[Congressional Record Volume 144, Number 135 (Thursday, October 1, 1998)]
[House]
[Pages H9194-H9201]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  THE HIGH COST OF PRESCRIPTION DRUGS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 7, 1997, the gentleman from Texas (Mr. Turner) is recognized 
for 60 minutes as the designee of the minority leader.
  Mr. KENNEDY of Rhode Island. Mr. Speaker, will the gentleman yield?
  Mr. TURNER. I yield to the gentleman from Rhode Island.


               Bad Conduct is not Grounds for Impeachment

  Mr. KENNEDY of Rhode Island. Mr. Speaker, I would like to thank the 
gentleman for yielding.
  Mr. Speaker, I apologize that I was cut off but those are the Rules 
of the House and that is the nature of the floor proceedings, but I did 
want to conclude with my remarks because I cannot emphasize enough to 
the people in this Chamber, my colleagues watching on TV and the 
American people at large, that this is no light matter that we have 
been talking about.
  We seem to be taking such a cavalier attitude to this, and I know 
that obviously a lot has to do with the politics of this season. I dare 
say, though, what we are embarking on truly goes to the nature of our 
whole form of government.
  I just had the opportunity last week, as a member of the Committee on 
National Security, to go to New York to listen to the President's 
speech on global terrorism, and I met many diplomats who have a working 
relationship with our allies, democracies around the world, in Europe 
and the former Soviet bloc countries, and all of them are so perplexed 
about what is going on here in this country.
  My friend who deals with them on a day-to-day basis told me that his 
judgment of why they are so perplexed is because they have not been at 
the democracy game as long as we have. They have been under tyranny, 
the tyranny of fascism and Communism, within their own lifetimes, and 
they know that the miracle of this system of government is not to be 
messed with. That is why they feel so strongly about what we are doing 
in this country is so wrong for the future of our constitutional form 
of government.
  As I was saying, in my opinion, what we are doing now by putting the 
cart before the horse, so to speak, by saying that we are going to have 
a preliminary inquiry before we know what the definition of impeachment 
is, to me violates the fundamental process of due process, where you 
know what the crime is before you begin to prosecute it.
  The reason the majority wants to vote on an impeachment inquiry 
before they know what impeachment really is is because they could never 
vote to initiate such an inquiry once they really knew what they were 
talking about. Once they knew what was really impeachable, then we 
would have to ask one more question: Is the impeachable offense, such 
as perjury, is the impeachable offense the kind of offense in which the 
President's remaining in office is worse for this country than the 
excruciating process of impeachment that it will take to remove the 
President from office?
  We need wisdom to prevail over politics. We must see past the 
passions of this moment and look to the true nature of this offense, 
which in my opinion is better judged by God and family than by the 
Congress and the media.
  What we have here is a reckless, embarrassing, personal act. It was 
wrong. The President was human in trying to hide it, and that was 
wrong, too. None of this, however, shows that the President was on a 
course that was dangerous to the public.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (Mr. Ewing). The Chair would admonish the 
Member not to refer to the personal conduct of the President and to 
address those outside the chamber.

                              {time}  1445

  Mr. KENNEDY of Rhode Island. Mr. Speaker, that was not dangerous to 
the future of this republic. It did not justify throwing this democracy 
into a constitutional tailspin, and it will not justify it. Gifts, 
testimony, executive privilege, all these things, do these justify 
paralyzing our constitutional form of government?
  People say this is about a certain offense, perjury, and we should 
not let anyone off the hook. But during the Watergate scandal, 
President Nixon perjured himself in his tax returns, and this was 
dismissed, this was dismissed, as not an impeachable offense. And what 
about when Caspar Weinberger

[[Page H9195]]

lied to this Congress about a secret war? Remember the Iran contra 
scandal? When asked, Caspar Weinberger said he had no details of such a 
military offensive, no details whatsoever. He lied to this Congress. 
Guess who pardoned Caspar Weinberger? Republican president George Bush, 
and he did so at the behest of Senator Bob Dole, who pushed him to 
pardon Caspar Weinberger.
  I just want to make a concluding couple of thoughts: Joe McCarthy, 
remember him? He used details of people's sex lives to extort 
cooperation from them and from former communists by threatening to 
expose what happened in their bedrooms.
  J. Edgar Hoover, remember J. Edgar Hoover? He tried to get Martin 
Luther King, Jr., to drop out of the civil rights movement by sending 
Coretta Scott King a copy of an illegally obtained elicit tape 
recording. It is documented.
  Ken Starr has done the same thing. Through his dump of lurid sexual 
details, he is trying to embarrass this president so much so that he 
disrupts our whole constitutional form of government by forcing him to 
resign. To me, this amounts to simply sexual McCarthyism.
  The bottom line is this: I would say that the majority needs to heed 
the words of your own party. President Gerald Ford was featured in the 
Hill Newspaper last week. You recall what he said? He said an 
impeachable offense is whatever a majority of the House of 
Representatives considers it to be at a given moment in history.
  But that is only what Gerald Ford meant with respect to a judge. He 
was asked to clarify his comments and apply them to a president of the 
United States, and I want everyone to listen to me, because they are so 
misunderstanding what President Ford said. President Ford added that 
the removal of a duly-elected president in midterm ``Would indeed 
require crimes of the magnitude of treason and bribery.''
  Mr. Speaker, we have a constitutional debate here, and I will venture 
to say that in my whole time in the United States Congress, I will not 
cast a more important vote in my whole time in Congress than the vote I 
cast next Monday against moving this country down such a reckless 
course that will imperil this republic and permanently damage this 
Constitution and the definition of what is an impeachable offense.
  In my mind, this is a sacrosanct document, and what is sacred in it 
is it is only used in those most extreme circumstances. To me, this 
inquiry does not rise to that level and threshold, and, for that 
reason, I encourage all my colleagues to join with me and put politics 
aside and say what is right for the Constitution, and that is to stand 
with the Constitution and vote against any inquiry down this maddening 
road.
  I thank the gentleman from Texas (Mr. Turner) for yielding to me.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair would admonish all Members that 
they should avoid references to the personal conduct of the President.
  Mr. TURNER. Mr. Speaker, I rise today to address an issue that is 
important to every senior citizen in our country, the problem of the 
increasing cost of prescription medications. This is an issue that has 
been growing in intensity in recent years as the costs of drugs have 
gone up and up and up.
  A number of Members of this body have joined together to try to 
address this problem and to pass legislation that would lower the cost 
of prescription medication. There are currently over 75 Members of this 
House who have joined in sponsoring legislation to deal with the high 
cost of prescription drugs. It is my pleasure to yield to one of the 
leaders in this effort to combat the cost of prescription medication, 
the gentlewoman from California (Mrs. Capps). I want to mention in 
passing that Lois is a proud new grandmother of a five-week-old boy, 
Walter Holden Brostrom, named after his grandfather, Walter Holden 
Capps, a former member of this body.
  The gentlewoman has been a hard worker on behalf of those who are 
fighting the high cost of prescription medication. She has a background 
in nursing, and, as the representative of the 22nd district of 
California, it is my honor to yield to the gentlewoman from California 
(Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I want to thank the gentleman from Texas 
(Mr. Turner). Of course, you warm my heart by talking about my 
grandson. It is a point of reference that I have with many grandparents 
throughout my Congressional district. It is with their faces in my 
mind's eye and with their stories in my heart that I rise today to 
speak about what I consider to be a real scandal going across this 
country that I have uncovered in my Congressional District out on the 
central coast of California.
  Seniors throughout the area are, we are finding out, paying 
outrageously high prices for their prescription drugs. Even worse, 
these inflated prices are subsidizing the very discounts that high 
profit HMOs get for these very same medications.
  A report we have released gives to the public our study, which 
uncovers this fact in my Congressional District and gives the reason 
why some of these costs are so high. There are very startling findings. 
I know the gentleman from Texas (Mr. Turner) is going to go into detail 
with the charts he has that show him the kinds of studies done in his 
district as well.
  Seniors in California on the central coast are paying on the average 
133 percent more for the 10 drugs most commonly used by seniors. This 
is 133 percent more than the HMOs are paying at the discounted rates 
they get for these very same prescriptions. These are drugs like Zocor, 
which reduce cholesterol, Norvasc for common blood pressure medication, 
and Relafen, which provides relief from arthritis.
  Prescription drug companies give these big discounts to managed care 
companies for these drugs, these same 10 drugs and other drugs as well, 
and then other buyers, like pharmacists must pay substantially more for 
the same drugs and then pass these higher costs on to seniors.
  For example, my study found that Ticlid, one of the most widely 
prescribed medications for people who have had strokes, sells to the 
HMOs for around $34 for 60 tablets. Yet in my area of the country the 
average pricing that seniors pay for this drug themselves when they are 
buying it out of their own pocket is more than $130, nearly a 300 
percent markup over the price that the HMO pays.
  The huge difference in prices is not going to the retail pharmacist 
in Santa Barbara or Santa Maria or Arroyo Grande. On average these 
local pharmacists are paying $100 to $110 for the same medication. The 
final price the seniors pay includes only a reasonable markup to the 
pharmacists and then they are bearing the burden of the profit that is 
going to the HMOs.

  That seniors are paying more money for drugs than they should while 
HMOs reap profits is based partly on the huge discounts they get from 
the drug companies. But there is an even sadder story. Many seniors 
simply cannot afford these high prices because of the fixed incomes 
they are living on, so they have done a variety of things, such as 
taking half the prescription or choosing of the several prescriptions 
that are needed for their life for life and death issues in many cases, 
or for the quality of life that they want or for their relief from pain 
and discomfort, and they end up just taking part of the medications 
that the doctors prescribe.
  I have a couple of examples that I will share with you. Clyde Vann of 
Pismo Beach told my staff he pays over $300 a month for seven 
prescription drugs, and he really needs to be taking two additional 
medications, but that would add an extra $150 to his monthly costs. He 
is on a fixed income, and he just cannot take these two other 
medications that he really needs to be taking.
  Harriet MacGregor of Santa Barbara told my staff that because of the 
high cost of her five prescriptions, she must sometimes skip or reduce 
her dosage. This is not the kind of health care we want to be providing 
for seniors in our country. They should not have to subsidize the 
profits of the HMOs. They should not have to choose between filling 
their prescription or buying food or paying the rent.
  So I was proud to sign onto the legislation of the gentleman from 
Texas (Mr. Turner) last week to address this issue. H.R. 4646 will 
allow pharmacies the opportunity to receive the same discounts that 
HMOs get for the drugs that they dispense to seniors. I believe that 
this is a long overdue measure.

[[Page H9196]]

  I am happy to yield back now. I want to continue the discussion at 
some point about what is happening also in parts of our country that 
are rural areas and where the reimbursement rate to the HMOs from 
Medicare is so little that the HMOs are pulling out because of their 
inability to make a profit in our rural areas. This is a double whammy 
for our seniors. It is giving them now fewer options for their health 
care in general, and also then when they do just have Medicare and then 
have to pay the full price, they are running into this problem that you 
and we have uncovered.
  The other thing that is interesting to me is that I have done this 
study on the central coast of California, the gentleman lives in Texas, 
we have other Members of Congress from Maine, from Arkansas, from 
around the country, and we know that this is going on all too many 
places right now.
  So it is something we want to address. I am pleased that the 
gentleman has this time on the floor this afternoon and we can be 
talking about this very serious issue.
  I will turn it back to the gentleman now and am prepared to talk a 
little bit more later on.
  Mr. TURNER. Mr. Speaker, I thank the gentlewoman from California 
(Mrs. Capps). We appreciate her strong leadership on this very 
important issue.
  Another leader in the fight to lower the cost of prescription 
medications for our senior citizens is the gentlewoman from the 10th 
District of Indiana (Ms. Carson). The gentlewoman, I know from talking 
to her, knows firsthand the problems that seniors are facing, because I 
have talked to her many times about how she represents her district, 
and she works at the grassroots, so I know she has got some interesting 
insight on this issue.
  Ms. CARSON. Mr. Speaker, I thank the very distinguished colleague 
from Texas for yielding, and I want to commend the gentleman for his 
insight and foresight in bringing this vital issue not only to the 
United States House of Representatives, but to the ears and eyes of 
America, because it is imperative that the American people understand 
that the Congress is in fact concerned about their well-being, 
especially those who are recipients of Medicare at this particular 
time, the senior citizens of our country.
  Mr. Speaker, I rise today again, along with my distinguished 
colleagues. It is kind of difficult to follow the eminence of my 
colleague the gentleman from Texas (Mr. Turner), and certainly the 
gentlewoman from California (Mrs. Capps). The senior citizens are very 
privileged to have this kind of representation in the Congress that is 
very sensitive to their needs.
  Of course, I rise, being on the verge of being a senior citizen, I 
would like to announce in the beginning I probably have a conflict of 
interest, because I want my medication affordable when I advance to the 
age of requiring Social Security. The skyrocketing prices for 
prescription drugs are unabated and they are hitting the senior 
citizens of our country very, very hard.
  Many of our seniors are on fixed incomes, and when they have to pay 
higher prices for prescription drugs, obviously they have less money 
for food, to pay for their heating bills, to pay their property tax or 
to pay their rent, if that is the case, and to accommodate some of 
their other vital needs for their own well-being. Seniors are paying 
too much in higher prices for prescription drugs than HMOs and other 
most-favored-customers who buy drugs in large quantities at a discount.
  In my district in Indianapolis, we did do a survey among the 
drugstores on drug prices based on the widely used common drugs. 
Albuteral, a common inhaler, costs as much as $18.35 in some stores, 
twice as much as at the cheapest store. HMOs can charge much less.

                              {time}  1500

  The drug, I think it is Vicodin, varies between 39 cents and $2.34 
per dose in Indianapolis.
  These high prices are feeding drug companies' growing profits. Our 
pharmacists are complaining that when they obtain these items, that the 
major cost is theirs to pay and they have to pass along those costs to 
the senior citizens at a very limited profit.
  It is just plain wrong for drug companies to be charging the high 
prices in behalf of our Nation's senior citizens. That is why I join 
the gentleman from Texas (Mr. Turner) and the gentlewoman from 
California (Mrs. Capps) and other colleagues in introducing H.R. 4646, 
the Prescription Drug Fairness Act.
  As my colleagues know, the legislation will allow retail pharmacies 
to buy medications commonly used by senior citizens directly from the 
Federal General Services Administration. GSA is able to buy 
prescription medications at much lower prices than individuals, 
allowing our pharmacists to pass on the savings to senior citizens.
  No one should be forced to choose between buying food or medicine, 
least of all our senior citizens to whom we owe so much. So I would 
urge my colleagues to join me in cosponsoring this legislation. I would 
encourage the leadership to set it on the calendar for hearing and for 
ultimate passage. Let us do something important for a change, 
especially in behalf of our senior citizens.
  I am more than happy to yield to the gentleman from Texas (Mr. 
Turner).
  Mr. TURNER. Mr. Speaker, I thank the gentlewoman for her support on 
this important issue and for her leadership.
  Another Member of the House that has taken a very prominent role of 
leadership on this issue is the gentleman from Maine (Mr. Allen). The 
gentleman is a sponsor of legislation to deal with this issue, along 
with many others that have joined with him, and it is an honor to have 
the gentleman here to talk about this issue that he has worked so long 
and hard on.
  I yield to the gentleman from Maine (Mr. Allen).
  Mr. ALLEN. Mr. Speaker, I thank my friend and colleague for yielding. 
I want to say to the gentleman from Texas (Mr. Turner) that I 
appreciate his organizing this Special Order today and for his 
leadership on this particular issue.
  I found, as many of us have back in our districts as we travel around 
and talk to seniors, that the high price of prescription drugs comes up 
at every meeting of seniors. It does not matter where we are or who we 
are talking to. As long as there is a senior in the room, it seems, 
this subject will come up, particularly if we give people an opening.
  There are some reasons for that. Seniors use one-third of all 
prescriptions in this country. While the average American under age 65 
uses only 4 prescriptions a year, the average senior uses 14 
prescriptions a year. In particular, older Americans suffer more from 
those chronic conditions such as hypertension, diabetes, arthritis, 
glaucoma and circulatory problems that require the taking of regular 
prescription drugs.
  When Medicare was created in 1965, it was designed as a system of 
acute care, so it did not cover prescription drugs. Now, the number of 
hospital beds is shrinking, people are not spending as much time in the 
hospital, and they are not there because of advancements in 
prescription drugs, and yet 37 percent of all seniors have zero 
coverage for prescription drugs.
  We all know that the prices have been going up at a rapid rate. The 
studies that have now been replicated in a number of districts are very 
revealing. Last June I requested that the Committee on Government 
Reform and Oversight staff investigate whether pharmaceutical companies 
are taking advantage of older Americans because of the high price of 
prescription drugs. There is a recent statement in a report on the 
pharmaceutical industry which reads, ``Drugmakers have historically 
raised prices to private customers to compensate for the discounts they 
grant to managed care companies. This practice is known as cost-
shifting.''
  I understand that the studies that have now been replicated in our 
districts around the country are the first studies to quantify the 
extent of price discrimination and how it affects seniors. The study 
investigated the prices of the 10 brand name drugs with the highest 
sales to the elderly. Ticlid, Zocor, Fosamax, Prilosec, Norvasc, 
Relafen, Procardia XL, Cardizem CD, Zoloft and Vasotec.
  The study looked at the price differential between what seniors pay 
when they walk into a local pharmacy and what the best customers of the 
pharmaceutical companies pay. And

[[Page H9197]]

the best customers are big HMOs, the Federal Government, like the VA. 
The study found in my district, and it is pretty much the same I 
believe in the district of the gentleman from Texas (Mr. Turner) and in 
the district of the gentlewoman from California (Mrs. Capps), that 
seniors pay 105 percent of the price, on average, that the drug 
companies' most favored customers get.
  Now, for comparison purposes, one thing is clear: That is, the markup 
or the price discrimination on prescription drugs is far higher than it 
is on other consumer goods. In fact, the price differential is about 5 
times greater than the average price differential for other consumer 
goods.
  Now, I wanted to say a couple of things about the pharmacists, 
because one of the things we found in the study is that the high price 
of prescription drugs is not the fault of pharmacies. Whether one is a 
chain drugstore or a local pharmacy, the markup is on average 3 and at 
times all the way up to 22 percent, but more often it is a reasonable 
markup of 3, 4, 5, 6 percent. In fact, it is the large pharmaceutical 
companies that are driving up the prices. Drug manufacturers makes 6 
times more profit on prescriptions than retail pharmacies.
  Mr. Speaker, I think that we obviously have to do something about 
this, and I am pleased that the release of a report in my district 
showed what it did, that the study has been replicated in districts 
around the country. This is, as we well know, a nationwide problem, not 
just a local problem.
  Despite the very important contributions that the pharmaceutical 
companies have made in improving the quality and the effect of 
prescription drugs, the fact remains, bring it down right to the 
grassroots level. The gentleman knows, the gentlewoman knows, I know 
people in our district who get about $600 or $700 a month in a Social 
Security check and that is all they have, and a good number of them are 
paying $100, $200, $300 a month are for prescription drugs.
  The math does not work. They cannot pay for food and rent and other 
necessities and still pay the cost of their prescription drugs. So what 
do they do? They do not take the drugs that their doctors tell them 
they have to take. That is the bottom line. Seniors in this country are 
not taking the drugs that their doctors tell them they have to take.
  Vi Karion from Maine traveled down to our press conference last week 
and she spoke of her difficulties and those of her friends and 
neighbors. She gets about $900 a month from Social Security, but cannot 
afford supplemental coverage for her prescription medication and she 
cannot always afford all of her prescription drugs.

  That is why I introduced the Prescription Drug Fairness For Seniors 
Act, very similar to the bill that the gentleman from Texas (Mr. 
Turner) and others have introduced. These two pieces of legislation are 
complementary, not competitive. We believe that the legislation will 
drive down the cost of prescription drugs for seniors by over 40 
percent.
  Mr. Speaker, it is too late in this session to have this bill become 
law, but I can tell my colleagues this: We are going to be back next 
year. This issue will not go away.
  We need to do something about the high cost of prescription drugs, 
and what our legislation would do, without adding to the Federal 
budget, without fixing prices, we would put the Federal Government on 
the side of every senior buying pharmaceutical drugs. And if we do 
that, the buying power of the Federal Government is strong enough to 
compensate for the high prices charged by the pharmaceutical companies, 
to drive down the cost of prescription drugs and really give our 
seniors a chance to eat the food they are supposed to eat and still 
take the medication that their doctors tell them they have to take.
  Mr. Speaker, I thank the gentleman. I am very pleased to have been 
here today.
  Mr. TURNER. Mr. Speaker, I thank the gentleman for his strong 
leadership on this very, very important issue.
  Another Member of this body who has worked hard on this particular 
issue is the gentleman from Georgia (Mr. Bishop), from the Second 
District of Georgia. I would like to yield to the gentleman.
  Mr. BISHOP. Mr. Speaker, I rise today as a cosponsor of H.R. 4646, 
which is a bill to provide for substantial reductions in the price of 
prescription drugs for Medicare beneficiaries.
  Mr. Speaker, this is a time when seniors seem to be taking the brunt 
of the cuts in health care costs, specifically in areas such as home 
health care and venipuncture. So I am honored to support legislation 
that would make prescription drugs affordable for our seniors.
  Today our parents and our grandparents are being forced to pay much 
steeper prices for prescription drugs than the so-called most favored 
customers of drug companies, such as HMOs, large hospital chains, and 
indeed the Federal Government. This is wrong. These entities are able 
to buy drugs at discounted prices, and drug companies subsequently 
raise their prices to seniors and others who pay for needed 
prescriptions for themselves.
  A Federal study that was initiated by the gentleman from Texas (Mr. 
Turner), who was the originator of this bill, and we congratulate him, 
asserts that our senior citizens are paying twice what the most favored 
customers are paying. This bill provides the solution to the problem by 
creating a level playing field. It allows retail pharmacies to buy 
medications used by senior citizens directly from the General Services 
Administration of the Federal Government. Because the GSA is one of the 
entities that is able to purchase these prescription medications at 
much lower prices, this procedure will allow pharmacists to pass on 
significant cost savings to our senior citizens.
  Mr. Speaker, I ask my colleagues to support this concept, and I 
congratulate the gentleman from Texas (Mr. Turner) for his foresight in 
working on this issue, and all of the other cosponsors who have joined, 
such as the gentlewoman from California (Mrs. Capps), to make sure that 
we lift this issue up to our Nation's consciousness and that as soon as 
possible we try to provide some relief for our seniors in the purchase 
of their much-needed prescription drugs.
  I thank the gentleman for yielding, and I again congratulate him for 
the hard work that he has done in pursuing this issue.
  Mr. TURNER. Mr. Speaker, I thank the gentleman. The gentleman has 
given outstanding leadership not only to this issue but to many others 
on behalf of the people of his district, and his support means a great 
deal to this issue. I thank the gentleman for his part in this Special 
Order.
  I would like to yield once again to the gentlewoman from California 
(Mrs. Capps).
  Mrs. CAPPS. Mr. Speaker, I thank the gentleman for yielding to me and 
I thank the gentleman from Georgia (Mr. Bishop) for his support. I want 
to echo that it is now becoming clear, as we are taking part in these 
Special Orders, how widespread this has become in certain areas of our 
country.
  To pick up on a theme that the gentleman from Texas (Mr. Allen) 
mentioned when we talked about the terrible choices that seniors have 
to make, as we have done our studies and as we have been engaged with 
the seniors in our own districts, as I have, and their faces come to my 
mind as I am standing here on the floor of Congress, the people who 
have come up to me with real fear and pain in their eyes about what 
they are facing on a daily basis. It is a shame, because the part of 
health care that seniors value the most is their ability to get their 
medications that keep them alive in many instances, that really prolong 
the kind of health that they now have become accustomed to because of 
the advances in medicine.
  It is to the pharmaceutical companies, for the research they have 
done, that we owe the advances in medicine for many of our seniors, so 
that they can keep their blood pressure under control and their 
cholesterol level down, and their arthritis aches and pains are not 
incapacitating our seniors as they once were.

                              {time}  1515

  What a shame that right now, in this day and age, when we have the 
resources to give them, that they are being asked to bear the burden of 
discounted prices.

[[Page H9198]]

  In other words, what the drug companies are coming back to us with 
after they see our studies is saying, this sounds like price-fixing. 
But what we know from our studies is that what the drug companies are 
doing is cost-shifting. That is what we need to address.
  They are shifting the costs in the savings that they are giving to 
large buyers, such as the insurance companies, such as the HMOs, they 
are shifting the cost from this large entity onto the backs of 
individual seniors in my district in California; in the district of the 
gentleman from Texas (Mr. Nick Lampson); in the the district of the 
gentleman from Texas (Mr. Turner); in Maine, in Arkansas, in 
Indianapolis. We are seeing this is happening across the country.
  Mr. Speaker, that is why we need to stand here today on behalf of 
these seniors and speak out for them and for the fear that they are 
experiencing, and the choices they are making between buying food for 
their tables or buying the medication that will prolong their lives.
  Actually, when we think of the cost, the cost of a senior then 
becoming ill because they are not able to take their medication, and 
having to go into a high-skilled nursing facility, is much more of a 
burden on their families, on themselves, and on society, really. So we 
are wise to take note of this and do something about it. It is not 
price-fixing, it is cost-sharing. That is what we want to make sure, 
that the seniors are not bearing an overburden of the price of the 
prescriptions that they need to be making.
  I applaud the gentleman from Texas (Mr. Turner) again for the work 
that he is doing for the seniors of our country, really. I am a proud 
co-signer of the gentleman's bill, and on the efforts that are going on 
around the country.
  Mr. TURNER. Mr. Speaker, I thank the gentlewoman from California, and 
I thank her again for sharing her insight. I guess it is the 
gentlewoman's nursing background that causes her to be so very 
sensitive to what we all see when we go out in our districts and talk 
about this issue. It is the seniors who are having trouble just making 
ends meet, who are faced with these high costs of prescription 
medications that we are trying to help here today.
  I had a lady come up to me in Orange, Texas, as I was talking about 
this legislation at one of my local pharmacies, a lovely lady named 
Frances Staley. She happened to be blind. She was very a proud lady, 
and she was telling me about how important she thought this issue was 
and how much she supported what we are trying to do.
  I began to ask her about her situation. She told me that she has $650 
a month in social security. That is her total check. She told me that 
she has $540 worth of prescription drug bills every month. She has nine 
different medications that she has to take.
  We were standing there, with her pharmacy over there, and she looked 
over and said, I am just glad that my pharmacist will give me credit. I 
still said to her, but if you have $540 in prescription drug bills 
every month and you only have $650 from social security, how do you 
live? And she leaned over to me in that proud sort of way, and said, 
well, sometimes I just take half my medication.
  Now, no senior citizen should have to make that choice. That is why 
we are here today.
  Mrs. CAPPS. The gentleman is absolutely right.
  Mr. TURNER. That is why we have introduced this bill. I appreciate so 
much the gentlewoman's leadership on this.
  Mr. Speaker, I yield to my dear friend and colleague, the gentleman 
from the 9th District of Texas (Mr. Nick Lampson), another leader in 
the fight to help our senior citizens.
  Mr. LAMPSON. Mr. Speaker, I thank the gentleman for yielding to me.
  Mr. Speaker, I rise today in support of the Prescription Drug 
Fairness Act. I really want to thank the gentleman from Texas (Mr. 
Turner) for the hard work that he has done on this extremely important 
piece of legislation. Obviously, we hope it is a success, and a big 
success, along the way.
  I say to the gentleman from Texas (Mr. Turner), as I was growing up, 
thinking back to the time that I was in Beaumont as a kid and knowing 
that I lived probably about a mile or so from the pharmacy that we 
used, the Highland Avenue Pharmacy, I know the relationship we built 
with the Masons, who owned and ran that drugstore.
  I remember that when we were sick, my mother could call them. They 
would send a prescription to our home in instances when we could not 
get there, and there were some difficult times in our own family when I 
was growing up that would prevent us from driving even that mile to 
pick up a prescription from the pharmacist.
  I knew if my mother needed to, instead of sending me to a doctor and 
spending that extra $5 or $10 or whatever she might have had to spend 
on me or my sisters or brothers, that she could sometimes pick up the 
phone and call Mr. Mason and ask a question, and get some advice about 
what we might need to do. There were instances where that relationship 
saved a significant amount of money.
  I know that as we face similar problems today with pricing of 
pharmaceuticals, we are in many instances losing that ability to have 
that relationship with our neighborhood pharmacist, with the people who 
provide much more than just an opportunity to retail-sale drugs to the 
people in the neighborhoods.
  I absolutely imagine the choices, the difficult choices that a loved 
one, perhaps my own mother, would have to face, as the gentleman was 
talking about a minute ago, when they were faced with the choice of 
buying medicine or buying food. I do not want my mother having to make 
that kind of a choice.
  I know that when I went to the White House Conference on Aging as a 
delegate in 1995, I heard the plea of the 2,500 or so elderly people 
who were there as designees from all over the United States asking that 
we keep those programs in place; that Congress, and I was not a Member 
of Congress then, but that we keep those programs in place that would 
help them keep their dignity and their independence, so they would be 
able to continue to live at home and not be a burden either on their 
children or on society.
  It is strange to me that we continue to enact, or try to deenact, if 
you will, so many things that are putting so many of these folks into 
troubled times, as the gentleman from Texas just spoke of, such as the 
woman who may not be able to live in her home if she cannot take the 
full amount of the medicine that the doctor says is necessary to keep 
her health good for her quality of life as she reaches those golden 
years, that are longer today than what they used to be, that we are so 
proud of. But if we cannot enjoy those days, why live them?
  That is not a question that our seniors need to be asking. They are 
paying too high a price, in many instances, as elderly folks, and even 
oftentimes we are, ourselves. Drug companies charge seniors on 
an average, I think the gentleman said earlier, 103 percent more than 
they charge their most favored customers.

  I looked at the chart that the gentleman has there. I have a copy 
here. I look across to some medicine that I have to take. I have a 
stomach problem and I take Prilosec. I want to ask the gentleman a 
question.
  From what I understand here, if I can buy, as a favored customer, my 
bottle of Prilosec that I have to buy every month and I pay $58.38 for 
it, if I go to my pharmacy at home in Texas I have to pay, for this 
same bottle, $107.97?
  Mr. TURNER. The gentleman is correct.
  Mr. LAMPSON. Mr. Speaker, if the gentleman will continue to yield, 
that is a 90 percent difference. What the gentleman is saying is that 
for this bottle that I am holding in my left hand I have to pay $58.38, 
but for the bottle that I am holding in my right hand I have to pay 
$107.97. That does not make logical sense to me.
  When I look at the problems that I know that my own mother faces in 
attempting to face these same decisions, I have a hard time accepting 
it, not just for her, but for all of the people in this country.
  Our neighborhood pharmacies may be put out of business because of 
these pricing practices. That is something that we all have to be 
concerned about. It will make senior citizens' lives worse, because 
they will not be able to depend on their neighborhood pharmacies for 
advice or even personal care.

[[Page H9199]]

  All of these other figures that the gentleman has cited, that the 
gentleman has put together through his study, are impressive, but they 
are also absolutely frightening. The Prescription Drug Fairness Act 
would protect older Americans from this type of discriminatory pricing. 
The legislation will create a level playing field by allowing retail 
pharmacies to buy medication used by senior citizens directly from the 
General Services Administration, the GSA of the Federal Government.
  Since the General Services Administration is able to purchase 
prescription medication at much lower prices, at those favored prices, 
then pharmacists will be able to pass on a significant cost savings to 
our senior citizens. Again, our senior citizens should not ever have to 
choose between their health or other necessities.
  One more time, it is the difference between the price of the bottle 
that I hold in my right hand or the price of the bottle that I hold in 
my left hand. I think we need to pass this legislation for the sake of 
all America. I thank the gentleman. I appreciate the great work he has 
been doing. I hope to be able to stand by the gentleman and continue to 
make a success of this bill.
  Mr. TURNER. Mr. Speaker, I thank the gentleman from Texas (Mr. 
Lampson). I thank him for his leadership.
  It is hard to understand how that same bottle of medication can cost 
$58 when it is sold to the big HMOs and the big hospitals and the 
insurance companies, and yet our senior citizens, walking into their 
local pharmacies, are having to pay $107. It is just not right. I thank 
the gentleman for his leadership on this.
  Mr. Speaker, I want to thank the gentleman from California (Mr. 
Waxman) personally for his leadership as the ranking Democrat on the 
Committee on Government Reform and Oversight in initiating with our 
minority staff the studies that many of us have been able to do in our 
own districts, to point out the problem that we are talking about here 
today.
  I thank the gentleman from California for his leadership on this 
issue, for the many years he has been working on this cause.
  Mr. Speaker, I am proud to yield to the honorable gentleman from the 
29th District of California (Mr. Henry Waxman), the ranking member of 
our Committee on Government Reform and Oversight, a leader on health 
care issues for many years, and another Member of this body who has for 
many, many years been a leader in the fight to try to lower the cost of 
prescription medication for senior citizens.
  Mr. WAXMAN. Mr. Speaker, I thank the gentleman very much for yielding 
to me.
  Mr. Speaker, I want to underscore the importance of this special 
order this afternoon in the House of Representatives, and the 
gentleman's leadership, and the leadership which the gentleman from 
Maine (Mr. Allen), the gentlewoman from California (Mrs. Capps), the 
gentleman from Texas (Mr. Lampson), and so many others have given to 
this very question.
  It is so unfair that our seniors are paying, on average, we have 
found, all across the country, twice as much for prescription drugs as 
those who are being treated in a more favorable light by the 
pharmaceutical manufacturers.
  This is an issue that affects American seniors all across this 
Nation. There is very little variation between what we have found in 
one part of this country as opposed to another. We see all over our 
seniors being asked to pay the most for these drugs.
  Of course, the reason they have to pay the most for drugs is that 
each senior goes individually to buy drugs. They do not have anybody 
acting on their behalf the way that the veterans have through the 
Veterans Administration, or the people in managed care plans have, when 
those managed care plans step in and negotiate a better price for all 
of their members who have drug coverage, or what we have even done for 
Medicaid recipients who have prescription drug coverage.
  On Medicare, our Medicare beneficiaries do not have prescription drug 
coverage under Medicare. I wish they did. It is a logical thing for 
them to have that coverage. Medicare covers doctor bills, hospital 
bills, all sorts of other services, medical services. But when it comes 
to prescription drugs that they use on an outpatient basis, Medicare 
will not cover it. Each person has to come in individually and pay the 
price.
  The manufacturers of these drugs have found that in order to keep 
their profits up when they have to give a discount to others, they just 
raise the price higher for individual seniors, often elderly women. 
Most people on Medicare are women, and they are the ones who have to 
pay that price.
  We have heard the story today, and all Members of Congress have heard 
it from our constituents, how the elderly are forced to choose between 
paying their rent, their food bill, their heating bill, or their 
pharmaceutical costs.
  A lot of people go without taking their drugs, or try to take them 
every other day, or cut the drugs in half and make them last longer. 
Many of them end up in hospitals because they get sicker as a result of 
not taking the pharmaceuticals that can keep them healthy. Then the 
government pays a lot more money under Medicare for their hospital 
bills.
  It does not make sense, and I think that the approach that the 
gentleman has taken and others have taken in trying to address this 
problem is very, very important.

                              {time}  1530

  The approach that is taken in the legislation is to say that we are 
going to insist as a function of government that seniors not be 
disadvantaged when they buy drugs and that we will use the buying power 
of the Federal Government to make sure they get that preferred price as 
well as other citizens.
  The way that this has been portrayed here today with the charts, with 
the demonstration of just showing right hand to left hand the same 
pharmaceuticals, but someone is left holding the bag, and it is usually 
our most vulnerable people, our seniors who do not want to be on 
welfare.
  Most of them are not on welfare. They have played by the rules. They 
paid throughout their working years for the Medicare program. When they 
need that program and are relying on it, we should not leave them 
adrift when it comes to high pharmaceutical prices. We ought to be 
there to protect them.
  If we are not going to cover drugs, at least we ought to assure them 
that, when they buy those pharmaceuticals, they are going to pay a 
preferred price and not an unfair price.
  I want to commend the gentleman. I think this is an important 
opportunity on the House floor to bring this issue home to people. It 
is the kind of issue people care about. So often here in Washington we 
are talking about things that I do not think most Americans think 
affect their lives in any way. But this issue affects every senior and 
their family members in every part of this country.
  This is the kind of thing we ought to be dealing with, just like we 
should be dealing with the protections for people who are in HMOs or 
managed care to be sure that they are not taken advantage of, that they 
have their rights protected as consumers. We ought to be addressing 
issues like this.
  We have only got 1 week left here in the Congress. We are going to go 
home at the end of this next week without passing a Patients' Bill of 
Rights for managed care, without addressing this pharmaceutical pricing 
issue, without doing anything about protecting our kids from being the 
subject of the tobacco companies' campaigns to get them to smoke at 12 
and 13 years of age, without probably the most important thing, passing 
legislation to reform our campaign finance system, which, without the 
reform in that area, leads to the inordinate power of special interest 
groups like the tobacco companies, like the insurance companies, and 
like the pharmaceutical manufacturers.
  I commend the gentleman for his leadership and for taking this 
opportunity on the House floor for many of us to speak on the issue.
  Mr. LAMPSON. Mr. Speaker, if the gentleman will yield, one of the 
points that the gentleman from California (Mr. Waxman) made is we 
continue to see the direction go like this where it is harder and 
harder for seniors to meet the demands that they have on the medicines 
that they need to buy and they make choices and not take all

[[Page H9200]]

of their medicine or not take the medicine at all, ultimately they will 
end up probably going back into institutionalized care.
  The gentleman from California just mentioned a number of things that 
we are facing right now, balancing our budget, passing appropriations 
bills we have not yet done. What are we going to have to be doing in 
the future if we see an increase in the number of people who are going 
back into institutionalized care, not being able to stay at home and 
take care of themselves?
  Mr. WAXMAN. Mr. Speaker, if the gentleman will yield, one of the 
short sides of this in the way that we approach these problems is we 
look at the cost of hospital care under Medicare, which is 
extraordinarily high, and we do not connect it to the fact that we have 
caused those costs to be incurred because we have not done anything to 
protect the elderly from the high cost of medications and the fact that 
many of them will go without the medications, forcing them to get sick 
and then to use more expensive care.
  Mr. LAMPSON. Mr. Speaker, if the gentleman will yield, then who is 
going to pay for that?
  Mr. WAXMAN. Mr. Speaker, if the gentleman will yield, we are going to 
pay for it. The country is going to pay for it. The elderly is going to 
pay for it. It is a cost of the Medicare program.
  When we look at the Federal Government expenditures, what we spend in 
Medicare is one of our very largest expenditures. It is not just from 
taxpayers, it is partly paid for by the premiums that the elderly pay 
for their Medicare. It is paid for also by the working people of this 
country who pay into the Medicare system in hopes that they will have 
it available to them when they need it when they become eligible 
because of their age to take out that Medicare policy.
  Mr. LAMPSON. Mr. Speaker, if the gentleman will yield, it really 
would make sense if we can cut the costs of seniors particularly who 
are in greater need of some of these medications than perhaps other 
citizens of the country are that we would perhaps be able to save money 
in the long run in our budget. We would have to appropriate fewer 
dollars in the future because of these cost saving measures that we 
take today.
  Mr. WAXMAN. Mr. Speaker, if the gentleman will yield, I think that is 
absolutely right. If we simply want to look at it as a dollar and cents 
issue, I think the case can be made that we would save money if we have 
protected the elderly from the high cost of prescription drugs and not 
have to pay that amount in hospital care costs for them.
  But even without just looking at it from a dollar point of view from 
a Federal Government standpoint, just from a common sense humanitarian 
point of view, how can we say to the elderly that we are going to 
protect them from being wiped out financially when health care costs 
hit them after they paid into this Medicare program during their 
working years, and we leave them vulnerable to such high out-of-pocket 
costs for their prescription drugs that they will not be able to afford 
their drugs or other necessities.
  Some people cannot even afford to pay their Medicare Part B premium. 
They are like people who are not even in Medicare Part B because of the 
high cost of that, or they cannot go out and buy supplemental insurance 
because of the cost of that added onto everything else they have to pay 
for.
  So we ought to recognize that, while we have done a great job in this 
country reducing the poverty levels of elderly people which used to be 
the single largest group under the poverty line, we still have a lot of 
people who are having difficulties especially when they have to pay for 
those high cost drugs.
  Mr. LAMPSON. Mr. Speaker, if the gentleman will yield, I would ask 
all of our colleagues to join the gentleman from Texas (Mr. Turner) and 
the gentleman from California (Mr. Waxman) and myself in supporting the 
Prescription Drug Fairness Act. Let us pass it and maybe we will be 
able to save those dollars.
  Mr. WAXMAN. Absolutely.
  Mr. LAMPSON. And help a lot of elderly folks along the way.
  Mr. TURNER. Mr. Speaker, I again thank the gentleman from California 
(Mr. Waxman) for his leadership on this issue. He has been a tireless 
worker for many years on behalf of health care for children, for senior 
citizens, and for all Americans.
  I again want to thank the gentleman for directing the staff of our 
Committee on Government Reform and Oversight, as our ranking member, to 
prepare these studies to document this very serious problem that we are 
talking about here today.

  The gentleman from Texas (Mr. Lampson) mentioned the difference in 
the price of one particular drug. On the chart to my right, we have 
depicted the results of the study that the Committee on Government 
Reform and Oversight staff did in my congressional district.
  What it did, Mr. Speaker, was to take the 10 most commonly prescribed 
drugs for senior citizens, and it took a look at the prices that those 
drug manufacturers are charging their most favored customers, those big 
HMOs, those big insurance companies, the big hospital chains, and even 
the Federal Government. Those prices are depicted here in this column.
  The one the gentleman from Texas mentioned right here was $58 that 
the favored customers paid. In the same study, pharmacies in my 
district on average were having to charge $107 to our senior citizens 
who walk in without insurance for that same quantity of prescription 
medication. This quantity here is about a month's supply of each of 
those prescription drugs. So you see in the last column the price 
differential.
  As the gentleman said, it was 90 percent for the drug that you take. 
The average of all of these 10 commonly prescribed prescription drugs 
in my district was 103 percent.
  We have heard others here today say it was 105 percent in their 
district, but, roughly, senior citizens are paying twice for 
prescription medication than what the drug manufacturers are charging 
their most favored customers.
  We talked about this in my district in a series of about 25 little 
meetings I had with pharmacists all across my 19 counties. I want to 
make it very clear today, and it is shown on this third chart that I 
have, that the problem is not a problem created by our local 
pharmacies. It is the drug manufacturers that are responsible for this 
disparity, not the retail pharmacist.
  In fact, in most of our districts, we see independent pharmacies 
going out of business every month because their margins are so small 
caused by this discriminatory pricing scheme that they are not able to 
make ends meet as pharmacies and are having to close down their 
businesses.
  What this chart shows you is that, of the total price differential 
shown in blue on the left-hand side, the average retail markup from 
average wholesale by pharmacies in my district was about 1 percent, a 
little over 1 percent. In fact, the highest markup for any prescription 
medication that we studied by retail pharmacists in my district was 19 
percent. So it is not the local pharmacies that are making the money.
  We looked, not only at the 10 most commonly prescribed prescription 
drugs for seniors, but we looked at a few other drugs. Ticlid, for 
example, look at the price differential on Ticlid. It is absolutely 
unbelievable to think the line in blue shows what senior citizens are 
paying for Ticlid and the line in the pink shows what the most favored 
customers are paying. It is just almost hard to believe that Ticlid 
could be costing senior citizens $117 and the favored customers, the 
big insurance companies and the hospital chains, get it for $33.
  Another one, Synthroid, was even more dramatic. Synthroid costs our 
senior citizens shown here in blue $25.86 when they go into our local 
pharmacy. The most favored customers can buy the same quantity of 
Synthroid for $1.78.
  Micronase, another drug that is prescribed for diabetics, costs our 
senior citizens and local pharmacists $45.60. The most favored 
customers or the big drug manufacturers get that same quantity for 
$6.89.
  So we see the problem. What we are trying to do about it in this 
legislation is to allow our local pharmacists to buy prescription drugs 
for Medicare eligible seniors directly from the Federal Government who 
is one of these most favored customers. We believe that is

[[Page H9201]]

the right thing to do. We think that it is the right thing for our 
senior citizens.
  I wanted to thank every Member of this Congress who has joined with 
us in cosponsoring this legislation. We hope we can pass it for our 
senior citizens so folks like Ms. Frances Staley, my constituent in 
Orange, Texas, can be able to afford her prescription medication.

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