[Congressional Record Volume 148, Number 53 (Thursday, May 2, 2002)]
[Senate]
[Pages S3793-S3795]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Ms. STABENOW. Mr. President, I rise to speak specifically to another 
proposal on principles that was released yesterday in the House of 
Representatives. We have been urging now, since I came to the Senate 
over a year ago, and certainly before that time, that our colleagues 
from the other side of the aisle join with us to act to get action in 
two areas related to critical health care and prescription drugs: One, 
a comprehensive Medicare prescription drug benefit. Modernize Medicare, 
update it. Everyone knows that it was written in 1965 and covers the 
way health care was provided in 1965. It needs to be updated to cover 
prescription drugs, the primary way that we provide health care today.
  Second, we know there are important actions we can take right now to 
lower the cost of prescription drugs for every family, not only for our 
seniors who use the majority of prescriptions--on average 18 different 
prescriptions a year--but also for those families who have a disabled 
child or another family member who is ill. We need to lower the costs 
now. We need to lower them for small businesses. We need to lower them 
for larger businesses. Our farmers are struggling with higher costs. We 
can do that.
  Certainly we appreciate that our colleagues have come together with 
fanfare to talk about four principles: One is lowering the cost of 
prescription drugs now. I suggest that putting those words on paper 
does not lower the cost of one pill. It does not make one more 
prescription available to our seniors.
  I welcome the words, but our seniors and our families have had enough 
words. They are interested in action. We have to be working in a 
bipartisan way. We come as Democrats to say: Work with us; let's get 
beyond the words, beyond the principles and get something done.
  We are interested in lowering the cost of prescription drugs, and we 
have numerous proposals. I will speak to those for a moment before 
speaking about Medicare prescription drug coverage.
  We know, for instance, if we allow the normal course of patents to 
run out and for the process to work where lower cost generic drugs can 
be used, we can dramatically cut costs immediately. We have 
colleagues--Senator Schumer and Senator McCain--who are putting forward 
an important bill to close loopholes that the drug companies have used 
to block generic drugs from going on the market and to block the 
lowering of the cost of drugs. We can pass that bill right now and drop 
the cost. We can open our borders to Canada. Senator Dorgan, of North 
Dakota, has introduced a bill; he is in the Chamber, and I am sure he 
will speak to that shortly. I am pleased to join him.
  This is an effort in which I have been involved since being in the 
U.S. House of Representatives. I have taken two bus trips to Canada 
with our seniors to demonstrate that by working through the Canadian 
Medical Society we can lower the cost of prescription drugs. It is 
astounding. These are American-made drugs. I am proud they are made in 
America. I am proud we have invested in the research and technology--
taxpayers, private companies, biotech companies, biomedical companies, 
drug companies. But when all is said and done, if no one can afford to 
get the medicine, what have we done?
  We now find ourselves in a situation where we subsidize and pay for 
the research from which the world benefits; yet our borders are closed 
and our own people cannot go across the border to get the same drug at 
half the price.
  Mr. KENNEDY. Will the Senator yield for a question?
  Ms. STABENOW. I will be honored to yield.
  Mr. KENNEDY. Is the Senator aware that under the House Republican 
plan, senior citizens would have to spend $670 before they received a 
dime of benefits? This is the cost of the premiums of $420, and the 
deductible which is $250. That comes to $670 before they get a dime of 
benefit.
  Is the Senator familiar with the fact that the average senior 
citizen's income is only $15,000, and the average prescription drug 
need is $2,200?
  Ms. STABENOW. Yes.
  Mr. KENNEDY. We all want to find common ground and work together. 
Requiring the seniors to pay $670 before they get a dime of benefits 
does not seem to me to fulfill the commitment this country made to our 
seniors when we passed Medicare and said: Pay in, and we are going to 
help relieve the anxiety you have about quality health care. I am 
interested in whatever comment the Senator wishes to make.
  Ms. STABENOW. I thank the Senator. As the Senator from Massachusetts 
has indicated, the Medicare proposal that we believe is coming--again, 
we only have principles. We do not have the specifics. We are piecing 
together from news stories and other sources what it appears to be. In 
fact, going beyond what the Senator from Massachusetts has said, not 
only are we talking about the premium, the deductible, the copays--and 
there are two different levels of copays--but nothing is covered once 
you reach $2,000 until you have spent $5,000. So there is a huge gap in 
the middle.
  If we take the example of a senior who is spending $300 a month on 
prescription drugs--and that is not unusual. It might be a breast 
cancer patient who is purchasing tamoxifen, which in Michigan is $136 a 
month. If you add to that blood pressure medication or cholesterol 
medication or another drug, the amount could easily come to $300 a 
month. If you add that up and look at all that it appears from that 
proposal, Mr. President, of the $3,600 a year that one would be paying 
out of pocket, one would still spend $2,914.
  If someone is paying $300 a month now in prescription drug costs, 
less than 20 percent of that would be covered under the Republican 
proposal.
  Mr. KENNEDY. Will the Senator be good enough to yield for another 
question? Does not the Senator think then we have to deal with the 
substance and the reality rather than the cliches and the slogans?
  Ms. STABENOW. Absolutely.
  Mr. KENNEDY. I am sure we are going to hear from the other side: We 
have a prescription drug proposal. Does the Senator agree with me that 
is really a misrepresentation? If we accept that as a concept, it will 
do people in my State little good.
  I understand the Senator is a strong supporter, and I see in the 
chair the Senator from Georgia who has worked very closely with the 
Senator from Florida on an excellent program, and I commend him for it.
  Does the Senator agree if we are going to do something, let's help 
our seniors and not misrepresent what we are trying to do for them?
  Ms. STABENOW. Absolutely. I add also, one of my deep concerns is that 
in order to pay for this, they are talking about Medicare ``reforms.'' 
Unfortunately, the reforms we are hearing about are proposals such as 
adding the cost of home health care, requiring a

[[Page S3794]]

copay for home health care. Our seniors who are now struggling to live 
at home, families who are struggling to make sure someone can live in 
dignity in their home as long as possible, have home health care. Part 
of that is their prescription drugs, and to pay less than 20 percent of 
the cost of prescription drugs, one of the things they are talking 
about is a copay for home health care. So they will be adding other 
costs to this process as well.
  I suggest: Beware of what is coming. It is very clear when the only 
people who are advocating for the proposal put forward by the House 
Republicans are the drug companies, that should tell us something. When 
they have fought every proposal for comprehensive prescription drug 
coverage, every proposal to lower the cost of prescription drugs, 
whether it is expanding generic drugs, opening the borders, lowering 
advertising costs--every single effort to get some control and 
accountability in this system so that our seniors can afford 
prescription drugs they have opposed.
  Mr. KENNEDY. Will the Senator yield one more time and give me her 
reaction?
  Ms. STABENOW. I will be happy to yield.
  Mr. KENNEDY. Is the Senator aware that the Bush budget allocates only 
$190 billion over the next 10 years for prescription drugs and Medicare 
reform, and the House Republican budget allocates $350 billion, but the 
cost of drugs for senior citizens during this same period will be $1.8 
trillion--$1.8 trillion? Does the Senator conclude from that, this is 
going to be a very inadequate response to a major health challenge for 
our seniors?
  Ms. STABENOW. I absolutely agree. With all due respect to our 
colleagues on the other side of the aisle, the math does not add up. It 
is time to get beyond principles and rhetoric and say to those watching 
this morning sitting at their kitchen table, seniors who are sitting 
down right now deciding, Do I eat today or take my medicine, that we 
are going to step up to the plate, do what is right, and do what is 
long overdue.
  I see my colleague from North Dakota. I would very much like to yield 
to him. He has been such a leader on this issue. We share, as border 
States, the frustration of citizens from our States who can easily go 
on a short trip across the border and pay lower prices for American-
made drugs.
  The Senator has been a real leader in this effort.
  Mr. DORGAN. Mr. President, how much time remains in morning business?
  The PRESIDING OFFICER. Six minutes 20 seconds.
  Mr. DORGAN. May I be recognized?
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. DORGAN. I appreciate the conversation about the prescription drug 
issue. It is important. There are two pieces to it. One is coverage for 
those who do not have access or the resources to get the prescription 
drugs they need. These are lifesaving medicines that can only save 
lives if you have access and can afford them.
  The second issue is price. That is an important issue. If we talk 
only of coverage, and not price, we break the bank. Connecting the hose 
between the prescription drug and the Federal tank means we will suck 
money out of the tank forever. We will break the bank if we do not do 
something about prices.
  Last year, the cost of prescription drugs increased 17 percent in 
this country. Year after, the cost increases have been double digit. 
There has been both utilization and price inflation, double-digit 
increases in the cost of prescription drugs for 5 years in a row. It 
will continue into the future unless we do something.
  We have to deal with coverage. We also have to be concerned about 
price: What kinds of approaches can we implement that put downward 
pressure on prices?
  I ask unanimous consent to show bottles on the floor of the Senate 
that have contained prescription drugs.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. Mr. President, I have introduced a bipartisan piece of 
legislation supported by Republicans and Democrats that allows 
pharmacists, licensed distributors, and wholesalers in our country to 
access prescription drugs in Canada--same drug, in the same bottles, 
made by the same company, sold in Canada and North Dakota, with 
radically different prices.
  This is a drug called Celebrex, which is used for arthritis. It is 
sold in identical bottles, except one cap is blue and one is white--
same pill, put in the same bottle, made by the same company, sold in 
Canada and the United States. The Canadian pays 79 cents per tablet, 
and the American pays $2.20 per tablet--same drug, same company, same 
pill bottle, but a huge difference in prices.
  Here are two additional examples. Most everyone knows that Lipitor 
lowers cholesterol. But we have two different prices for the same pill, 
put in the same bottle, and made by the same company. It is $1.01 
wholesale in Canada and $1.86 per tablet to the United States consumer.
  One more example is Paxil which is used to treat depression. Paxil is 
packaged in a bottle that is identical whether you get it in Canada or 
in the United States. The only difference with Paxil is the difference 
in price--as in the case of most drugs. It costs 97 cents per tablet 
for the Canadian, $2.20 per tablet for the American consumer. The U.S. 
consumer pays the highest prices in the world for the prescription 
drugs. It is the same pill, made by the same company, put in the same 
bottle, for which there is a radical difference in cost.
  I use one other example without a bottle. It is called tamoxifen, 
which is used to treat breast cancer. For every 10 cents charged to a 
Canadian, $1 is charged to an American consumer. If you are buying 
tamoxifen, you can buy it in Canada for one-tenth the price charged in 
this country.

  With respect to these prices, there is a little town in North Dakota 
called Michigan, not so far from the Canadian border. At the end of a 
meeting one night, a woman, perhaps in her late seventies, came to me 
and said: Mr. Senator, can you help me? I said: What is the problem? 
Her eyes began to well with tears, and her chin began to quiver. She 
said: I have heart disease and diabetes; my doctor prescribes a great 
deal of medicine I must take, and I don't have the money to purchase 
the drugs. The doctor says I must have these drugs in order to continue 
to live a good life.
  That is the problem. We need prescription drug coverage. We also need 
restraint on pricing. The two, together, can help the American people 
access lifesaving drugs. Miracle drugs can only provide miracles if 
people can afford them. That is why we are fighting to make some sense 
of this policy.
  What I have tried to do, on a bipartisan basis, with Republicans and 
Democrats supporting this reimportation bill that we have now 
introduced, is to allow pharmacists and distributors to access those 
same drugs that are sold at much lower prices in our neighboring 
country of Canada.
  I yield for a question.
  Mr. SCHUMER. I thank my colleague from North Dakota for his eloquent 
exposition.
  We are working on the same track. The Senator from North Dakota has a 
bill to lower prices by allowing reimportation. Senator McCain and I 
have a bill to extend generic drugs. We have to deal with both: Getting 
prescription drugs as part of Medicare, but also lowering the cost. As 
the Senator from North Dakota has said over and over again, we are not 
going to get the one without the other.
  I bring to his attention and ask if the Senator saw an article in the 
Wall Street Journal on the front page, another way the drug companies 
are going way overboard. They are getting lists from pharmacists of 
people who have a prescription for a certain drug and then are writing 
those people and saying: Why don't you switch to this drug? Do you know 
why they ask them to switch? The generic drug is coming on board for 
their original drug, and now they are trying to manipulate the generic 
drug law.
  The drug company is extending the dosage, going for a weekly pill 
rather than a daily pill.
  Mr. DORGAN. I ask unanimous consent for 5 additional minutes, and I 
yield to the Senator from New York.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. SCHUMER. The drug company's applying for a new patent because the 
daily pill--same medicine--expires.

[[Page S3795]]

  The drug industry has some good arguments. I don't disagree with 
their argument that they need money for research. And these new pills 
have helped people. But faced with all of these blockbuster drugs that 
are going off patent, and the companies being so used to the high rate 
of return they have had--higher than any other American industry--they 
are pushing the envelope way too far in terms of trying to keep that 
level of profitability.
  They ought to understand--and I ask my colleague from North Dakota to 
comment on this--their job is to go back into the laboratories, come up 
with real new drugs, and work on those--not extend the patent--or, in 
the case of what the Senator from North Dakota has discussed, make the 
U.S. price above all the other prices. This involves lots of work and 
lots of focus.
  Every time I read one of these articles, it makes my blood boil. When 
I came here, I was not regarded as a hardliner on this issue. I have a 
great deal of respect for companies that research and produce these 
drugs. However, the limits they are going to, with the advertising on 
television--and I know my colleague from Michigan is working on this--
with the huge price differential where the United States consumer pays 
for all the research, yet around the world the costs are much lower--I 
know my colleague from North Dakota is looking into this--to the 
manipulation of the generic drug law, which Senator McCain and I are 
looking at, something is rotten in Denmark.
  I thank my colleague his remarks and his persistent leadership on 
this issue and ask him what he thinks of what is going on, and has he 
seen this change over the years?
  Mr. DORGAN. Mr. President, I chaired a hearing recently at which 
Senator Schumer testified and Senator McCain, as the ranking member, 
attended. Generic drugs are a very important issue.
  I push for price restraint because I think it is very important with 
respect to what is happening to price increases of prescription drugs. 
However, I bear no ill will toward this industry. I think the drug 
industry is a remarkable industry. It does some remarkable things. We 
should compliment them for some of the programs they have initiated in 
recent weeks, for the low income senior citizens. That is a good step. 
They do some awfully good work. Tamoxifen costs one-tenth the price in 
Canada; you pay 10 times more if you are an American, that drug 
resulted from public funding and public research at the National 
Institutes of Health.
  So I worry very much that what is happening is that the public is 
paying for research in some areas and, when the drugs are privatizing, 
a price is affixed to them that is way out of bounds.
  I bear no ill will towards this industry. I want them to do well and 
to continue to search for lifesaving drugs. But I think it is important 
to point out that, when we talk about miracle drugs, Americans who need 
them will get their lifesaving benefits only if they can have access to 
them, and can afford them. There are so many Americans who cannot chase 
double-digit price increases every year. That is why we deal with this 
issue. The issue I have been concerned about is reimportation from 
Canada. Not because I want anybody to have to go to Canada to buy 
prescription drugs, that is not my goal. My goal, of course, is the 
repricing of those drugs in this country because, if distributors and 
pharmacies can go to Canada and access the same drugs, it will force a 
repricing of those drugs here.
  I want to have a prescription drug benefit in the Medicare Program 
but I don't want to break the bank. If we do that and do nothing about 
price restraint and downward pressure on prices we will break the bank 
of this Government. We must address both issues, coverage and price.
  Ms. STABENOW. Will the Senator yield for a moment? I just wanted, as 
we conclude this time, to thank my colleagues for their continued 
leadership and to, once again, call upon our colleagues across the 
building, in the other Chamber, the Speaker of the House of 
Representatives and his colleagues, to go beyond the principles that 
were put out yesterday and join with us in the concrete proposals that 
we have.
  We have the ability to act now. We could do it this month if they are 
willing to join with us. We ask them to get beyond the words and let's 
get together and let's do the right thing.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. BAUCUS. Mr. President, I commend the Senator from North Dakota 
who organized the preceding discussion with respect to the high price 
of drugs and unavailability of prescription drugs. I asked the General 
Accounting Office to do a study of coverage of prescription drugs in my 
home State of Montana. The conclusions were for those seniors in our 
State who are not covered by health insurance, those seniors pay more 
for prescription drugs than do seniors anyplace else on the face of 
this Earth. That is more than any other part of the United States and 
certainly more than people overseas, as has been demonstrated ably by 
the Senator from North Dakota. The same drug by the same company is 
less expensive to someone overseas as compared with the United States.
  This is a critical issue. I thank my friend from North Dakota as well 
as the Senator from Michigan, Ms. Stabenow, and others.

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