[Congressional Record Volume 140, Number 106 (Thursday, August 4, 1994)]
[Senate]
[Page S]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: August 4, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                           PRESCRIPTION DRUGS

  Mr. DORGAN. Mr. President, I ask unanimous consent to use some 
information that I used in the committee to demonstrate the price of 
prescription drugs on the floor.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DORGAN. Mr. President, Senator Pryor and I recently held a 
hearing in the Governmental Affairs Committee on the issue of 
international prescription drug prices. We are in the throes of trying 
to figure out how to deal with escalating, ever-increasing prices in 
the U.S. health care system. As you know, we have plan after plan out 
here for debate. We are under enormous pressure to do something on 
health care reform, and the central engine of this is to do something 
about skyrocketing prices that are pricing health care out of the reach 
of too many American people.
  There has been little discussion about one component of skyrocketing 
costs which I want to call to the attention of colleagues.
  Senator Pryor has done an enormous amount of valuable work in this 
area, and I have assisted him when I was on the House side and now on 
the Senate side. We jointly chaired a hearing last week that I want to 
bring to the attention of the Members of the Senate.
  Prescription drugs are enormously valuable to those who take them to 
deal with some health problem or another. They save lives. They extend 
lives. They are very valuable.
  We want to encourage new research and development into prescription 
drugs. We do that in many ways--tax breaks, very generous tax credits, 
and other ways. The Federal Government does an enormous amount of 
research and development on new drugs and so do the prescription drug 
manufacturers. This is not about whether prescription drugs are good. 
They are. They help people. The question is, how are they priced? 
Prescription drugs are not a luxury. They are a necessity for those who 
have been prescribed the drug by their doctor.
  I want to tell you about a woman in her mid-eighties who I met in 
North Dakota. She is a women with a low income. She said:

       I have heart disease and diabetes, but I cannot afford the 
     drug that my doctor tells me I need to take to stay well. I 
     just don't have the money, so what I do is I buy the 
     prescription the doctor asks me to buy and I take only half 
     the dose so it will last twice as long. It is the only way I 
     can afford it.

  Prescription drug prices have increased dramatically in recent years.
  We asked a very simple question in last weeks hearing. Why is it that 
we pay such a much higher price for drugs in this country versus other 
countries?
  I want to show my colleagues a couple demonstrations of that. The 
General Accounting Office compiled some data--which I do not have with 
me on a large chart--that shows 20 of the top 100 selling prescription 
drugs in the United States. It has the manufacturers wholesale prices 
for the same dosage, of the same drugs, from the same manufacturer in 
the United States, Canada, Sweden, and the United Kingdom. The price 
for almost every drug is highest in the United States, sometimes 
several times as high. At the hearing, GAO presented data that shows 
that drug prices in the United States are higher than those in Canada, 
England, Sweden, Germany, Italy, France, and I could continue. Why is 
it that we pay more, not just more, but much more, for exactly the same 
drugs? Let me demonstrate this.
  This is Premarin, the top-selling drug in this country. Premarin is 
an estrogen drug. This bottle of Premarin, produced by the same 
company, put in the same bottle, in the same quantity and in the same 
dose, sold for the prices on this chart.
  That bottle of Premarin is sold in Sweden for $93, in the United 
Kingdom for $100, in Canada for $113, and in the United States for 
$297. Same bottle.
  This is a bottle of Xanax. Xanax, of course, is used to treat ulcers 
and is the second biggest selling drug in this country.
  Let us take a look at the price for Xanax. This is GAO information 
for the same drug. If you bought this bottle, same dose, same 
manufacturer, you pay $10 for it in Sweden, $15 in the United Kingdom, 
$20 in Canada, and $56 if you were in the United States.
  Why do we pay so much more for the identical drug?
  Zantac, this bottle, same drug, same manufacturer, same dose. In 
Sweden, $64; United Kingdom, $84; Canada, $102; the United States, 
$133. Why? What would give rise to asking Americans to pay so much for 
the same drug.
  Let me show you one last bottle, something a lot of Americans are 
familiar with. Valium. Many say Americans take too much of this. Valium 
deals with anxiety.
  This bottle, exactly the same drug, produced by the same company, is 
sold in various countries. If you buy this bottle of this identical 
drug in this dosage, you pay $4 for it in Sweden, $4 in England, $9 in 
Canada, and $49 in the United States.
  By what justification would this bottle be sold by the same company 
for $4 in Sweden and $49 in the United States? By what authority, by 
what justification, are drug manufacturers overcharging in the United 
States, not just double, not just triple, but in some cases 10 times 
for the same product produced by the same company, in many cases an 
American company?
  Well, we held a hearing on this question. The answer is the drug 
companies do not know. They did not send their executives to the 
hearing. They sent a trade organization executive who told us he does 
not know.
  I think I know. In virtually every other country in the world, they 
say you can make a profit, you can recover all of your costs, plus make 
a profit. But in our country, we say we do not care what you charge. 
Katie bar the door. Prescription drug manufacturers charge whatever 
they want to the American consumer. Therefore, the American consumer 
pays 50 percent, 100 percent, 200 percent, 1000 percent more for 
exactly the same drug made by the same company.
  Now if we go through health care reform and say this does not matter 
to us, there is something fundamentally wrong.
  Do you know if the American consumer had bought the same menu of 
prescription drugs but did not buy them here they would have saved 
billions of dollars. If they went to Canada to buy all their 
prescription drugs, the same drugs, they would have spent $7 billion 
less. Or, if the American consumer could have gassed up the car and 
gone to the drugstore, but actually had driven to the United Kingdom, 
they would have paid $11 billion less for purchasing exactly the same 
drugs?
  Now, when we finish health care reform, we ought to address this 
question. Is there justification to have these companies put the same 
pill in the same bottle with the same label at the same strength and 
say:

       You, American consumers, line up over here. All the of the 
     rest of you, we are going give you a sale price, but you 
     Americans, we are going to gouge you. You get the privilege 
     of paying the highest price in the world for your drugs. And 
     when you are done, thank us for all the research and 
     development we use to justify it.

  Well, it is not justified. We pump billions into research and 
development in lucrative tax breaks and tax credits. The U.S. 
Government pumps billions in to Government supported research and 
development, and the drug manufacturers do as well. But these medicines 
ought to be priced fairly when they are sold across this world.
  Let me make one final point. I appreciate the indulgence of my 
friends.
  I was at a restaurant last Saturday night in Minot, ND. I ordered 
some walleye pike and mashed potatoes. The waitress, as she delivered 
the food, said:

       I know this is unfair of me, but you are Senator Dorgan and 
     I have got to say this to you. I am 23 years old and I have 
     seizures, not a lot of them, but it affects my health. I 
     cannot get insurance anyplace, and this restaurant does not 
     offer health insurance. I know that you are lobbied by all 
     kinds of organizations and they are putting things on TV that 
     I see.

  She said:

       Just remember when it is quiet, when you are thinking about 
     this health care issue, remember there are people like me out 
     there who are not making a lot money and simply cannot 
     purchase health insurance.

  As we go through this health reform issue, let us remember people 
like that. Let us remember the people who, every day, are buying 
prescription drugs. Let us remember the low-income individuals whose 
doctor prescribed a prescription drug, and who are driving to the 
corner drugstore and are now paying double, triple, or 10 times what 
the consumers in the rest of the world are paying.
  And it is for the woman I described before, from a central North 
Dakota town, at the age of 85 or so, who has heart disease and 
diabetes, who decides she can only take half the dose her doctor 
prescribed so her medicine will last twice as long because she simply 
cannot afford it. That is wrong.
  Let us address health care generally. Let us deal with prices and 
access and quality health care. We should do that.
  I commend the President, I commend Senator Mitchell, and I commend 
the Democrats and Republicans who say this is an issue we need to 
address. But let us not address it and forget this issue, either. Let 
us decide in the next couple of weeks to ask difficult questions on 
this floor.
  I hope to bring a proposal to this floor that says: By what 
justification would we allow corporations to continue to overcharge 
American consumers for needed prescription drugs?
  Mr. President, I yield the floor.
  Mr. ROCKEFELLER addressed the Chair.
  The ACTING PRESIDENT pro tempore. The Chair recognizes the Senator 
from West Virginia.
  Mr. ROCKEFELLER. Will the Senator yield for a question?
  Mr. DORGAN. I am happy to yield.
  Mr. ROCKEFELLER. Mr. President, I am very interested and agree very 
much with what the Senator from North Dakota said.
  It also interests me that those same drug companies that are charging 
so much more to us than they do to others for the same prescription 
drugs, that in addition to that, they get enormous tax breaks from the 
taxpayers of the United States, because so many of those drugs are 
produced in Puerto Rico. They get billions of dollars of tax breaks for 
making drugs not on our continental shores, and yet they still do that.
  That reminds me of another thing. And this is interesting because 
this deals with something that the Senator and I were working on 
recently, product liability. The Senator from North Dakota was primary 
in causing me to take the Food and Drug Administration part out of 
product liability.
  But what was fascinating to me in that whole debate, I say to my 
friend from North Dakota, was that those, of course, were drug 
companies we were talking about for a large part, but they never in any 
way lobbied for the position which I was trying to maintain for them. 
There was no help whatsoever. They never showed up. I never saw them. 
They were never there.
  It strikes me as ironic, and the answer is in your charts. They are 
making so much money. They say they want to do research, but when it 
came to somebody on the floor trying to get them a chance to do more 
research, they were disinterested. So I think they must be making 
enough money.
  Mr. DORGAN. I would say to the Senator from West Virginia, in 1992 
the pharmaceutical manufacturers made triple the average rate of 
profits of all the top 500 companies in this country, and the head of 
one drug company made more money than the combined salaries of every 
Member of the U.S. Senate.
  With respect to this question of drug prices in other countries, I am 
reminded of the old Tom Paxton song, ``I Am Changing My Name to 
Poland.''
  The solution? Some on this floor would stand up and argue until they 
are blue in the face that they would not accept any price controls 
under any conditions. Maybe we ought to allow some sort of purchasing 
co-op to go over and buy these drugs in Germany and resell them here at 
half the price.
  What is wrong with that? If it is a global market, maybe we ought to 
be able to go over and purchase the same drug in Germany at half the 
price and ship them back here and sell them to the American consumer. 
We should not have to go that route, but maybe that is one of the 
suggestions we ought to talk about in the next couple of weeks.
  Mr. ROCKEFELLER. I thank the Senator.

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