Congressional Record, Volume 144 Issue 135 (Thursday, October 1, 1998)

[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.

____________________