[Senate Hearing 117-363]
[From the U.S. Government Publishing Office]
S. Hrg. 117-363
LOWERING HEALTH CARE COSTS FOR
NEVADA SENIORS: TAKING ACTION TO BRING
DOWN PRESCRIPTION DRUG PRICES
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
LAS VEGAS, NEVADA
__________
AUGUST 23, 2022
__________
Serial No. 117-22
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
48-558 PDF 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
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Stacy Sanders, Majority Staff Director
Neri Martinez, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Jacky Rosen, Member of the Committee 1
PANEL OF WITNESSES
Maria Moore, State Director, AARP, Las Vegas, Nevada............. 3
Christina Madison, Pharm.D., FCCP, AAHIVP, Founder and CEO, The
Public Health Pharmacist, PLLC., Las Vegas, Nevada............. 5
Jeffrey Klein, FACHE, President and CEO, Nevada Senior Services
Inc., Las Vegas, Nevada........................................ 7
Regina Milner, Patient Advocate, Las Vegas, Nevada............... 9
APPENDIX
Prepared Witness Statements
Maria Moore, State Director, AARP, Las Vegas, Nevada............. 31
Christina Madison, Pharm.D., FCCP, AAHIVP, Founder and CEO, The
Public Health Pharmacist, PLLC., Las Vegas, Nevada............. 34
Jeffrey Klein, FACHE, President and CEO, Nevada Senior Services
Inc., Las Vegas, Nevada........................................ 37
Regina Milner, Patient Advocate, Las Vegas, Nevada............... 42
LOWERING HEALTH CARE COSTS FOR
NEVADA SENIORS: TAKING ACTION TO BRING
DOWN PRESCRIPTION DRUG PRICES
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TUESDAY, AUGUST 23, 2022
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 2 p.m., at
College of Southern Nevada Board of Regents, 3200 E. Cheyenne,
North Las Vegas, Nevada, Hon. Jacky Rosen, Member of the
Committee, presiding.
Present: Senator Rosen
OPENING STATEMENT OF SENATOR
JACKY ROSEN, MEMBER OF THE COMMITTEE
Senator Rosen. Good morning, the Senate Aging Committee
will come to order. I am glad to be here today, and I want to
thank the College of Southern Nevada for hosting this important
hearing. I also want to thank our witnesses and everyone who
has been able to join us here in person, as well as those, of
course, watching online.
We are holding this morning's field hearing in Las Vegas to
discuss a pressing need for Nevada's seniors, lowering the high
cost of prescription drugs. The past two and a half years have
been incredibly challenging for so many Nevadans, and as we
work to finally put the COVID-19 pandemic in the rearview
mirror, we must continue to invest in the health and well-being
of our most vulnerable, especially our seniors.
What does that mean? Well, it means that making sure that
seniors in Nevada and across the country, well that they have
easy access to quality, affordable health care no matter what
community they live in. It means taking steps to address the
high cost of prescription medications, including by allowing
Medicare to use its buying power to negotiate for lower drug
prices, and it means capping out-of-pocket prescription drug
spending for seniors on Medicare Part D.
Medicare is a sacred promise. It is a promise of guaranteed
access to health care after a lifetime of hard work. Despite
this promise, we know that many seniors still have trouble
affording and assessing much needed prescription medication. No
one, and especially seniors living on fixed incomes, should
have to choose between buying groceries and taking lifesaving
medication, but for years, far too many Nevada seniors have
faced this impossible choice. In fact, unfortunately, many
seniors ration their medications or skip taking them altogether
because of high costs, and we are going to hear real life
stories of this today, but simply put, this is unacceptable.
That is why after nearly 30 years of inaction, I am proud
to have worked with my colleagues in Congress to deliver on the
promises that so many have previously made and to finally,
finally lower drug costs.
We are bringing about real relief for Nevada seniors and
seniors across America, and this hearing could not be more
timely. My Democratic colleagues and I just passed the
Inflation Reduction Act, and just last week, President Biden
signed this historic bill into law. This transformative new law
will finally allow Medicare to negotiate the best price of
prescription medication for America's seniors.
The Inflation Reduction Act will also cap seniors' yearly
out-of-pocket spending on prescription drugs at $2,000, and it
will cap the price of insulin for Medicare beneficiaries at
just $35 a month. This new law will usher in an era of
increased access to an affordability of lifesaving prescription
medication for Nevada's seniors, and because private insurance
often follows Medicare, the new negotiation authority included
in this bill could end up lowering prescription drug costs not
only for seniors, but for all families.
As we prepare for this new law to go into effect, I am
thrilled to have the opportunity to hear from our excellent
panel of witnesses today about how the high cost of drugs has
imposed--have imposed burdens on Nevada seniors, how high drug
costs impact seniors' health and well-being, how this impacts
health care professionals and caregivers, and how the new law I
helped pass will soon help reduce costs right at the pharmacy
counter.
I am also looking forward to hearing about how Congress can
best implement this new law and continue our work to lower
health care costs across the board for Nevada's seniors,
including through legislation I have introduced. Before we
begin, I want to remind the witnesses to please keep their
remarks to five minutes, and with that, I am going to introduce
all of our witnesses at once, and then we will proceed to your
opening statements. Our first witness, Ms. Maria Moore, who
serves as a State Director of AARP Nevada. Thank you, Maria.
She is a longtime advocate for the aging community. Ms. Moore
previously served as AARP Nevada's Community Outreach Director
since 2003.
She has also served on several boards and commissions,
including the Nevada Commission on Aging, VA Southern Nevada
Health Care System, Volunteer Association, and the United Way
of Southern Nevada Emergency Food and Shelter Board. Thank you,
Ms. Moore, for being here with us today and sharing your
expertise with the Committee.
Next, I will introduce Dr. Christina Madison, a Clinical
Pharmacist and Associate Professor at Roseman University
College of Pharmacy. Dr. Madison also works with patients at--
excuse me--at Huntridge Family Clinic, one of the largest
providers of HIV prevention and gender affirming care in
Nevada, and volunteers in medicine of Southern Nevada, where
she provides immunization and communicable disease care.
As a Clinical Pharmacist, Dr. Madison has seen firsthand
the roadblocks that patients experience in trying to access
their prescription medications. As an Associate Professor, she
has supported residents and fellows as they begin their own
journeys into pharmacy care. Thank you, Dr. Madison, for being
with us today and sharing your expertise with the Committee.
Our next witness, Mr. Jeff Klein. He is President and CEO
of Nevada Senior Services. Nevada Senior Services is a health
care organization that works to find ways to make health care
more affordable and accessible for seniors all across the Las
Vegas Valley. Prior to his service at Nevada Senior Services,
Mr. Klein founded Altila Associates, where he conducted and
supervised extensive engagements for hospitals, medical groups,
and academic centers.
He has also spent time in health care leadership and
hospital management in New York State. Thank you for being here
and sharing your expertise with us, and finally, our next
witness is Ms. Regina Milner from Las Vegas. Ms. Milner, well
she is a patient advocate and Medicare beneficiary who
personally knows the struggle of managing multiple health
conditions and affording her many medications.
She will share the stress and the burden that she has faced
during her own health journey to access lifesaving insulin and
the other medications that she needs. Thank you, Ms. Milner,
for being with us today and for sharing your personal
experience with the Committee, and of course, all of us across
the country.
I am going to proceed now to witness testimony. We will
begin with Ms. Moore. You may begin your testimony. Thank you.
STATEMENT OF MARIA MOORE,
STATE DIRECTOR, AARP, LAS VEGAS, NEVADA
Ms. Moore. Thank you, Senator Jacky Rosen, for having us
here today. AARP, on behalf of our 38 million members,
including over 300,000 members in Nevada and all older
Americans nationwide, appreciates the opportunity to submit
testimony on this important hearing of the Senate Aging
Committee.
AARP has been fighting for decades to make prescription
drugs more affordable, which is why we pushed so hard for drug
pricing provisions in the recently enacted Inflation Reduction
Act of 2022. These new policies will go a long way to lower
drug prices and out-of-pocket costs for older Nevadans.
We thank Senator Rosen for her support of this law and the
Senate Aging Committee for this--for its recent hearings and
other efforts to keep prescription drug pricing reform in the
spotlight. For perspective on this historic nature of this new
law, it is important to fully understand the difficulty that so
many older Americans face in trying to afford the medications
they need to stay healthy.
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 Nevada, the average annual cost of prescription drug
treatment increased 26.3 percent between 2015 and 2019, while
the annual income for Nevada residents only increased 18.8
percent. This population simply does not have the resources to
absorb the rapidly escalating prescription drug prices, and
many are really facing the reality of having to choose between
their medications and rising prices of other basic needs, such
as housing or food.
We know the number one reason someone does not fill a
prescription is because of its costs. 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, and 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 quarters of the top 100
drugs with the highest spending in Medicare Part D. After years
of promises, Congress has enacted the historic changes in the
Inflation Reduction Act.
This new law will finally require Medicare to leverage its
buying power and begin to negotiate with drug companies for
lower prices. The provisions will apply to a growing number of
drugs that are among the highest cost to consumers in Medicare,
resulting in substantial savings for both seniors and
taxpayers.
The Congressional Budget Office estimates this policy alone
will save Medicare nearly $100 billion over 10 years. The law
will also give peace of mind to millions of seniors with high
drug costs by capping their out-of-pocket Part D drug spending
at $2,000 per year. There is currently no cap on these costs,
and many Medicare beneficiaries simply do not have the
financial resources to fill prescriptions that cost them
$10,000 or more every year.
The law also caps insulin co-pays in Part D at $35 a month,
which will help--which will be a major help for the roughly one
in three Medicare beneficiaries with diabetes. These are
incredibly important policies that will not only save millions
of Americans, but it will also save lives.
The Inflation Reduction Act will also require drug
companies to pay penalties if they raise their prices faster
than inflation. This policy will address the long standing
practice of drug companies raising their prices year after
year, often at more than twice the rate of inflation. This will
help rein in seniors out of pocket cost sharing and Medicare
drug premiums. In addition, the Inflation Reduction Act will
make available certain recommended vaccines for seniors on
Medicare with no cost sharing, like the shingles vaccine that
has a list price around $350.
This policy already applies to Medicare Part B covered
vaccines and a small group of private markets, but for years,
Medicare beneficiaries have had to pay some level of cost
sharing for Medicare Part D covered vaccines, depending on
their plan coverage. This will not only save seniors out-of-
pocket costs but is also an important preventative benefit to
help older adults from illness.
Approximately 4.1 million Medicare beneficiaries received a
vaccine covered under Part D in 2020. This new law is a
historic victory for families across the country who are
struggling to afford their prescriptions, but the fight isn't
over. Big drug companies will spend millions trying to overturn
or undermine the law so they can keep charging Americans the
highest prices in the world.
AARP will keep fighting big drug companies' out of
controlled prices and we won't back down. Thank you again to
the Special Aging Committee for holding this hearing in Nevada,
and to Senator Rosen for inviting us here to raise awareness
about this critical issue. Thank you.
Senator Rosen. Thank you, Ms. Moore.
We will now turn to Dr. Madison. You may begin your
testimony.
STATEMENT OF CHRISTINA MADISON, PHARM.D., FCCP,
AAHIVP, FOUNDER AND CEO, THE PUBLIC HEALTH
PHARMACIST, PLLC., LAS VEGAS, NEVADA
Dr. Madison. I first want to take a moment to thank Senator
Rosen for hosting this Committee meeting, focusing on an
extremely important topic of prescription drug cost and how it
impacts our Nevada seniors. Let me first take a moment to
introduce myself. My name is Dr. Christina Madison. I am a
Clinical Pharmacist and Associate Professor of pharmacy
practice.
I am also the Founder and CEO of the Public Health
Pharmacist, which is a consulting firm specifically focused on
public health. I have been training the next generation of
allied health professionals, including pharmacy students and
pharmacy residents, as well as medical physician assistant and
nurse practitioner students for the past 15 years.
In my nearly two-decade career, I have spent counseling
patients on how to treat and prevent the spread of infectious
diseases, and for the past two years, I have been working
overtime on the COVID-19 response, providing vaccinations,
testing, and treatment.
I have personally facilitated the administration of over
12,000 doses of the COVID-19 vaccine, and now I am helping to
coordinate the monkeypox response through the increased access
to vaccinations, which are currently in limited supply. My work
over the years, and especially during the pandemic, has put a
spotlight on the need to focus on health equity, which includes
access to affordable prescription drugs.
It is my honor and privilege to provide witness testimony
as a public health advocate who has dedicated my professional
career to caring for the underserved and vulnerable
populations. I am thrilled to be sitting here with you today
following the recent passage and sign it into law of the
Inflation Reduction Act by President Biden on August 16th.
This new law is an historic down payment on a deficit
reduction to fight inflation, invest in domestic energy
production and manufacturing, and will reduce carbon emissions
by roughly 40 percent by 2030. More pertinent to this hearing
is the fact that this law will also allow Medicare to negotiate
for prescription drug prices and extend the expanded Affordable
Care Act program for three years through 2025.
Our country is on the verge of another health crisis, and
seniors across Nevada are struggling with affordable care and
coverage. Addressing health disparities and inequities is one
of the main focuses of public health, and as a patient
advocate, I know firsthand the importance of making sure
patients have their basic needs met, which includes making sure
that they have access to their medications by making them more
affordable.
Understanding that seniors, in particular those in the
BIPOC community, or APPI, and Indigenous brothers and sisters
are facing more than just issues with their medications, but
just getting to their doctor's visits in the first place, as
well as structural racism and historic trauma. With most
seniors taking multiple medications and having issues with
polypharmacy, we know that several are having to make the
difficult decision of paying rent, groceries, or gas, before
paying for their prescription medications.
More and more are accessing food pantries and donations to
supplement getting their basic needs met in order to afford
their medications while living on fixed incomes. The passage of
the Inflation Reduction Act of 2022 is going to make a
meaningful and measurable difference in the lives of Nevadans.
Nevada residents are being disproportionately impacted by
high prescription drug prices. Per AARP, over 200,000 Nevadans
have been diagnosed with diabetes. Almost 270 Nevadans have
been diagnosed with either asthma or COPD, and over 230,000
Nevadans have been diagnosed with some form of cancer. These
are three very expensive disease States that require chronic,
high cost prescription medications.
For example, between the years 2015 and 2020, the price
difference of these medications are as follows. Victoza, which
is a very common treatment for diabetes, went from a little
under $8,000 to over $11,000 per year. Another medication,
Revlimid, used to treat some forms of cancer, went from
$185,000 to over $260,000.
Last but not least, Spiriva Handihaler, used to treat COPD,
went from almost $4,000 per year to over $5,000 per year, just
in a span of five years. We know that this represents a
significant price increase that far exceeds normal increase due
to inflation. These are just a couple of examples of the
exorbitant drug costs that seniors are currently experiencing.
As I work with nonprofits and community partners, I see
that more and more people are accessing these types of social
services in order to just deal with their every day. Everything
costs more, but that shouldn't include necessary lifesaving
medications. I have conducted many medication review sessions
called brown bag events with seniors in the community, and I
often see them holding on to medications because they don't
know when they may need it again.
This is that depression era thought process. This is
incredibly dangerous, especially if they get these older meds
mixed up with the new medications. The first thing I do is I
ask them what their medical conditions are, why they are taking
each of their medications, and if they are taking them as
directed.
Oftentimes, there are at least a few that no longer have an
indication or duplicated medication and can be safely
discarded. Ultimately, I know that this generation doesn't like
to let things go because they are used to doing more with less
because their meds are so expensive. This just is one of these
things that they just don't want to let go of. Did you know
that 20 percent of all medications are never picked up at a
pharmacy?
Typically because of lack of transportation, perceived
need, and ultimately cost. Reducing the cost of prescription
medications through the Inflation Reduction Act of 2022 is
going to help not just the cost of prescription drugs, but
people's quality of life because they will be able to afford
other things.
Medications don't work if you don't have them, and you
can't take them if you can't afford them. That is why I am
relieved that Congress just passed the Inflation Reduction Act,
which will help lower costs for Nevada's seniors, including for
many of the patients I serve every day.
This new law will be the first time that Medicare will be
allowed to negotiate for lower drug prices in history. It will
cap seniors' out of pocket spending at $2,000 per year and the
price of insulin and other lifesaving medications for thousands
of Nevada seniors at just $35 per month.
Thank you, Senator Rosen and the congressional Democrats,
for working to pass this legislation, which is critical, and it
is a lifeline to so many who live here in Las Vegas. I am
providing this testimony to bring attention to these issues and
to discuss solutions for our struggling Nevadans so that they
can live healthier and happier lives.
Thank you so much for the opportunity to speak with you
today.
Senator Rosen. Thank you. Thank you, Dr. Madison, for your
statement. We are going to proceed to Mr. Klein.
Mr. Klein, you may now begin your testimony, please.
STATEMENT OF JEFFREY KLEIN, FACHE,
PRESIDENT AND CEO, NEVADA SENIOR
SERVICES INC., LAS VEGAS, NEVADA
Mr. Klein. Thank you. On behalf of Nevada Seniors Services
and our aging community in Nevada, thank you for the
opportunity to provide testimony to the Senate Aging Committee.
I would be remiss if I did not thank Senator Rosen for this
invitation to appear and for the Senator's steadfast support of
Nevada's seniors and all our older Nevadans.
I am also grateful to Senator Rosen, the Senate Special
Committee on Aging, as well as other members of our
congressional delegation, including Senator Cortez Masto,
Representative Susie Lee, Steven Horsford, and Dina Titus for
their support in passage of the Inflation Reduction Act of
2022.
I have the privilege to serve as the President and CEO of
Nevada Senior Services, and also as a board member of both the
American Society on Aging and the National Association of
Nutrition and Aging Services Programs.
A trusted nonprofit leader in aging services for Southern
Nevada, Nevada Seniors Services provides a comprehensive range
of quality programs and are designed to assist seniors and
their family caregivers to live their best lives while aging in
place. Our goal is providing remarkable care, balanced with
culture that supports autonomy, choice, and safety.
We accomplish this providing a no wrong door model of
inclusive service delivery as the Aging and Disability Resource
Center for most of Southern Nevada. We offer adult day health
care, memory loss programs, case management, in-home respite
and personal care, home repair and modifications, caregiver
support programs, and Hospital2Home, which is a unique dementia
friendly care transitions program.
This remarkable program has achieved a less than one
percent hospital readmission rate. Nevada Seniors Services
serves over 2,500 seniors and their families every year. By way
of example, Hospital2Home assists persons with complex health
conditions, cognitive impairment, and those without home social
supports to transition safely from the hospital to home without
a readmission.
Frequently, this requires immediate resourcing to ensure
availability of critical medications, nutrition, follow on
medical care, and psychosocial supports for family caregivers.
Nevada Senior Services has a long history of offering vaccine
clinics for flu, pneumonia, shingle, and most recently, COVID,
reaching out to our most vulnerable seniors, family caregivers,
and frontline staff.
Our Nevada Care Connection Resource Center assists persons
to connect to resources and to ongoing long-term services and
supports such as medication, nutrition, housing,
transportation, case management, and access to benefits,
including Medicaid and SNAP. Last year, we provided over 3,500
critical resource connections to our citizens.
HomeMeds is our latest initiative, an evidence-based
medication review for identifying potential medication related
problems in collaboration with pharmacists and physicians. It
is designed to reduce the risk of medication errors and adverse
effects, including unnecessary medication related
hospitalizations.
This program targets seniors and persons with cognitive
impairment, and it is made possible by, actually by a grant
from the U.S. Department Administration for Community Living.
Nevada's demographics and population characteristics make
senior care in general and prescription medications critical
issues to address.
We continue to be one of the three States with the highest
rate of growth in the over 65 population in the country and
14.3 percent of our seniors live alone. Nearly nine in ten
persons aged 65 or older currently taking prescription
medicines are reporting that they take four or more
prescription medicines.
In addition, one-fourth of them report that it is difficult
to report--afford their prescriptions, particularly those who
are either in the fair or poor health status categories and
whose income is below $30,000 annually, and who take four or
more prescriptions. One-fifth of our older adults report not
taking their prescriptions as prescribed due to cost.
Many seniors are poor reporters, not sharing the decisions
about not taking their medications as prescribed with their
prescriber. It is not an infrequent occurrence for seniors to
admit making difficult choices between nutrition, housing, pet
care, and taking their prescription medications. Polypharmacy
is a significant risk factor for hospitalizations and falls
frequently resulting in hospitalizations.
Medication related issues associated with seniors and
diabetes closely correlates with falls and with medication
related drug overdoses. The Inflation Reduction Act of 2022
makes an important down payment in addressing these
prescription drug issues that impact the ability of older
Americans to have their best possible lives, aging in place
with their family and friends. It accomplishes this by
impacting a number of issues that have been longstanding
priorities for our seniors, Nevada Seniors Services, ASA,
NANASP, and many local organizations serving our aging
community.
Three of the priorities included in the legislation are the
$2,000 cap on out-of-pocket costs for prescription drugs for
those on Medicare beginning in 2025. It is estimated that over
1.8 million older adults spend more than that amount every
year. No co-pays or cost sharing for vaccines covered solely
under Medicare Part D beginning in 2023.
Expanding the low-income subsidy, the LIS, to include
beneficiaries with incomes up to 150 percent of the poverty
line beginning in 2024. As members of this Committee know,
within Part D prescription drug program, START, standard
benefits is an initial $480 deductible before coverage even
begins. For this is a high enough barrier to forgo purchase and
needed treatment for many of our seniors.
The legislation allows for the first time in history for
Medicare to negotiate for the price of drugs, unfortunately,
not till the beginning of 2026 and starting with just ten
drugs. It also caps co-pays for insulin for Medicare
beneficiaries at $35 a month. As of 2024, those drugs with high
costs enough to qualify for the program's catastrophic
coverage, would no longer have to pick up the five percent co-
pay for each prescription.
We have a duty to address these important issues associated
with affordability and access to prescription medications. We
must be committed to helping seniors manage their health span
while their life span increases, and while they stay engaged in
life and maintaining their independence.
We are grateful for the support and work and contributions
of the Senate Aging Committee in making these objectives more
attainable. I thank the special Committee for allowing me to
speak today, and I am very happy to take any questions.
Senator Rosen. Thank you so much, Mr. Klein, for your
statement. We will wrap up our witness remarks with Ms. Milner.
Ms. Milner, please, you may begin.
STATEMENT OF REGINA MILNER,
PATIENT ADVOCATE, LAS VEGAS, NEVADA
Ms. Milner. Thank you and your staff so much for having me
here today to share my experience with insulin and other
expensive prescription drugs. My name is Regina Milner. I am a
60-year-old type I diabetic patient, a patient advocate, a
systemic lupus warrior, and a resident of Las Vegas, Nevada.
I am also a stiff person syndrome, rare disease warrior who
is GAD-65 seropositive, which has also caused my type I
diabetes. That is a genetic disorder. That is one--it is one in
a million chance and strikes one in a million people. However,
most importantly, I am proudest of my titles of mother and
grandmother.
My children and grandchildren have witnessed my 20 plus
years of struggling and consistently advocating for diagnoses,
medications, and equitable medical care and treatment, all
while navigating my way through an unfair and unequal, systemic
medical discrimination system.
In process of--in the process of paying for my medical care
and medication to try to maintain health as possible--my health
as possible, I became completely indigent and I now presently
rely on my daughter, who also suffers from autoimmune disease,
to provide me with a roof over my head and the care that I
need.
My many illnesses require me to use over 20 drugs, actually
27 drugs and medical supplies that include two specific brands
of insulin, Tresiba and Humalog, which require prior
authorization, as well as my Dexcom G6 device and glucose
monitor. In addition, I take weekly injections of Benlysta for
my lupus and autoimmune diseases. I am now in need of IVIG
treatment.
The cost of maintaining my health isn't cheap. One of my
lupus medications, Benlysta, has a retail price of almost
$5,000. It is thanks to my enrollment in Medicare Part D extra
help program, which subsidizes my Benlysta payment to under $10
that I can afford it. I also take insulin products and need
insulin twice a day, but the products I use are not included in
the formulary.
During COVID, my glucose levels increased to over 700 while
doctors' offices were closed, which is extremely dangerous and
can result in diabetic coma. Unfortunately, my physicians
didn't understand my genetic type of diabetes and told me that
I did not need diabetes medications or insulin.
The test results were repeatedly dismissed until I found
myself sleeping into a coma. It took several weeks of more
advocating for prior authorization to get the correct insulins
that worked for my illnesses. I know all too well the dangers
of not having access to the lifesaving medications I need.
My father, also deceased, suffered from the same illnesses.
Senator Rosen, your advocacy and that of your Democratic
colleagues is so much appreciated. The Inflation Reduction Act,
which has just been signed into law last week, will cap out-of-
pocket costs at $2,000 per year and cap insulin at $35 per
month for people on Medicare, which is a life changing amount
for folks like me.
Instead of rationing or skipping medications, seniors and
others like me across the country can finally put their health
first without being worried about the cost. Related disease
management and these exponential growth costs have cost me my
quality of life. I have worked in many administrative roles.
I used to type 90 words per minute. I now have a muscle
disorder. I was also a game dealer for the Monte Carlo Resort
and the casino on the Las Vegas Strip. I am a single parent,
and I knew I had to make ends meet for my children, but the
diseases I have made it impossible to keep a job. Capping the
cost of prescription drugs--excuse me, my muscle disorder is
affecting my speech--will make a difference for so many Nevada
seniors and so many other minorities and people who are
struggling.
I don't have a choice in the medications I take or the
genetic diseases I was born with, but I do see a brighter
future, especially with the passage of the Inflation Reduction
Act and the cost savings to come. I am losing my ability to
verbalize myself clearly due to my muscle disorder and
autoimmune disease.
My next statement is loud and clear. America's seniors have
long needed prescription drug reform and these out-of-pocket
costs caps for many people on Medicare are the right step
forward. I know that I am not alone in this struggle.
There are so many of us who need our prescription drugs,
especially in the autoimmune disease and chronically ill
community. We can't afford to wait, but with the Inflation
Reduction Act, thank God we won't have to. In closing, I am
thankful to wake each day and begin each day with gratefulness,
because it is by the grace of God that I am alive and standing
before you today.
In the process, I have had to fight for my life, and I have
dealt with a lot of disparity that has resulted in me being
misdiagnosed, receiving treatment that has endangered my
health, and I have been barred from treatment that I should
have received, unfortunately. I am so grateful that you have
taken the time to listen to my story and have me here today.
I thank you for all of your time and for listening to my
medical experience. I know that other people are experiencing
this as well, and I hope that I can be a help to them as well.
Again, I sincerely and truly thank you, Senator Rosen, and all
of your staff. They have been beautiful. They have been
wonderful. This opportunity to share my story today, and for
your hard work and the successes that you have accomplished to
help us.
Senator Rosen. Well, Ms. Milner, you are the reason why we
all do what we do. You are the reason why we are here today.
Your strength and your bravery is--people watching, people who
know you. You fight for those who don't quite have the strength
and we are so grateful that you are here. It is why we are
here. It is why we are having the hearing, and I really, really
appreciate you.
I think we will get started on some questions, so if you
need a drink, if you need anything from our team, you just let
us know, Ms. Milner, okay? Okay, perfect. Why are we here? The
high cost of prescription drugs, the new out-of-pocket spending
cap. It is no secret that Americans pay far more for
prescription drugs and people in other industrialized nations,
and in fact, according to Rand Corporation, a recent report
from the Rand Corporation, Americans pay more than two and a
half times more, two and a half times more for the average
prescription drugs than do citizens in 32 other developed
countries, and that is when it comes to brand name drugs.
Americans pay nearly--excuse me, when it comes to brand
name drugs, Americans pay nearly three and a half times more
than our counterparts in other countries. Fortunately,
President Biden just signed into law the Inflation Reduction
Act, which congressional Democrats recently passed.
All of our strong support, my strong support and this new
law, as we spoke about, you have heard, will soon cap the out-
of-pocket costs for seniors on Medicare Part D at $2,000 per
year total no matter how many prescriptions they may take and
no matter what those prescriptions are.
You said there are people on sometimes 20 different
medications. It is--there is a lot for people to navigate. Ms.
Milner, you said how many prescription drugs do you take a
month?
Ms. Milner. With my prescription drugs and supplies that I
need, including my Dexcom G6, which I am so grateful for, it
saves my life every day, I take 27.
Senator Rosen. 27.
Ms. Milner. 27 prescriptions.
Senator Rosen. You are enrolled in the Medicare Part D
extra help program, which helps you subsidize those costs?
Ms. Milner. Yes, ma'am, and I am so grateful. I just began
using it this month, and this SHIP program has been so helpful
to me in helping me to get enrolled and to understand Medicare.
It has been a new education.
Senator Rosen. If you didn't have this program, how much
would you spend if you just had to pay for it?
Ms. Milner. You know, they are still at this point
itemizing the total cost of my drugs with my new----
Senator Rosen. Right----
Ms. Milner [continuing]. Part D, but at this point, it
looks like I would be well over $15,000----
Senator Rosen. A year----
Ms. Milner. Benlysta is----
Senator Rosen. Per month?
Ms. Milner [continuing]. $5,000 by itself, per month.
Senator Rosen. If you are estimating about $15,000 a month,
and we are going to put in a $2,000 a year cap, that is just
about $167 a month. I don't know, maybe you could sum that up
in a sentence or two with how that is going to change your
life?
Ms. Milner. I thank God. I am so grateful because every
morning that I wake up is a blessing and I can take my
medication. I can still think clearly and still navigate and
still advocate for myself. Being able to have my medication is
a blessing. Being able to have your help, all of your help is a
blessing. I am so thankful and grateful. That is all I can say
is thank you.
Senator Rosen. Well, it is coming, the help is coming, and
so we are going to talk now a little bit about Medicare price
negotiation, because that is really going to make a huge
difference, because one of the core components of the Inflation
Reduction Act, again I am so proud to help pass that, we have
finally made it possible for Medicare to negotiate directly,
directly with big pharmaceutical manufacturers to ensure the
lowest possible drug prices for our seniors, and so over the
next few years, the Department of Health and Human Services
will be allowed to negotiate the prices of the most expensive
drugs on the market to help lower costs for seniors in Nevada
and across the country. Many of the most expensive drugs, which
often have limited or no competition, are for serious
conditions like cancer, and I am going to repeat the statistics
for Nevada.
Cancer impacts more than 230,000 Nevadans. My mother died
of lung cancer. I was one of those Nevadans that--it impacted
my family. Diabetes that impacts more than 202,000 Nevadans,
and asthma, which affects more than 260,000 Nevadans, and so I
am pleased that as a result of this new law--again, I can't
reiterate enough Medicare is finally, finally going to be able
to use its purchasing power to deliver those lower costs for
seniors who rely, like Ms. Milner, on the lifesaving
medication. Ms. Moore, we are going to talk about AARP Nevada.
You have just been a longtime advocate for Medicare drug
price negotiation, and can you just maybe give a few more words
about not just how hard you work, but how you have come to this
point? The Inflation Reduction Act, you were a champion.
AARP is a champion for it. How it is going to help millions
of Nevadans--well, millions of seniors across the country,
Nevada seniors, of course, keep our prescription drug prices
down.
Ms. Moore. Thank you, Senator Rosen. As you stated, AARP
has made the argument for many years, for decades, that with
more than 50 million Americans getting their medications
through Medicare, if the program was allowed to negotiate
prices, the power of those numbers would deal a much better
deal for Medicare beneficiaries and for taxpayers who
ultimately foot the bill for the lion's share of the medication
costs, and after decades of pushing for this reform, the
Inflation Reduction Act finally authorizes Health and Human
Services Secretary to begin negotiating the prices of ten of
the highest costs medications or prescription drugs in 2023,
and the negotiated prices will go into effect in 2026 for Part
D medications, and in 2028 for drugs covered under Medicare
Part B.
The number of drugs whose prices will be negotiated on
behalf of Medicare will increase in subsequent years, and by
2029, a total of 60 drugs will be subject to a negotiated
price--negotiated prices.
Overall, this process will create substantial savings for
seniors and taxpayers by reducing the prices of the growing
number of expensive and widely used prescription drugs. The
Congressional Budget Office estimates that this program will
save Medicare approximately $100 billion in 10 years, and
according to the Kaiser Family Foundation report, Medicare
negotiation could actually drive down prices for drugs used by
8.5 million people on Medicare, accounting for nearly one in
five, 18 percent of the 47.7 million Medicare Part D enrollees
in 2019.
Senator Rosen. Thank you. You know, I think we all know
that an ounce of prevention is worth a pound of cure, so by
providing these medications, we can keep people healthier,
happier. It is better for their families, of course, for their
pocketbooks. They don't have to make choices, and most
importantly, we can keep them away from the most expensive
care, which is obviously going to the hospital, and so, Mr.
Klein, I am going to turn to you, because I would say not many,
but I would say probably all of the seniors that you serve are
on Medicare, right, and so this Medicare negotiation provisions
ensure that people get their medication, and they stay
healthier. They don't have to make the choices, maybe they are
not entering the emergency room. How do you think it is going
to impact the work that you do and others like you?
Mr. Klein. We are very excited about the prospect. This has
been a long time coming. As Senator knows, the VA has been at
this for forever, so has the Department of Defense. Every
managed care organization negotiates prices for drugs. The
people who have really been on the raw end of this problem are
those people frequently who just above the poverty line,
seniors on fixed incomes, and without a controlled drug costs,
making those big decisions between food, pets, and life. Every
day we go through the process of trying to find resourcing for
people to get medication because they either have a plan that
they can't afford, they can't afford another plan, the
alternatives leave the costs too high, and so they are
constantly making major health choices.
This is the cavalry coming for those people on fixed
incomes, and while it may not affect everybody tomorrow, it
will over time, and with an aging population, folks who are
going to live into their 80's, maybe 90's, the long haul here
is really important, so we are--we think this is going to have
a big impact day to day.
In the short run, we think, it is going to create some
incentives and opportunities for us to look at alternative
medication funding mechanisms to try to help people on fixed
incomes kind of span the time while they wait for this to
really hit home.
Senator Rosen. That is fantastic. We know that people
living with chronic disease, we live better and longer, and
that medication is what is helping that, and I am sure you work
with many grandparents, so those grandkids are the true
beneficiaries, perhaps, of getting to know their grandparents,
but we are going to turn next to you, Dr. Madison, because
nobody knows better than you than the high prescription drug,
the costs, the impacts on patient health outcomes, compliance,
and their health care providers, you being one of them.
Unfortunately, we have far too often seen that the high cost of
prescription drugs, well, it impacts both the seniors who need
them and also the health care providers who manage their care,
doctors, pharmacists, other health care professionals.
Well, you didn't go into this job not to help people. You
went into this business to make a difference, to save people's
lives and help them, but when it comes to prescribing or
recommending treatments, you can only do your job--everyone can
only do their job if, effectively if patients don't face those
insurmountable financial barriers, and for many seniors, there
are barriers for each and every one of their prescriptions.
Think about Ms. Milner. Again, according to AARP, the average
older American takes roughly five prescriptions a month,
typically on a chronic basis to treat conditions like we have
talked about, cancer, asthma, COPD, diabetes, heart disease,
and others.
Shockingly, the average annual list price for one brand
name drug used on a chronic basis was over $6,600 in 2020,
which is more than one-third of the average senior's Social
Security retirement benefit. Think about that. More than one-
third of your yearly income just spent on one brand name
prescription drug. Even existing Medicare Part D coverage can't
always make that affordable for most seniors.
Dr. Madison, I am going to turn to you. As a clinical
pharmacist, I know how deeply and passionately you care about
this. You have been involved in assessing both patients health
needs and their medication evaluation, as you have spoken to,
and their management, so can you tell us about the times when
you have recommended medications to your patients that you know
that are appropriate and effective, the best medication, but
had to instead suggest something perhaps less effective or less
beneficial because the patient simply couldn't afford the
choice.
Dr. Madison. Absolutely. One of the first things that I was
thinking of when I was thinking of this question was, you know,
our lovely advocate over here, Ms. Milner, and really the high
cost of diabetes. There have been amazing innovations in
diabetes therapeutics over the past, really just the past five
years, and seeing a lot of these newer medications that are
injectable therapies that are taken maybe once a day, but they
are quite expensive, so you know, knowing that someone could
benefit from an injectable long acting medication and not being
able to receive it, having to use things like oral medications,
oral medications that are taken multiple times a day, which we
know directly impacts an individual's ability to remember
taking their medication, we are talking about seniors--exactly.
The more we can simplify their regimen, the more likely
they are to get the most benefit from their therapy, and so,
many times we have had to recommend a generic or something that
is more likely to impact their kidneys or their bones or their
eyesight. You know, I just, I was so touched by Ms. Milner's
testimony, and I see so many of the patients that I have worked
with over the years in her, and even just thinking about my own
grandmother who passed during the beginning of the pandemic and
thinking about her care and, you know, having dementia and not
understanding, you know, all of the different things that she
needed and caregiving and making those decisions when you get
to that twilight of our lives, and it is really impactful, you
know, the work that you are doing, the work of Congress, and I
am so excited to see the improvement in quality of life that
our seniors are going to have, and not just that, but our
economy, because think about it, if people don't have to worry
about affording their medications, they are more likely to
engage in doing and going out and spending money and being
consumers, so it is not just about the amount of life, but the
quality of life that our seniors can live.
Senator Rosen. You want the best patient outcome----
Dr. Madison. Absolutely.
Senator Rosen [continuing]. and you answered some of my
other questions, but you didn't answer, I want you to talk more
about the hoops that you might have to go through as a medical
provider if you know that there is a good medication out there
that is really going to make a difference, to try to get that
financial assistance for your patients. Tell me about that.
Dr. Madison. There is a couple of different things that we
can do. Obviously, there are certain manufacturers that have
copay assistance cards, so that is very helpful, but not every
pharmacy has the time to be able to go through and do that and
so that can be a little bit challenging, and then also, you
know, if you are having an issue with receiving your
medication, there may be some things about, you know, delivery.
As I mentioned before, 20 percent of prescriptions are
abandoned usually because they can't access them, or they can't
afford them, and so if transportation is an issue, being able
to deliver the medication to the patient's home is extremely
impactful, and then not being able to provide them with the
best medication has other possible side effects, so it is not
as good, so the medical condition that they have may not be
treated to the best of its ability, but then they may also be
more likely to experience side effects from the medication as
well, and so those are the things that we really want to try to
avoid.
Unfortunately, the hoops that we have to jump through are
prior authorizations, things not being on a formulary, going
and negotiating with the managed care offices because they put
certain things on because they got it because there was two or
three other medications that that manufacturer also made and
they made a bundle and they said, okay, we are going to put all
of these medications on the formulary, and unfortunately, the
rhyme and reason to that is not something that the average
senior understands. They just understand that they are not able
to access the best medication, and it is really hard----
Senator Rosen [continuing]. time jumping through hoops when
you could be actually dealing with patients, and so that takes
away your time to be able to do direct care.
Dr. Madison. Yes, absolutely.
Senator Rosen. I have one more question for you. Well, we
have a bunch more to go through, but I was a caregiver for my
parents and in-laws as they aged, so I understand that aspect,
but have you seen the high cost of prescription drugs? How does
it impact the caregivers who take care of your patients? Maybe
if people aren't able to get the best medication or they are
having to ration or whatever you are seeing.
Dr. Madison. Well, we are seeing people consolidate
households. We are seeing people dipping into their savings, if
they even have savings. You know, if they are living paycheck
to paycheck, they are going to social services.
They are accessing food pantries, they are accessing
assistance programs, you know, meals on wheels, dining with
dignity, all these different things that, you know, I am seeing
people that ordinarily wouldn't access those services or are
coming but are reluctant because they feel embarrassed, or they
feel like they don't understand how they got into this
situation, and they are so thankful when they come and receive
donations, clothing. You know, some people lost their jobs
during the pandemic and lost everything, and so the caregivers
of people who have chronic medical conditions, they need a
respite as well, and so you see a lot of stress, anxiety,
depression in those caregivers because they are internalizing
the hurt and the pain that the people that they are taking care
of are experiencing.
Senator Rosen. Giving people their medication at affordable
prices creates a better community for everyone----
Dr. Madison. It impacts so many things.
Senator Rosen [continuing]. that is the bottom line right
there. Well, we are going to talk a little bit specifically
about diabetes now for a minute, because currently more than
375,000 Nevada seniors receive prescription drug coverage
through Medicare Part D, and over a quarter of them, more than
93,000 Nevada seniors, have diabetes, so across the U.S. in
2020, Part D enrollees spent a total of $1 billion, $1 billion
on out-of-pocket on insulin. That is an average of $54 per
insulin prescription. For many Nevada seniors living on that
fixed income, $54 for each insulin prescription, we know, we
know it is just not affordable.
Despite being a lifesaving drug, many seniors, including as
we have heard today, you, Ms. Milner, are forced to sometimes
ration your insulin or you simply don't buy it at all, but
again, we are proud to report helps on the way thanks to the
Inflation Reduction Act.
Beginning next year, it will be here before we know it, the
cost of insulin will be capped at $35 a month for Medicare
beneficiaries, not just here, across the country, and so $35
insulin.
I know you take 27 medications, but just tell me how that
feels--how that feels to you, just that one change.
Ms. Milner. That one change makes me feel so relieved
because as I stated, the--as Dr. Madison understands, it isn't
on the formulary. I had to go through many hoops, hurdles in
order to have my physicians do the prior authorizations,
dealing with the MCOs who in prior authorization, departments
that sometimes don't understand how important it is because
other medications, insulins can make you very ill, as it did
with me, and so having that relief is just a burden that I feel
is just--I can breathe. It is gone.
Senator Rosen. It is going to help the rest of your medical
condition just to have that stress removed.
Ms. Milner [continuing]. and that is because when your
glucose is not right, nothing is right. Nothing feels good. It
is the worst feeling in the world, so it is a total relief,
just that drug alone, knowing that $35, oh, my God. I mean, I
am so--again, the only word I can use is grateful, and
regardless of how ill I am, for me, the solution is to wake up
every day and be grateful for all that I do have, for the
people that have helped me, the people who have sacrificed for
me. I am grateful, and I am grateful for you and you and you.
For everything, I am grateful.
Senator Rosen. We are grateful for you too and we are----
Ms. Milner. It is a godsend.
Senator Rosen. We are proud to do this work, and so I am
going to turn over to Ms. Moore in AARP, because this is just
one story. I probably could have a thousand people here, and
you would hear a similar story about their struggles, about the
relief they will feel when just this one burden is off of their
mind, and you represent over 320,000 Nevada seniors. I know we
are hearing from one, but you can speak on behalf of them. What
do you think--if you just want to think about the emotional
relief or what that might mean to people, just give your
impression.
If you can consolidate 325,000 seniors into a couple of
sentences, what do you think just that one change means?
Ms. Moore. Like Ms. Milner, she is one of many stories. We
know that many families across Nevada and across the country
really are struggling with the outrageous prices of insulin,
and really people needed to stay alive and healthy.
That is the bottom line. It is just one tragic example of
the larger problem, we have heard from Dr. Madison, of the drug
industry that affects so many different medications, and
thankfully, the $35 monthly cap for insulin in Medicare that
AARP supported will affect very soon.
Like you said, 2023 is right around the corner and Part D
plans will require to offer this copay a month even before the
enrollee meets the deductible for the year, so people will see
the co-pay changes at the beginning of the year, and AARP would
welcome the chance to extend this cap to others beyond Medicare
as well, whether it be at State or Federal level.
AARP offices across the U.S. have been active in the State
Legislatures and across the country, as I said, for over the
past few years, to pass insulin co-pays in State laws that
would apply to private insurance, so AARP will keep fighting
for Americans 50 plus, and for all, so that they can afford
their medications.
Senator Rosen. Thank you. Mr. Klein, I know you work with
so many seniors and you are going to be able to maybe put some
of your financial resources or some of the magic that you do to
help those thousands of seniors every year. Give me a little,
from your perspective, $35 insulin, how is it going to help
your team, help others, and what is the impact on what you do?
Mr. Klein. It is a huge boost. First of all, it is going to
be a boost to the team. Folks who work in the trenches take
this seriously. It weighs on them every day. Every time
somebody comes through the door, a patient comes through the
door who needs help, and you don't have a resource, it is a
failure in the minds of the people who are attempting to take
care of them and help them. This is the cavalry coming. First
of all, it is hope, and hope is really important in this
population. It is almost more important than the immediate--to
know that something is coming----
Senator Rosen. Give you a boost.
Mr. Klein. It gives you a boost. It tells you that there is
an opportunity to impact it. Second, for this particular
population, our staff are constantly looking for resources,
attempting to find other not for profits, who might have a
medication program that we could pair with, well if we can
lower the cost, can we fill in the blank to help them get
coverage for the short period of time that might be the bridge
between programs or to wait for something larger to come along,
so this is major news. It is major news not only for the
senior, but importantly, it is major news for caregivers who
have really been struggling with this and who take it home with
them every night.
Senator Rosen. Will be able to put those resources to some
other benefit. Dr. Madison, from a medical perspective, we know
the impact it is going to have, so just tell us the impact if
people take their medications regularly on time, at the right
dose. Tell me how you are feeling about that.
Dr. Madison. Yes. The three Rs, right. Right drug, right
time, and the right way.
Senator Rosen. See, there you go. I didn't even----
Dr. Madison. Tell people the three Rs. I mean, it is
incredible, right. Obviously, you know, we are talking a lot
about diabetes because it impacts so many individuals, but
really, these concepts and these, you know, these interventions
go across any chronic medical condition, and so for me, my
biggest thing when I talk to my patients is, do you feel better
or worse or the same?
If it is the same or worse, then I need to think what is
going on, is the medication that you are taking appropriate? If
it is not, how can we fix it? Having the ability to be able to
take your medication at the right time and the right way and
the way that it was intended by your health care professional,
by your physician, by your nurse practitioner, by your
physician assistant, right, it is so critical because when you
start getting between that relationship, now you have messed
things up, and the intended purpose of that medication goes
away because now the patient can no longer be adherent because
the medication only works if you can take it and you can't take
it if you don't afford it.
This is incredible. I think just looking at, you know,
chronic disease management, there are so many ripple effects
that will go toward this. If you are able to be healthier
because you are able to take your medications, you are going to
be a more productive member of society.
You are going to be able to do more things. You may start a
small business. You--there are so many different things that
you could do. As a senior, you may be able to take care of your
grandkids that you maybe weren't able to before, and that could
help the family, and then you can--then you can potentially
help your children so that they don't have the burden of
childcare. There is so many ripple effects that this can help
with just by simply making sure people can take their
medication.
Senator Rosen. Thank you. Well, we are going to talk about
some other prescription drugs now because this is just one of
them, the first one that is going to hit right away, no
deductible. It is going to be so impactful, but we are going to
put caps on price increases for drugs under Part D, because we
have discussed today, Nevada's seniors, including those with
Medicare Part D insurance coverage, well, it goes without
saying, they are paying far too much for their prescription
drugs, and drug manufacturers have continued to raise prices at
unsustainable rates, and so, in fact, according to a recent
Kaiser Family Foundation study, half, half of all Part D
covered drugs had price increases greater and the rate of
inflation in 2020, greater than the rate of inflation in 2020.
This is just unacceptable, and it is one of the reasons why
Democrats in Congress, why we did pass the Inflation Reduction
Act, and so we are going to talk a little bit more about the
law.
Starting next year, this new law will require manufacturers
that raise the prices of drugs faster than inflation to pay
rebates back to Medicare. This way, drug companies will either
need to keep prices affordable in line with actual increases in
the cost to make them or have to pay a rebate to Medicare.
Either way, seniors win. I want seniors across Nevada and
across the country to hear us loud and clear. This new law will
bring relief to seniors by lowering their expensive drug costs.
Ms. Milner, I know we are going to keep going around the table,
but you take a lot of medications, and so you have had some of
them that have gone up and up and up, and so I am going to ask
you, from your perspective, not just the cost, we know they are
unaffordable, but what is the emotional burden when you see the
drug go up so high year after year?
Ms. Milner. It is an insurmountable emotional burden,
because as you have all stated, it is a domino effect. It
affects not just me, but my family. I think, wow, I have got
three grandsons. I want to still be able to get down on the
floor and play racecars with my grandsons, and I can't do that
if I can't afford my drugs.
However, I have noticed, and I want to say, since I am on
the right diabetes medication, I can afford to eat right, and
when I can afford to eat right, God bless me, I take less
diabetes medication, less insulin, and it makes me feel so good
because then I have more energy. I am more cognizant.
I can just do better all the way around, so it means the
world to me. It really does. I mean, I think that if we have
more people who could help others who are in this situation to
advocate for themselves, they would be a whole lot healthier. I
mean, just understanding that, yes, you have to take your
medication, but you also have to eat right.
Senator Rosen. That costs money, so now you spend less
money on your medication, you can eat healthier----
Ms. Milner. I can afford to buy the vegetables I need.
Senator Rosen. That is right.
Ms. Milner. Eat right and keep my glucose at a level that
it should be, and it really matters.
Senator Rosen. Sounds fantastic. Well, Ms. Moore, I keep
turning to you because you get to represent all the seniors in
Nevada, and so on a bigger note, what do you hear from Nevada
AARP members about the drug manufacturers just raising these
highly inflated costs well over the rate of inflation. What do
you hear from your AARP members about this?
Ms. Moore. Senator Rosen, the rising prices of prescription
drug prices, that is the number one. One of the things that we
hear most from our members, and it is no secret, so you are--we
hear your stories every day.
In the years leading up to the passage of the Inflation
Reduction Act, 37,724 Nevadans signed AARP petitions calling on
Congress to take action to reduce drug prices. I know that the
Senator got many of her emails, letters, and--just about every
day. We were relentless. It was truly tragic when an older
person, fixed income, has to choose, like you said, between
essentials like food and rent and the medications that they
need to keep themselves healthy. It is a ripple effect, and
when the prices of those drugs are increasing and often much
higher than the rate of inflation, there is simply no way for
these seniors to keep up. You just can't. It is also important
to keep in mind that these increases are at the top of
sometimes decades of annual price increases, and those price
increases add up over time.
Senator Rosen. Thank you. I am going to--I want to say I am
grateful for the AARP partnership. Those e-mails helped, and
those letters and those calls and all the conversations we had.
Honestly, I carry those stories with me. I retell those
stories. I am grateful for that partnership, and Mr. Klein, I
guess the same thing to you, because you see different. We have
a patient. You talk about all the seniors. You have a lot of
boots on the ground. Again, we are going to try to get those--
they may go up, but only to the rate of inflation.
Mr. Klein. Cost escalation for people on fixed incomes, and
many seniors are just that, people on fixed incomes, and we
can't forget that many of our seniors are taking care of even
older parents, taking care of a spouse, taking care of a child,
and frequently taking care of grandchildren in today's world,
so you take someone who is on a fixed income, who is also
caregiving for a wider group, and then you apply cost
escalations that force them to make choices, and those choices
are serious. They are not just choices about themselves and
what they do for themselves, but they are in effect choices of
what they make for their entire caregiving unit.
At the end of the day, some people end up in nursing homes
when that cost gets to be too great for them to bear. The
consequences of high escalation and pharmacy costs really bring
those costs on the bear, so this is again, this is, as I
mentioned earlier, this really is in many respects the cavalry.
This is putting a lid on just how much burden some of these
families will have to absorb, and also, we think it will also
put a lid on some of the other problems that these choices
make, so you know, to Regina's comment about nutrition, when
you have to make a choice between good nutrition and
medication, you can't win in that choice.
Senator Rosen. That is right.
Mr. Klein. Putting a lid on it, creating certainty, is
really critical, and I think this has been an amazing and
important accomplishment.
Senator Rosen. Well, and I think to your point, whether it
is a multigenerational household like Ms. Milner's, or whether
they are the seniors who are living independently on their own,
we want to keep them there. We want to keep them from moving,
if we can, to a nursing home or some of those, and keep them
either independent or with their family where it is much
better.
I am going to just ask you, doctor, as a provider--now if
again, you are looking to provide a medication or multiple
medication, so knowing that this isn't going to go up
exponentially, how do you feel as a provider when you walk in
the room and you are going to have to talk to a patient?
Dr. Madison. Incredible. That is the best way to say it,
incredible.
You know, when you look at a patient's face when you tell
them the cost of a medication and you see sort of the life
drain from their face and the emotion change, it is
devastating, and to know that these prices will be capped and
that now they don't have to make those difficult choices
between their basic needs being met and their life saving
medications is just incredible. I can't think of a better word
other than that to say it and really just----
Senator Rosen It will remove stress and burden from
providers because you don't want to go in with the
disappointing news, so that is going to make your ability to
care for patients so much better.
Dr. Madison. Not to mention the fact that as a provider,
you take those stories home too.
Senator Rosen. Right.
Dr. Madison. I think it helps everyone. It is not--you
know, I think about many times where I just think about just
recently where I was helping out at an advocacy agency, and we
were giving out food to seniors, and a woman drove up and we
were walking over to start helping out, and she was turned away
because they were closed at that time, but because of a
language barrier, she didn't realize that they were just closed
for lunch and not closed for good, and so she had asked me
earlier, like, I was walking over in the parking lot, and she
asked me where to go, and so when I told her, I knew she was
there for the food assistance, and so as I saw her about to
leave, I noticed she didn't have the food in her hands, and I
said, ma'am, you know, is there anything else I can help you
with? She said, oh, no, no, no, they said that they are closed,
and I said, oh, they are just closed for lunch, can you wait
like another like maybe 20 minutes, and they will open up
again, and she said, oh, yes, thank you, thank you, so very
like sense of relief, and then about an hour later, we went
back to help give out the food and she came back.
I was so happy to see her because, I mean, it was just the
difference of better communication, but I was just thinking
like how many other people in her house that she was feeding
that were depending on that food.
Senator Rosen. The ripple positive effects in advocating
for people, and so I am going to--it leads me directly into my
next question, which is really advocating for patients in need,
and of course, all of you are advocates, but Mr. Klein, I am so
incredibly proud of the work that Nevada Senior Services does
to help educate, advocate for seniors who need help finding
health care, finding resources, navigating complex agencies,
trying to do those home modifications sometimes you may need in
a bathtub or bathroom getting, you know, whatever those things
are so you can age safely in place, and services are just so
important.
You know, Nevada senior population is growing so quickly.
Between 2011 and 2018, Nevada's population, age 65 and older,
increased by 40 percent. I think that puts us in one of the
faster growing States, I might say, and the population of
Nevadans aged 85 and older increased by 25 percent. That is
double the national rate, and so one of the programs you do,
one that particularly stands out to me is your comprehensive
geriatric assessment program, and you bring together a team of
medical and social service professionals to examine that
patient's overall well-being, and that, of course, includes
prescription medication review and management, so can you just
talk to us a little bit or walk us through the comprehensive
geriatric assessment process, and in particular, well, you are
going to have hopefully have a little bit of help with the
Inflation Reduction Act, but how you help them navigate the
cost of the prescription drugs, which is why we are here.
Mr. Klein. Thank you. Very quick, we are very proud of that
program. It was a first in Nevada. I would love to say it was
the first in America, but I actually opened one of these in
1972 in Philadelphia, which was actually the idea of one of our
medical directors at a hospital I was working at. I have
carried it with me.
Senator Rosen. That is a good thing to carry.
Mr. Klein. It was, and when we created it in Nevada, we
created it as a collaboration, so we have a board certified
physician in geriatrics who comes to us from Touro. We have
pharmacy--former geriatric pharmacy help who comes to us from
Rosemont.
We have our own geriatric nurses, our social workers,
occupational therapy that also comes from Touro, and that team
gets together and spends about three hours examining the
records and the history of the person who is coming to them,
usually with their family caregiver, and then doing an in-
person exam of the patient to try to get at the root of all the
complex problems people have, some of which are purely medical,
but most of which are combinations of complex issues that
include family caregiving issues and always medication issues.
Senator Rosen. Right.
Mr. Klein. It is not unusual for us to find people on drugs
that they shouldn't be on in the first place that are
contraindicated for seniors.
It happens all the time, and we are in a position then to
go back to their physicians and their primary care physicians
and say, well, you might want to think about some alternatives,
and it is not unlikely that we get that story of the person
that says sheepishly, well, I haven't been taking this one or
that one because, and inevitably because it is dollars, and so
one of the people in the room is a navigator or a social worker
who has got real skills in navigating where opportunities for
reimbursement and other financial supports are, and they go to
work. Nobody leaves there without their medications.
Senator Rosen. Right.
Mr. Klein. Nobody leaves there without a resource for
medications. Nobody leaves there without the opportunity to get
follow-up from the team, and so it works well, and it works as
a family endeavor of not only the whole health care team, but
the family caregiver in conjunction with the person who is
receiving services.
Senator Rosen. That seems like this great overall
comprehensive project and group, and I think that is what gives
you so much success. We are going to move on to our last
question and something that we have been thinking about--well,
we always think about this, but because of COVID-19, it has
really been on the forefront of everyone's mind, which is the
vaccinations, and of course, for seniors, there is quite a few
vaccinations that they can take to help improve their lives and
keep them disease free, and so free vaccinations for seniors on
Medicare Part D. Dr. Madison, many of the senior patients you
see, I hope they have the Part D plans and therefore almost
half a million Medicare eligible individuals in Nevada, 15
percent of our population, actually has a Part D, and in rural
counties, have a higher percentage per capita of Medicare
beneficiaries with Mineral, Nye, and Douglas counties' Medicare
eligible population is currently over 30 percent, 30 percent of
their total populations.
Thousands of Nevada seniors who could benefit, again, from
reduced health care costs from the Inflation Reduction Act
because we are going to establish zero cost sharing for
vaccines for seniors on Medicare Part D starting in January,
zero cost sharing.
That is what the Inflation Reduction Act is doing. It is an
especially important relief. Some of these diseases, I know
there is pneumonia and shingles. You could probably tell me all
the ones there are, but some of these vaccines like shingles,
we talked about the price, are so expensive.
Can you tell me, Dr. Madison, how you think the Inflation
Reduction Act's free vaccine provisions, how that is going to
make a difference for the population that you serve, and what
are the health care consequences of seniors foregoing these
vaccines?
Dr. Madison. First and foremost, I want to say public
health is obviously my focus, and you know, vaccinations are
literally the single most effective public health intervention
in modern medicine, right. That is how we were able to get rid
of smallpox, and up until about a month ago, polio, right, and
so it is so important for us to be able to provide these
preventative care measures, in particular to seniors, because
these vaccine preventable diseases can be devastating to
seniors.
When we think about hospitalizations, especially when we
think about things like influenza, that 36,000 individuals per
year being hospitalized and potentially passing away is usually
from the secondary bacterial pneumonia that they get after
getting the flu, so when we can provide things like
pneumococcal vaccination, influenza vaccination, it helps to
not only keep those seniors healthy, but out of the hospital,
which again, creates more health care cost and more burden on
themselves and their families and their communities, so this is
extraordinary that they will be able to provide these
vaccinations at no cost to seniors, and I just think about
individuals who have suffered from shingles. If anybody has
known anyone who has had shingles, it is something I would not
wish on my worst enemy, and now that the ACIP, which is the
Advisory Committee on Immunization Practices, has now
recommended it now all the way down to the age of 19, there are
now people who can get it that have autoimmune diseases that
are more at risk because their immune system is suppressed, and
it puts them more at risk for getting things like shingles, so
extraordinary, incredible.
Can't think of anymore, you know, fantastical words that I
can use, but just so great that we can provide these
vaccinations, lifesaving, life changing vaccinations to
seniors.
Senator Rosen. Mr. Kline, all these vaccinations are going
to be free, so how are you going to be sure that you get the
word out to all the seniors, even more working with your
partner agencies, every senior in Nevada that who wants one can
get one free of charge due to the Inflation Reduction Act.
Mr. Klein. Advocacy, advocacy, advocacy. We are really
proud. We have been running vaccine clinics for as long as I
can remember. It started with flu and pneumonia and the latest
flu vaccine comes out, the latest pneumonia vaccine, we try to
get the word out into the community.
Importantly, we work with a network of other not for
profit, so organizations like Helping Hands, so folks who
deliver food banks, who are food pantries, we get the word out,
we collaborate. We try to reach the people who are hard to
reach, those seniors who are not out about as much, and to
encourage them to come out.
Then we follow-up with them because they can't get all
their shots at one time, so we have to run a second clinic and
then we say, gee, we are really glad you got your pneumonia
shot, but it is time you get your COVID booster, or it is time
for you to get your flu shot, and so we have a pretty
aggressive, in a most positive way, loving way we can make it,
a line of encouragement with our partners all over Southern
Nevada, and then we run programs, and we run--we provide food.
We provide education. We try to do things that encourage folks
who otherwise can't get out, and those who can't get out, who
are homebound, we send somebody to them.
Senator Rosen. That is fantastic. You are going to get the
last question because speaking of advocacy, AARP, really, you
are the big umbrella organization looking at all of these
things, and so how are you going to help everyone here today be
sure that the word gets out to every senior in Nevada, rural
and urban, regardless of the language that they speak, that
they have access to free vaccines starting next year?
Ms. Moore. We have a saying at AARP that says what we do
for one, we do for all. It is our founder's--I feel it is my
favorite quote from her. The free vaccines under Medicare, as
Dr. Madison said, there is only one word for it, incredible.
Incredible and very soon, so for this benefit and all benefits
of this historic law, we are certainly going to plan major
public education and outreach and push various articles. We
have our comms director here with us today, ensuring that folks
know where to go for the best information, and we will be
producing videos, we will be doing lots on our website.
That is--you know, it is not only for our members, but
really anyone can access that information. We want our members
and the public to have a clear sense of what this--what is
expected and what is to come in this new law, and we welcome
the work of our Members of Congress.
You know, we work really well with you, Senator Rosen, and
we know that that will continue, or really any other
stakeholders we work with. Jeff, very well, and other not for
profits, nonprofits, and community partners because we want to
keep a focus on this issue.
We want to help educate the public about the prescription
drug provision in the Inflation Reduction Act, so our work is
not done.
Senator Rosen. Well, and you have a partner in me, and I
know that you have a partner with everyone here, and of course,
the rest of the Democratic Federal delegation, and so I can't
thank you all enough for being here, for contributing your
time, your expertise, your emotions, your passion, all of it.
It means so much to so many, and of course, I want to thank the
College of Southern Nevada for giving us this wonderful space
to do this, and because you know what, in a country as
prosperous as ours, we should do better. We should always do
better, especially for our seniors, and no senior, as we have
spoken about, should be forced to choose between paying for
life saving medication or keeping their lights on. No senior
should have to choose between affording their insulin or
putting food on the table, and no senior should be expected to
spend nearly all of their Social Security check on the
prescription drugs they need just to live their everyday lives.
Unfortunately, as our witnesses have testified today, this
is far too often the case in Nevada and across the country. We
can and we must do better, and now, thanks to action in
Congress, we are going to do better, and I am proud again to
say that Democrats in Congress, well, we have been listening to
Nevadans and to the American people.
We have taken your stories, these stories here today and
those you represent back to Washington, and we enacted bold,
historic legislation in the Inflation Reduction Act,
legislation I am proud to have voted for that will finally
lower prescription drug costs, and as we have heard today, I am
going to reiterate all of this. This new law will do just this,
finally, finally allow Medicare to negotiate for the best price
of prescription drugs.
Finally cap seniors' Part D out of pocket spending at
$2,000 per year. Finally, cap seniors' insulin costs at $35 per
month. Finally, cap prescription drug price increases to no
greater than the rate of inflation, and finally, increase
Medicare subsidies for lower income Americans.
We are going to do even a little bit more. We are going to
ensure that all seniors receive all their vaccines at $0 cost
sharing, free, free, and we are going to reduce burdens on
those health care providers, like Dr. Madison and others, and
the caregivers, those angels and our family and those that work
with us, by delivering lower costs for seniors across the
board, and I am so proud of the work my Democratic colleagues
and I have done to lower these costs for seniors to protect and
to expand Medicare, but I want everyone to know this is just
the beginning.
Moving forward, I will continue to fight to protect
Medicare, to reduce health care and prescription drug costs for
Nevada's seniors, and I will continue to work with all my
colleagues to make Medicare even stronger for years to come.
Now our closing business, if any Senators not in attendance
today have additional questions for these witnesses, any
statements you would like to add for the record, the hearing
record will be kept open for seven days until next Tuesday,
August 30th.
With that, thank you all again for participating, and this
concludes today's hearing.
[Whereupon, at 3:48 p.m., the hearing was adjourned.]
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APPENDIX
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Prepared Witness Statements
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