is now. Thank you.
    Senator Warnock. Thank you so very much, Ms. Ernst. Dr. 
Gogineni?

            STATEMENT OF KEERTHI GOGINENI, MD, MSHP,

            ASSOCIATE PROFESSOR HEMATOLOGY-ONCOLOGY,

              EMORY UNIVERSITY SCHOOL OF MEDICINE,

                        ATLANTA, GEORGIA

    Dr. Gogineni. Thank you. Hello, everyone. Thank you, 
Senator Warnock, for inviting me to speak today about the 
importance of lowering prescription drug costs for our Nation's 
seniors. I am an Associate Professor of Hematology and Medical 
Oncology at Emory University School of Medicine.
    I began taking care of patients with cancer 15 years ago, 
and now specialize in the care of patients with breast cancer 
at Grady Memorial Hospital and Emory Winship Cancer Institute. 
As a general disclaimer, please understand that these views I 
am about to share are my own opinions and not that of my 
employer. There has been thrilling progress in the field of 
oncology.
    New drugs offer greater chances of cure and enable us to 
tell a patient with incurable cancer that they can live for 
years despite a metastatic diagnosis. Increasingly, the latest 
targeted agents are pills, which is a huge advance for 
patients' quality of life. To not be hooked up to IV 
chemotherapy multiple times a month is game changing, but the 
optimism afforded by new oral drugs has been countered by the 
astounding price tags that accompany these medications, and 
that is why passing legislation like your Capping Prescription 
Costs Act is so important for everyday Americans seeking 
quality care. The patients I take care of come from many 
different walks of life, but no matter their socioeconomic 
background, the strain a cancer diagnosis places on a patient 
and their household is profound. In addition to the physical 
and emotional toll, at least half struggle with the financial 
toxicity of the diagnosis.
    The impact on patients living in rural areas, and on black 
and Hispanic patients is even greater. According to the CDC, 
one in three Americans experiences financial burdens due to 
necessary medical care. This burden is even more striking for 
cancer patients who have greater out-of-pocket costs for 
lifesaving care. Half of Medicare beneficiaries with cancer 
spend at least a 10th of their income toward out-of-pocket 
treatment costs, including prescription drugs. Keep in mind, 
the average age of a patient diagnosed with cancer is 66.
    Many, therefore, will be on Medicare. There is a spiral 
that begins with diagnosis. Treatment often means patients have 
to work less, which means less income and depletion of savings, 
which in turn affects their ability to afford treatment. The 
monthly costs of these drugs force patients to make impossible 
decisions between being able to get their medication versus 
paying for rent versus paying their electric bills.
    High out-of-pocket costs associated with novel anti-cancer 
drugs prolong the time it takes to start therapy and compromise 
the ability to stay on therapy, and ultimately staying on a 
drug affects whether a patient's cancer stabilizes or 
progresses. People who get diagnosed with cancer are 2.65 times 
more likely to declare personal bankruptcy.
    Horrifyingly, patients who declared bankruptcy had a 79 
percent greater risk of dying compared to the cancer patients 
who did not have to declare bankruptcy. Mrs. X was first 
diagnosed with breast cancer in 2012 and thought she was cured. 
Unfortunately, her cancer came back 10 years later.
    When she came to see me in February, her metastatic breast 
cancer was getting worse on her current treatment. Although she 
had stage four disease, Mrs. X still had options that could 
prolong her life by years with hopefully minimal side effects. 
I prescribed two oral drugs called Exemestane and a drug called 
Afinitor or Everolimus. When she followed up in March, a month 
later, she shared that she would not been able to start the 
Afinator because it was too expensive.
    Without insurance, this drug would have cost $6,000 a 
month. Now, Mrs. X had insurance. In fact, she would been 
employed by the Federal Government. Her insurance required her 
use of the generic version of the drug. However, the monthly 
co-pay would still amount to $1,450, absolutely unaffordable, 
especially for seniors who are typically on a fixed income.
    We tried to get her access to a manufacturers assistance 
program, but to qualify, she had to be prescribed the branded 
drug. Her insurance repeatedly denied permission to do so, 
despite us explaining in a series of appeals that the generic 
drug was still unaffordable and that the branded drug would 
enable access to copay assistance. Her social worker applied 
for support from three different foundations, but funds had 
dried up.
    Finally, we were able to get a patient assistance program 
to supply her drug through this December. It took 4 months of 
effort, from the patient to a dedicated pharmacist, and social 
worker to get a patient with health insurance onto a standard 
of care regimen for her metastatic breast cancer.
    This is one patient's story. Multiply this by the nearly 
1.9 million Americans diagnosed with cancer each year. Many of 
our patients with cancer are seniors. Given the soaring costs 
of oral anti-cancer therapy, lowering prescription drug costs 
is literally lifesaving. It is difficult enough for a person to 
receive a cancer diagnosis, but to then realize promising 
treatments are out of reach because they are unaffordable, is 
devastating.
    This is why Senator Warnock's Capping Drug Costs For 
Seniors Act is so critical. On behalf of our patients and my 
colleagues, I thank you for your time and help.
    Senator Warnock. Thank you so much for your expertise and 
care of so many patients and for your statement this morning, 
and now, Ms. Spring, you may begin.

                 STATEMENT OF GRETCHEN SPRING, 
                  CAREGIVER, MARIETTA, GEORGIA

    Ms. Spring. Senator Warnock, thank you for having me here 
today to speak about my experience with expensive prescription 
drugs. My experience is, unfortunately--[technical problems.] 
My name is Gretchen Spring, and I am a proud resident of 
Marietta, Georgia. I am a widow and a retired caregiver. In 
2016, my husband Peter was diagnosed with Alzheimer's by a 
neuropsychiatrist.
    During my 6 years of being the caregiver, I had to keep as 
active as possible, or my husband would have passed away 1 year 
or 2 years prior than he did. On April 7th of this year, after 
almost 17 years--thank you--of marriage, the love of my life 
passed away. Yesterday would have been our 17th anniversary. 
His condition had required him to use many different 
medications, 11 total. He was on Eliquis for heart condition 
and Namenda to slow down the process of Alzheimer's.
    We were paying an arm and a leg for Eliquis and Namenda. 
Spending $250 to $300 a month per medication and that was with 
insurance. I was even on a first name basis with everybody at 
the pharmacy. We were in our golden years, but the only people 
that were seeing gold were the pharmaceutical companies, and 
this is in addition to the costs of my own prescriptions.
    The cost was overwhelming. Peter and I had Part D coverage 
through Medicare Advantage plans, but my husband's medication 
broke the bank. We are talking about $800 to $1,000 out of 
pocket every month. With 15 prescriptions between the two of 
us, we would easily spend at least $12,000 a year. I loved 
Peter dearly and I did everything I could to keep him healthy.
    When he was diagnosed with Alzheimer's, he had to leave the 
workforce and I started my fourth career as caregiver, which 
played havoc on our finances, but at the same time, it was also 
important to me to listen to our doctors about our health. That 
meant putting the costs of our medications on credit cards, 
sometimes maxing our limits, and the last thing a senior 
citizen wants is--on a fixed income, is using a credit card 
with 21 to 28 percent interest.
    Due to my husband's expensive prescription drugs, we also 
had to delay making needed updates to make our home more 
comfortable, and sometimes we had to make difficult decisions 
about purchasing basic essentials like groceries. At one point, 
we even reached out to family members about setting up a Go 
Fund Me page because of the strain on our finances.
    It was only because of the generosity--of friends' 
generosity and our pension funds that we didn't go into debt. 
We went through $60,000 of pension money. Addressing the high 
costs of prescriptions is an issue that is personal to me. My 
husband has passed, but there are many, so many seniors and 
families in our State who are struggling to afford lifesaving 
medications. Let me be clear, we don't have a choice when it 
comes to prescriptions.
    It is simply wrong and unethical that seniors are faced 
with these decisions. Senator Warnock, your leadership on this 
issue means a lot for you Capping Drug Costs for Seniors Act, 
which would cap out of pocket cost of $2,000 per year for 
people on Medicare--would have made all the difference for my 
husband and I.
    I am a proud 74, and it is with your continued support on 
lowering costs, that I am looking forward to 75 with more 
reasonable prescription costs. In closing, it is past time 
Congress addresses high prescription drug costs, and I am just 
one of many with the story about struggling with the affordable 
medications.
    Thank you again for the opportunity to speak with you 
today. I look forward to addressing any questions you may have.
    Senator Warnock. Thank you so very much of Ms. Spring, and 
again, prayers and strength to you. Thank you for your 
statement and thanks to all of our witnesses. I want to begin 
now a round of questions, and I am going to ask everyone to 
just take a second and check and make sure your phone is on 
silent as we proceed with the questions.
    There are over 1 million AARP members in the State of 
Georgia, and many of these members are struggling to afford 
their prescription drug costs. Even with Medicare Part D, 
seniors face high out-of-pocket costs, and that is 
unacceptable. Mr. Baker, can you talk about the difficulties 
that AARP members right here in Georgia experience when trying 
to afford their medications?
    Mr. Baker. Yes, it is one of those things that candidly is 
heart wrenching. We would get calls, and with technology, some 
of those calls that would go into our State office would funnel 
to my laptop or my cell phone, and I hear calls from seniors 
saying we simply need help.
    As Senator Warnock mentioned the last 10 to 12 years doing 
this work with AARP at that same time as trustee, chair of our 
church, and Senator Warnock, very familiar with the situation 
where members come to a place where they feel they can get 
help, and so frequently, Sunday afternoons after service, we 
are back in the finance room trying to figure out how we can 
help somebody that is now in a situation where they can't help 
themselves. It is an incredible strain, particularly on the 
seniors here in Georgia. It is a strain on their families, you 
know, caregivers.
    We are sitting here now with two people that are or have 
recently been caregivers on this panel this morning. It is a 
strain. The strain of being a caregiver leaks over into other 
aspects of your life. They are stressed, and so they begin 
taking medication, so it is a bit of a domino effect.
    As I mentioned earlier in the testimony, you may not be 
taking medication, but you are affected. Right now, I don't 
take any medications right now, other people in my home do, and 
we have had those stories. One of my children is allergic to 
fish, and getting an EpiPen is not an enjoyable experience, and 
sometimes it is challenging to even get it, and so the ability 
to navigate the system, particularly for our seniors, when you 
don't have the support system in place to help you argue, if 
you will, at the pharmacy, to navigate, if I use this program, 
can I use that program, it is incredibly difficult, and some 
people simply throw up their hands and they shouldn't have to 
do that.
    Senator Warnock. What are some things that Congress could 
do that would directly help your members, AARP?
    Mr. Baker. One of the biggest things--and I am happy that 
we heard a little bit of news yesterday, as I understand it, 
that through the reconciliation process, it appears that 
perhaps we are going to get some movement on allowing Medicare 
to negotiate prescription drug prices.
    Again, as you mentioned early on--you know, in my day job, 
I am a financial advisor. I help people grow and keep their 
wealth, so I have no problems with a capitalist society, but as 
you said, what kind of capitalism is it that does not allow me 
to negotiate the price and that is a problem, so if there is 
any one big thing at AARP that we support to help this, that 
could bring about relief literally in the span of, I guess, the 
next 18 months, is allowing Medicare to negotiate prices, and 
so again, we fully support that, and I would say immediately 
and really big impact, that is the one.
    Senator Warnock. I agree with that, which is why I am 
pushing to get us to be able to negotiate the costs or Medicare 
to be able to negotiate the cost of prescription drugs, as the 
VA currently does. In addition to that, capping the cost of 
insulin and capping the cost of prescription drugs.
    In all of your testimony today, all of you have made clear 
that our health care system is failing patients, and even for 
those with insurance, like Medicare Part D, as you point out 
Dr. Gogineni, prescription drugs can be out of reach due to the 
high out-of-pocket costs, so Dr. Gogineni, could you share with 
us what you experienced as a provider when your patients cannot 
afford their medication and how that can literally affect their 
health outcomes? Can you say more about that?
    Dr. Gogineni. Sure. Thank you for the question. You feel 
like you are failing--sure--I, you know, I pride myself on 
being able to talk to a patient about their diagnosis and 
options for treatment with compassion, and I really want to be 
able to inject hope into that process, and I want to be able to 
tell folks that we are going to be able to give you the most 
effective drug we can for what you are going through.
    I don't want to have to tell people I can't get you that 
drug because it is simply not affordable even though you have 
insurance, and so it is devastating. I mean, people are already 
under a great deal of strain from the diagnosis and then trying 
to cope around coming up with a plan for how they are going to 
manage this and then to have to spend the energy and the time, 
and it is a full time job trying to get access to some of these 
medications, and without a doubt, you know, your ability to 
start something on time and how that stabilizes a cancer, and 
if you can't get the drug, you can't--you can't control that 
cancer, and people suffer from the side effects of what that 
cancer is causing and the strain of knowing that they are 
waiting to get started.
    You know, people are very motivated to get treated and 
invested in getting better, and to not be able to empower them 
to actually do that is not what I set out to do.
    Senator Warnock. Sure. Sure, and in your testimony, you 
spoke about how it took 4 months for a patient with metastatic 
breast cancer--?
    Dr. Gogineni. Yes.
    Senator Warnock To get the care that she needed, and it was 
only through your persistence and other colleagues that you 
were finally able to get medication. Meanwhile, the disease is 
not waiting, right, so can you talk about some of the other 
hoops that you as a provider have had to jump through just to 
give financial assistance to your patients?
    Dr. Gogineni. Yes. I think we were educated in school about 
how to make a diagnosis and how to treat people. We were not 
educated to navigate the maze of the financial system around 
treatment. I am really lucky that I have staff that work with 
me, like the pharmacists and like the social workers, to try to 
do everything we can to get access for affordable medication, 
but it does not mean that happens overnight. Frequently, there 
are processes where we are trying to secure less costly drug 
assistance programs, foundations, and you can't necessarily do 
those things in parallel. You have to sort of get denied by one 
and then you go on to the next one, so this process, in terms 
of the time it takes, accumulates and all the while this person 
is sitting there untreated, and it is not often that 
medications in cancer are interchangeable. There is a hierarchy 
of what works best and what works less well, so the idea of 
substituting for something that's less effective is just--you 
know, when someone has a limited amount of time, and you are 
trying to make the most of that time, it is you really want to 
give them the best shot possible without having to compromise.
    Senator Warnock. Thank you so much for your answer. Health 
care access and affordability, as you point out, go hand in 
hand. If you can't afford it, you can't access it, and it 
doesn't matter if they are some of the best and most effective 
medications on the market if patients are not able to afford 
them.
    One drug that treats cancer costs over $1,000 per day, 
according to the AARP. Ms. Ernst, how bad are the health care 
access and affordability challenges facing Georgia families and 
seniors? How bad is it out there?
    Ms. Ernst. Thank you for that question, and it is pretty 
bad. I mean, I think that we have heard a lot of stories, and 
these are just a few that we can all share about how difficult 
it is, and I think we know from research that patients with 
high out-of-pocket drug costs often are more likely to avoid 
treatment, abandoned treatment, or interrupt treatment, and 
this leads to worse health care outcomes.
    I spoke about Yolanda in my opening remarks, and where she 
has rationing her diabetes medication, which she needs to stay 
alive, and as a result, she was experiencing vision loss and 
kidney compromise, but one part of that story that I didn't 
share is that, as a result of the worry and the stress of 
struggling to stay alive, and either through getting her 
medications or being able to eat or house herself, she 
developed terrible depression and anxiety as a result, and from 
that, you know, to get treatment, the mental health treatment 
she needs costs more money, so it is just, the cycle--the cycle 
of violence continues, all because she could not get her 
insulin and her diabetes medication, and it is--so it is a 
domino effect that we are seeing, and as you share, it is 
personal. With Gretchen, it is personal. I think everyone in 
this room has a story about a family member or a community 
member or a neighbor about how high drug costs are affecting 
our health outcomes. We see people in pain. We see people 
forgoing treatment.
    Doctors are put in a terrible position of either having to 
prescribe a different form of a medication that might not be as 
effective, but it is cost effective for the patient, so the 
patient just continues with like, you know--not as an effective 
form of treatment. That has happened to a gentleman, Alex, 
where he couldn't afford his asthma medication and ends up 
losing his voice and having major lung complications, so you 
know, it affects us all and it is something that we can do 
something about. Everyone is eager to make this happen, and we 
appreciate, from Protect Our Care, your willingness to take 
this issue head on, and----
    Senator Warnock. How would a provision like capping the 
costs of seniors to no more than $2,000 per year impact the 
folks that you are seeing on the ground here in Georgia?
    Ms. Ernst. Well, I think Yolanda would be able to survive 
and not have painful nerve damage, and she wouldn't develop 
depression and anxiety, so she could take care of her 
grandchildren.
    She could be an active member of the community. Also, too, 
it saves taxpayers a tremendous amount of money. One thing that 
we haven't talked about is how a lot of times patients don't 
know the cost of those drugs until it is time to fill them. 
Pharmacies fill them. They don't pay for them. They go 
unclaimed, and then that just gets absorbed by the entire 
health care system, and then everyone in this room is paying 
for those high prescription drug costs in our premiums and our 
deductibles, so that is--those are just a couple of examples.
    Senator Warnock. So all of us have a stake in lowering the 
cost of prescription drugs?
    Ms. Ernst. Absolutely. Absolutely.
    Senator Warnock. I am always deeply appreciative when folks 
can share their personal stories in a forum like this, and that 
is why I am so glad that Gretchen Spring is here, that we can 
hear directly from you and your voices in the conversation.
    Can you say a little bit more? You talked about the care 
you had to provide to your husband, Peter, and your marriage of 
nearly 17 years, but I do think it is important sometimes to 
put a human face on the public policy we would make or fail to 
make. Can you say just a little bit more about Peter?
    Ms. Spring. Wow. You got a couple days?
    Senator Warnock. No, but we have a couple of minutes 
though.
    Ms. Spring. Okay----
    Senator Warnock. Tell me--and tell me about some of the 
challenges he faced. You know, what were some of the medical 
and health challenges he faced that required prescription drugs 
as you were navigating your way--?
    Ms. Spring. Okay. I am sorry to say, Senator Warnock, I 
cannot do that. I never knew I could live with somebody 24/7 
and enjoy their company as much as I did it, and it ended up 
being a godsend for me. Peter was a very affectionate person. 
He was a very humorous person. His humor put a smile on my face 
every day.
    The trauma for me came in the last year because all of a 
sudden he became more of a child, and the stressful part was 
the fact that he couldn't take care of himself--of going to the 
bathroom. He was on depends. I was having to change the beds 
every day, and that, you know--and there is nothing, there are 
no prescriptions to stop that at all, and you just have to 
write it out. The reason he ended up in the condition is 
because of affordability. He stopped taking his drugs because 
he couldn't afford them, and it wasn't until I stepped in and 
started taking over all the finances that I understood more of 
what was going on with prescription drugs.
    Senator Warnock. In addition to the stresses of care, you 
had the stress of the cost of care?
    Ms. Spring. Yes--I mean, I was taking care of an adult 
child, and that adult child was not going to grow up. End of 
story, and that is the reality of it. I even--and. I hate to 
admit this, but I smoke because that was my tranquilizer, 
because I knew if I took tranquilizers, they would put me to 
sleep because I am very susceptible to that medication. I was 
on antidepressants.
    You know, I did request our primary care doctor. 
Fortunately for me, we had a primary care doctor that we were 
seeing every 3 months that was making sure that the medications 
we were on were right. She was working hand in hand with the 
cardiologist. The cardiologist, primary care doctor were 
working hand in hand with the pharmacist. I mean, yes----
    Senator Warnock. So you are managing all of these things 
and costs at the same time and--thank you so much for sharing 
your deeply personal story and helping to put a human face on 
this issue.
    It is clear from the testimony today that lowering 
prescription drug costs for seniors will have an immediate and 
a lasting impact on the lives of everyday people, and I am glad 
that there is clear bipartisan movement right now to addressing 
this issue, and I will keep fighting until we get something 
done. That said, we also need to make it clear that this is an 
urgent matter that needs to be addressed expeditiously.
    As we close, I would like to ask each of you to take this 
opportunity, each of our witnesses, to speak more broadly about 
the importance of lowering prescription drug prices right now, 
even here in Fayetteville, Georgia. We are on the official 
record. This is a congressional hearing, and in just a couple 
of minutes, would you tell us what you would like to say to 
Congress about the importance of addressing this issue of the 
cost of prescription drugs for seniors? We will start again 
with Mr. Baker.
    Mr. Baker. Senator Warnock, and everyone here, particularly 
you, Senator Warnock, I hope you will forgive me or allow me a 
little bit of poetic license and say to yourself and other 
Members of Congress why we can't wait. We can't wait because we 
are in the midst of a longevity revolution.
    People are going to live longer and longer, and in most 
instances, be taking medication for an extended period of time. 
The reason we can't wait is because we have got a whole lot of 
things coming at us. We have got inflation. We are paying more 
at the pump. We are paying more at the grocery store and having 
to make those choices, and there is no other relief in sight. 
We can't wait, frankly, because it is unjust to have to hear 
Gretchen's story. That is it.
    Senator Warnock. Thank you. Thank you so much. Ms. Ernst.
    Ms. Ernst. Thank you for that question, and I think it is 
something that we on this panel too say time and time again, 
day in and day out, we cannot wait because people are dying. 
People are getting sicker.
    We are disrupting families and costing everyone more for 
lower quality of care, all because of prescription drug costs. 
It is just been unregulated--or not negotiated, and the time is 
now. We see the need. The benefit is great, and the proposals 
on the table are solid and popular and the time is now, and 
let's not wait any longer.
    Senator Warnock. Thank you so much. Dr. Gogineni.
    Dr. Gogineni. Yes. Thank you. No one plans to get cancer, 
and we have had this revolution in new drugs and novel 
treatments, but it is meaningless if people can't access this. 
The strain of a diagnosis and treatment is tough enough without 
then having to navigate trying to actually be able to afford 
drugs that are lifesaving.
    This is why it is absolutely critical that Medicare be able 
to negotiate for drug prices. It is critical for patients to be 
able to have a cap on those annual drug costs, and we are 
asking for people to have access to available treatment, and I 
think that--I mean, this is fundamentally a human right, and I 
think we need to catch up on the legislative side.
    Senator Warnock. Thank you so much. Finally, Ms. Spring.
    Ms. Spring. I personally feel like we are in the dark ages 
when it comes to our prescription drugs because they are so 
expensive. They don't need to be that way. They really don't, 
you know. No one, you know--I mean, at one point I was going to 
set up a Go Fund Me just to pay for our prescriptions, and it 
is like, that is not fair to me and that is not fair to anybody 
else, you know. It is like you said, we--like all of you said, 
we should be able to live a healthy life and it be--not be so 
outrageously expensive.
    Senator Warnock. Thank you. I want to thank all of our 
witnesses today for contributing your time, your expertise, and 
also your deep experience with this issue. It is unacceptable 
that in our country, one of the richest in the world, seniors 
are making impossible decisions about whether or not to pay for 
lifesaving medication or other basic essentials.
    No one should be forced to choose between affording their 
medication and putting food on the table, but these decisions 
are all too real for Georgia seniors. Their testimony from--the 
testimony from our witnesses today has shown how important it 
is that Congress acts, and acts on this issue right now.
    I am glad that we could bring together voices from our 
great State on this issue, from Dr. Gogineni, a provider at a 
safety net hospital, Grady in Atlanta, to Mr. Baker, a leader 
with the AARP, to Ms. Ernst, a strong advocate for improving 
access to affordable health care, to Gretchen Spring, and whose 
testimony was especially powerful, thank you. I will keep your 
words, especially with me, as we continue this fight in the 
Senate. No one should be forced with the decisions that Ms. 
Spring and her husband faced, but unfortunately, that will 
continue to be the reality of our country if we do not do 
something about it, and that is what I am pushing us to do in 
the Senate. We don't have time to wait. We can't wait.
    To our witnesses, thank you so very much for your advocacy. 
Thank you so very much for your stories. Stories I will keep in 
mind as I work to lower the cost of prescription drugs, and 
thank all of you for participating today.
    I see that there are members of our General Assembly who 
are here, other elected officials, and those who serve in law 
enforcement, and just concerned citizens. It is great to be in 
Fayetteville for this important hearing.
    Thanks, everybody. This concludes the hearing.
    [Whereupon, at 11:15 a.m., the hearing was adjourned.]



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


                                APPENDIX

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





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


                      Prepared Witness Statements

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




 [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]