[Congressional Record Volume 148, Number 41 (Monday, April 15, 2002)]
[Senate]
[Pages S2637-S2639]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Mr. DORGAN. Mr. President, last week a number of pharmaceutical 
companies announced a new program by which some Medicare enrollees, 
particularly those at the lower income levels, will be able to access 
prescription drugs at a lower price. Let me compliment them for that. 
These companies are certainly moving in the right direction by 
recognizing that price is a very serious problem for a lot of Americans 
with respect to prescription drugs. The companies that founded Together 
Rx are Abbott Laboratories, AstraZeneca, Aventis Pharmaceuticals, 
Bristol-Myers Squibb Company, GlaxoSmithKline, Johnson & Johnson, and 
Novartis Pharmaceuticals Corporation. Pfizer and Eli Lilly have 
separate programs that they have already announced. I think it is a 
step forward, and I compliment these companies.
  We have much more to do, but having been very critical of the 
prescription drug manufacturers for price increases, let me say thanks 
for these programs because they will benefit a good number of lower 
income senior citizens.
  However, let me describe one of the problems that still exists. This 
chart is of a Washington Post article, from within the last month, 
``Prescription Drug Spending Rises 17 Percent in the Last Year.'' There 
have been double-digit increases year after year after year after year 
for prescription drugs.

[[Page S2638]]

Taking a prescription drug is not a luxury. It is a necessity. 
Prescription drugs can only save lives if you can afford to access 
them.
  We talk a great deal about senior citizens and the need to help them 
by adding a prescription drug benefit to the Medicare Program. We do 
that because senior citizens are about 12 percent of America's 
population, but they take one-third of all the prescription drugs. Many 
senior citizens are taking five, eight, and ten different kinds of 
prescription drugs. The price increases that have been occurring have 
been devastating, not just to senior citizens but to all Americans 
trying to access the supply of prescription drugs they need.

  It is useful to understand that the debate about access to 
prescription medicines is not just a theoretical one. From time to 
time, I have described to my colleagues the experience I have had 
holding town meetings and hearings across North Dakota and the country 
on prescription drug prices. The issue of the pricing of prescription 
drugs is a very serious one for real people every day.
  The U.S. consumer is charged the highest prices for exactly the same 
prescription drugs than anyone else in the world. The same pill made by 
the same company put in the same bottle costs much more in the United 
States than in other countries.
  Tamoxifen, to treat breast cancer, is 10 times more expensive in the 
United States than in Canada, as an example. I ask unanimous consent to 
demonstrate the point.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. DORGAN. I am holding here empty prescription drug bottles from 
the United States and Canada. It is useful to compare the prices of 
these drugs. This is a drug called Zoloft which is used to treat 
depression. There are two bottles here; the same tablet made by the 
same company put in different bottles. But if you buy it in the United 
States, it is $2.34 per tablet. The same tablet purchased in Canada is 
$1.28. So the same company makes the same pill and puts it into two 
different bottles. The difference is, when an American consumer buys 
it, they pay $2.34. If you buy it in Canada, $1.28.
  To give another example, Norvasc is a drug used to treat high blood 
pressure. You buy it in Canada--same tablet, put in the same bottle, 
made by the same company, shipped to two different places, the United 
States and Canada--and it costs 90 cents and in the United States it 
costs $1.20.

  Cipro is a drug commonly used to treat infections. This bottle holds 
a hundred 500 milligram tablets and costs $171 in Canada and $399 in 
the United States--the same tablet, the same bottle, and manufactured 
by the same company. Often drugs are produced in a U.S. manufacturing 
plant to be sent to Canada and sold at a much lower price. And you have 
the same thing happening in Italy, France, Germany, England, Sweden.
  Now, why is that happening and what should we do about it? It is 
happening because we are the only country in which there is not some 
kind of governmental regulatory system to limit what is charged for 
prescription drugs. Actually, we do have price controls on prescription 
drugs here in the United States. It is just that the pharmaceutical 
manufacturers are the ones in charge of controlling the price. They 
ratchet up the price as high as they possibly can, and the result is an 
industry that is the financially healthiest in the United States.
  But these high prices for drugs ultimately affect the relationship 
between a doctor and his patient. A doctor from Dickinson treats a 
woman with breast cancer. The woman, who is on Medicare, comes back to 
the doctor after having a mastectomy, and the doctor says: ``Here is 
what we have to do given the type and grade of your breast cancer. You 
have to be on some prescription drugs that will substantially lessen 
the recurrence of breast cancer for you.'' She says: ``What would this 
cost?'' When told what the cost of the drugs would be, she says, 
``Well, doctor, I don't have the money to pay for that. There isn't any 
possible way I can take those prescription drugs. What I will have to 
do is just take my chances with the breast cancer.''
  That is repeated in doctor's office after doctor's office around the 
country. I have senior citizens telling me they cannot possibly afford 
their drugs, so they cut them in half and take only half a dose so it 
will last twice as long. In the small community of Michigan, North 
Dakota with perhaps 300 or 400 people, after a farm meeting one 
evening--a woman in her late 70s grabbed my arm at the end of the 
meeting and said: ``Mr. Senator, can you help me?'' She began to tear 
up. Her eyes got full of tears and her chin began to quiver, and she 
said: ``I am supposed to take these prescription drugs in order to stay 
alive, but I can't afford them. The doctor says that I must take them. 
Can you help me?''
  This is repeated all over the country. I am talking about senior 
citizens. But you could be talking about anybody who needs prescription 
drugs and finds that the prices are simply out of reach. There was a 17 
percent increase last year in the cost of prescription drugs.
  Reimportation of drugs from Canada will save our citizens a lot of 
money. Dr. Alan Sager from Boston University was a witness at a hearing 
I held at which he described a study that showed that Americans would 
save $38 billion a year if we paid Canadian prices for prescription 
drugs. North Dakotans alone would pay $81 million less in a year.
  Some would say that by allowing the reimportation of prescription 
drugs, we are trying to import price controls. But what we are trying 
to do is force a repricing of prescription drugs in this country--a 
fairer price for the United States consumer. Why should we pay a dollar 
for the same market basket of drugs for which the Canadians pay 60 
cents? Why should we pay a dollar, when virtually every other consumer 
in the world is paying a fraction of that for the same drugs? We should 
not and it is not fair.
  There is a law on the books that prevents the reimportation of drugs 
from other countries, except by the manufacturer. If this is a global 
economy, we say let's allow the reimportation of drugs as long as there 
is a clear chain of custody and we can do it safely. I will offer, 
along with my colleagues, a proposal that would allow licensed 
pharmacists and distributors to access that lower-priced, identical 
prescription drug from a Canadian supplier and pass the savings along 
to the U.S. consumer.
  I understand why the pharmaceutical manufacturers would not like 
that. But the point is, if this is a global economy, why should it only 
be good for the big interests? How about for other interests as well? 
Why should we not allow the reimportation of prescription drugs? The 
same drug put in the same bottle, manufactured in a FDA-approved plant. 
Why should we not allow that to be reimported to the U.S. as long as 
there is no safety concern?
  All we need is to import a less expensive drug that is identical and 
made in an approved facility, to be able to provide a substantial 
benefit to the American consumer. So we are going to be proposing 
another amendment on that in the coming months. I know that the 
manufacturers will resist us aggressively. I started by complimenting 
them on the programs they are developing, but, frankly, we can't 
continue to see these cost increases in prescription drugs every year.
  The miracle of medicine means nothing if you can't afford it. There 
has been a 12, 15, 16, or 17 percent increase year after year, and it 
is breaking the back of the American consumer and the back of health 
plans. The fact is, it cannot continue. The prescription drug 
manufacturers, pharmaceutical manufacturers, simply have to understand 
that.
  They say that if you do anything that restrict our ability to charge 
these prices, there will be less research for the new miracle cures. 
But we have doubled funding to the National Institutes of Health. We 
are providing substantial amounts of public funding for research, from 
which the pharmaceutical industry often is a major beneficiary.
  I might also say, with respect to the pharmaceutical industry, they 
spend as much or more on advertising, marketing, and promotion as they 
do on research. That is a fact.
  So I think there is a lot to be done here. I pointed out that the 
industry has announced some positive steps, but there is much more to 
do, and we must take the right steps here in the Senate to address this 
issue.

[[Page S2639]]

  That is why a group of us will, once again, offer an amendment that 
deals with the reimportation of prescription drugs--this time, only 
from Canada, where there can be no safety issue.

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